VENETOCLAX'AS'A'BRIDGE'TO'ALLOGENEIC'STEM'CELL'TRANSPLANT'IN'HIGH'
POSTER'23'
RISK'MANTLE'CELL'LYMPHOMA'
'
Catarina!Fernandes,!Sofia!Alves,!Filipa!Moita,!Maria!Inês!Barbosa!and!Maria!Gomes!da!Silva!
!
Instituto!Português!de!Oncologia!de!Lisboa!Francisco!Gentil,!Lisboa,!Portugal!
!
Background:!
The!prognosis!of!mantle!cell!lymphoma!(MCL)!has!improved!drastically!in!the!past!decade.!
However,! the! outcome! of! patients! with! high! risk! features,! such! as! the! presence! of! a! TP53!
mutation! or! blastoid! histology,! remains! dismal,! even! for! younger! patients! treated! with!
intensive!strategies,!with!an!overall!survival!of!less!than!two!years.!
It!has!been!reported!that!allogeneic!stem!cell!transplant!(ASCT)!can!overcome!the!prognostic!
impact!of!TP53!alterations,!leading!to!durable!remissions.!Strategies!to!obtain!responses!in!
patients!refractory!to!chemotherapy!or!BTK!inhibition!before!ASCT!are!needed.!
Objectives'and'methods:!
We! present! the! reports! of! two! patients! with! MCL,! refractory! or! relapsed! after! ≥1! prior!
therapy,! with! a! TP53! mutation! detected! at! relapse! by! immunohistochemistry,! that! were!
treated!with!a!venetoclaxJbased!regimen!as!a!bridge!to!ASCT.!
Case'description:!
The!first!patient!is!a!53JyearJold!male,!with!classic!MCL!stage!III,!MIPI!5.25!and!Ki67!40%!at!
diagnosis.!A!complete!response!(CR)!was!achieved!after!firstJline!treatment!according!to!the!
Nordic!regimen.!He!was!unable!to!proceed!to!high!dose!chemotherapy!due!to!poor!stem!cell!
mobilization.!After!3!cycles!of!rituximab!maintenance,!relapse!with!histologic!transformation!
to!blastoid!morphology!was!documented,!with!a!Ki67>75%!and!a!TP53!mutation.!The!patient!
was!primarily!refractory!to!2nd!line!ibrutinib!(monotherapy),!then!received!3rd!line!treatment!
with! rituximab,! bendamustine! and! cytarabine! (RJBAC)! with! disease! persistence! after! 6!
cycles.!Fourth!line!treatment!with!venetoclax!was!initiated,!with!an!ongoing!clinical!response!
after!more!than!two!months!of!therapy!and!without!significant!toxicities.!The!patient!is!now!
undergoing!evaluation!before!ASCT!with!a!matched!related!donor.!
The! second! case! is! a! 61JyearJold! male,! with! classic! MCL! stage! IV,! MIPI! 6.5,! Ki67<30%! at!
diagnosis.!After!first!line!treatment!according!to!the!Nordic!regimen,!a!short!partial!response!
rapidly! evolved! into! rapid! progression! with! transformation! to! pleomorphic! histology! and!
TP53! mutation.! Combination! therapy! with! ibrutinib! and! venetoclax! was! initiated,! with!
achievement!of!CR!and!without!significant!toxicity.!Ten!months!after!therapy!initiation,!the!
patient!proceeded!to!a!matched!unrelated,!reducedJintensity!ASCT.!
Conclusion:!
Venetoclax! monotherapy! or! in! combination! can! lead! to! disease! control! and! durable!
responses! in! high! risk! MCL! patients,! and! can! be! an! option! in! this! difficult! scenario,!
particularly!when!ASCT!is!being!considered.!Larger!studies!should!be!considered!in!order!to!
validate!this!strategy.!
! !
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES