MARCO(LADETTO((ALESSANDRIA)(
(
DO(WE(STILL(NEED(ASCT(IN(MCL?(?(PRO(
!
Initial! approaches! based! on! ASCT! in! MCL! date! back! to! the! late! nineties! 1,2.! However,! the!
superiority! of! ASCT! was! clearly! demonstrated! only! in! 2005.! In! this! study,! patients!
consolidated!with!ASCT!had!a!superior!PFS!compared!to!those!receiving!IFN>maintenance.3!
In! the! subsequent! decades,! ASCT>containing! programs! have! been! improved! in! terms! of!
induction! treatment! with! the! inclusion! of! ARA>C! and! Rituximab! containing! regimens! and!
adoption!of!less!toxic!conditioning!regimens.4!Finally,!patient!outcome!was!further!improved!
by!the!adoption!of!maintenance!regimens!with!Rituximab!or!Lenalidomide!which!allowed!to!
better! maintain! over! time! the! high! level! of! cytoreduction! obtained! with! ASCT.5,6! Based! on!
these!considerations,!international!guidelines!still!recommend!ASCT!as!the!most!appropriate!
standard!treatment,!in!both!high>risk!and!low>risk!MCL!patients.!7,8!For!example!the!!level!of!
evidence!!for!ASCT!according!to!ESMO!guidelines!is!IB.!7!Despite!the!recognized!efficacy!of!
ASCT,! evidence! is! accumulating! that! such! a! treatment! might! be! suboptimal! in! some!
biological!subgroups!such!as!those!with!TP53!inactivation.9!Even!if!such!limitations!should!be!
acknowledged,! currently! there! is! no! widely! explored! alternative! approach! that! could!
challenge! ASCT! in! the! everyday! practice,! outside! clinical! trials.! The! only! potentially!
alternative! approach! is! intensified! non! ASCT>based! programs! such! as! R>Hyper>CVAD.10,11!
However! these! approaches! have! not! been! evaluated! as! extensively! as! ASCT,! and! more!
importantly!they!are!neither!less!toxic!nor!more!applicable!than!ASCT.!Moreover,!there!is!no!
evidence! that! they! could! be! more! active! in! high>risk! biological! subgroups.! ! Of! course,! a!
number!of!novel!biological!agents!are!entering!the!clinical!arena!in!MCL.!These!include!BTKi,!
Bcl2! inhibitors,! novel! antibodies! and! cellular! therapies.12>19! Nevertheless! solid! phase! III!
results!in!the!frontline!setting!are!still!awaited.!Currently!large!randomized!trials!such!as!the!
TRIANGLE!(NCT02858258)!are!challenging!ASCT,!based!on!the!hypothesis!that!novel!agents!
could!allow!adequate!disease!control!without!its!use.!However,!while!waiting!these!results,!
it!would!be!difficult!not!to!propose!ASCT!to!a!young!healthy!patient!with!advanced!MCL.!!!!!
!
References(:((
1.! Magni! M,! Di! Nicola! M,! Devizzi! L! et! al.! Successful! in! vivo! purging! of! CD34>containing! peripheral!
blood!harvests!in!mantle!cell!and!indolent!lymphoma:!evidence!for!a!role!of!both!chemotherapy!and!
rituximab!infusion.!Blood!2000;!96:!864–869.!
2.!Milpied!N,!Gaillard!F,!Moreau!P!et!al.!High>dose!therapy!with!stem!cell!transplantation!for!mantle!
cell!lymphoma:!results!and!prognostic!factors,!a!single!center!experience.!Bone!Marrow!Transplant!
1998;!22:!645–650.!!
3.! Dreyling! M,! Lenz! G,! Hoster! E,! et! al.! Early! consolidation! by! myeloablative! radiochemotherapy!
followed!by!autologous!stem!cell!transplantation!in!first!remission!significantly!prolongs!progression>
free!survival!in!mantle>cell!lymphoma:!results!of!a!prospective!randomized!trial!of!the!European!MCL!
Network.!Blood.!2005!Apr!1;105(7):2677>84.!
!4.! Hermine! O,! Hoster! E,! Walewski! J,! et! al.! Alternating! courses! of! 3x! CHOP! and! 3x! DHAP! plus!
rituximab!followed!by!a!high>dose!cytarabine!containing!myeloablative!regimen!and!autologous!stem!
cell! transplantation! versus! 6! courses! of! CHOP! plus! rituximab! followed! by! myeloablative! radio!
chemotherapy! and! autologous! stem! cell! transplantation! in! patients,! 65years! (MCL! Younger):! a!
randomized,! open>label,! phase! 3! trial! of! the! European! MCL! Network.! Lancet.! 2016! Aug!
6;388(10044):565>75.!!
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