SOHO 2026 | Current role of autoSCT and chemotherapy-free approaches in frontline MCL

So for many years, the standard approach for patients with mantle cell lymphoma would depend primarily on their fitness. And those patients who were fit would get chemotherapy followed by a stem cell transplant. Those who were less fit would potentially get a less aggressive chemotherapy and then often didn’t get a transplant. What’s going on, though, in recent years is that we’re recognizing two things. The first is that the more intensive treatment and the use of autologous stem cell transplantation may not be as important as we once thought it was. And we also are now starting to see novel sort of non-chemotherapy containing regimens emerge. So as far as the transplant is concerned, this was developed at a time when we didn’t have a lot of good options for patients with mantle cell lymphoma. But we now have a number of good induction therapies. We have the BTK inhibitors, and we have a number of other emerging treatments. So there’s been a couple of studies now looking at how important is it for us to do the stem cell transplant. And what we’ve seen in two large studies is that there does not appear to be a significant benefit for the vast majority of patients with regards to the transplant. In one particular study, they looked primarily at patients who achieved a complete remission and were MRD negative and whether or not they needed to get a transplant. And it was fairly clear from that study, the EA4151 trial, that the transplant did not provide any added benefit for that group of patients. Perhaps you could argue that patients that are MRD positive might still benefit, and that’s still an open area of question. But for me, at least in my own practice, I’m almost never offering autologous transplant given some of the recent data. Now, as far as moving away from chemotherapy entirely, I think that’s definitely the goal. And I think for a lot of reasons, being able to avoid chemotherapy is very exciting and I think is potentially the future. But as I mentioned during my talk at SOHO, this disease is not CLL. And what we found is that when patients recur, the disease can be very aggressive, and that the non-chemotherapy-containing regimens, at least so far, while they’ve been effective, have not resulted in the same duration of remission that we’re seeing with some of our chemotherapy-based induction. So I think we still have a little bit of work to do, but I would not be surprised if in the future, more and more patients are getting a chemo-free approach.

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