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Tandem Meetings 2026 | The changing role of transplant in MCL with the incorporation of BTK inhibitors into upfront therapy
Krish Patel, MD, Sarah Cannon Research Institute, Nashville, TN, discusses how the role of transplantation is changing in mantle cell lymphoma (MCL), highlighting the shift away from autologous transplant for fit young patients who achieve deep responses with covalent BTK inhibitors and chemoimmunotherapy. Dr Patel notes that for transplant-ineligible patients, BTK inhibitors are being incorporated into both induction regimens and maintenance therapy to prolong disease control and improve progression-free survival (PFS). This interview took place virtually.
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Transcript
Historically, we have typically used more intensive chemotherapies for patients who were considered transplant-eligible, and then as they achieved deep responses, consolidated with an auto transplant. That standard of care has really shifted now, where the thinking is by incorporating covalent BTK inhibitors into the upfront chemoimmunotherapy regimen, we may be able to spare most of our patients’ autologous transplants...
Historically, we have typically used more intensive chemotherapies for patients who were considered transplant-eligible, and then as they achieved deep responses, consolidated with an auto transplant. That standard of care has really shifted now, where the thinking is by incorporating covalent BTK inhibitors into the upfront chemoimmunotherapy regimen, we may be able to spare most of our patients’ autologous transplants. That’s, again, defined by the TRIANGLE trial, but also other trials that show patients who achieve very deep responses, MRD-undetectable responses after induction therapy, really don’t seem to benefit from an autologous transplant. So the standard of care, I think, has shifted away from incorporation of autologous transplant for fit young patients.
For older adults, it is, again, really with a focus that maybe transplant was not considered for these patients from the get-go. And so really thinking about what’s the best opportunity to maintain remissions. And there we see, again, incorporation of BTK inhibitors, not only into the induction regimens, but also into maintenance to try to prolong disease control and improve progression-free survival.
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