Dr. Goy on Different Presentations of MCL

Andre H. Goy, MD, physician in chief, Hackensack Meridian Health Oncology Care Transformation Service, chairman & chief physician officer, John Theurer Cancer Center, Lydia Pfund Chair for Lymphoma, Academic Chairman Oncology, Hackensack Meridian School of Medicine at Seton Hall University, professor of medicine, Georgetown University, discusses differentiating between disease presentations in mantle cell lymphoma (MCL).

Substantial progress has been made in improving the ability to differentiate between biological presentations of MCL, Goy says.

Research has revealed that there are 3 main presentations of classical MCL, he explains. More than half of patients will experience aggressive blastoid or pleomorphic MCL, which has a high proliferation index by Ki-67. These patients are also characterized by a complex karyotype, TP53 mutations/ deletions, MYC rearrangement, and other abnormalities, Goy explains. Accordingly, patients with this disease presentation tend to experience worse prognosis, a comparatively lower median overall survival, and will relapse faster compared with patients with other presentations, he says.

Conversely, patients with smoldering MCL exhibit lymphadenopathy on imaging or colonoscopy, have low-bulk disease, and are generally low-risk, Goy continues. Rather than undergoing treatment up front, these patients experience a median time to therapy of 1 to 3 years, Goy states.

Patients may display various degrees of genetic high-risk features or TP53 abnormalities across the rest of the disease spectrum, Goy notes. Therefore, it is important to consider the variety of presentations, and use next-generation sequencing to screen for notable genetic factors in routine clinical practice, Goy concludes.

Editor’s Note: Dr. Goy reports serving in a consulting or advisory role for AstraZeneca, Elsevier, Gilead Sciences, Janssen, Kite, a Gilead company, OncLive Peer Exchange, Physicans' Education Resource, Resilience Care, Vincera Pharma/Vincerx Pharma; he has employment with OM Pharmaceutical Industries, Regional Cancer Care Associates; he received institutional research funding from Acerta Pharma, AstraZeneca, Celgene, Constellation Pharmaceuticals, Genentech/Roche, Infinity Pharmaceuticals, Infinity/Verastem, Janssen, Karyopharm Therapeutics, Kite/Gilead, Pharmacyclics; he has ownership interests in and serves in a leadership role for COTA, Genomic Testing Cooperative, Resilience Care; he served on a speakers’ bureau for Bristol-MyersSquibb/Celgene.