Curie Brief
Turn on cookies to sign in
Signing in saves your progress to your Curie account. We can only do that with cookies on — turn them on to continue.
News
Two landmark trials are rewriting the playbook for mantle cell lymphoma (MCL). Data from the TRIANGLE and EA4151 trials show that adding a BTK inhibitor — or skipping transplant in MRD-negative patients — delivers equal or better survival without the grueling autologous stem cell transplant (ASCT). Experts say ASCT in frontline MCL is now largely a "dead issue."
For decades, autologous stem cell transplantation (ASCT) was a cornerstone of frontline mantle cell lymphoma (MCL) treatment. But two major phase 3 trials are changing that — fast. The TRIANGLE trial showed that patients who received the BTK inhibitor ibrutinib without ASCT had a 4-year overall survival (OS) rate of 90%, compared to 81% for those who got standard chemoimmunotherapy plus ASCT. Meanwhile, the EA4151 trial found no survival benefit to ASCT in patients who achieved undetectable minimal residual disease (MRD) after induction — rituximab maintenance alone performed just as well.
Dr. Brad S. Kahl of Washington University summarizes it simply: there are now two clear paths to skip the transplant — add a BTK inhibitor upfront, or confirm MRD-negative status and forgo ASCT altogether. The next frontier? Whether high-dose cytarabine is still needed during induction, and how to best treat high-risk, TP53-mutated MCL, where chemotherapy-free regimens are showing early promise.
By the Numbers:
Why it matters: These findings effectively end the routine use of ASCT in frontline MCL, sparing patients a grueling procedure with no added survival benefit — and pointing the field toward smarter, targeted strategies.
