Addendum to British Society for Haematology Guideline for the management of mantle cell lymphoma, 2018 (<i>Br. J. Haematol.</i> 2018; 182: 46–62): Risk assessment of potential <scp>CAR</scp> T candidates receiving a covalent <scp>Bruton tyrosine kinase</scp> inhibitor for relapsed/refractory disease

O’Reilly, Maeve; Sanderson, Robin; Wilson, William T.; Iyengar, Sunil; Lambert, Jonathan; McCulloch, Rory; Eyre, Toby A.

doi:10.1111/bjh.18378

Cited by 5 publications

(9 citation statements)

References 20 publications

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“…Around a third of patients do not respond to second-line cBTKi and prognosis for this group is very poor. 91,92 High-risk patients should be discussed with a CAR-T centre and early response assessment is recommended to minimise delay to next therapy (full details in the recent BSH Addendum 93 ). Where possible, high-risk patients should be prioritised for clinical trials.…”

Section: Management At First Relapsementioning

confidence: 99%

“…113 Our guidance proposes a risk-based surveillance strategy for potential CAR-T candidates at first relapse, with the goal of identifying those at high risk of early ibrutinib 91,97,98,114 and capturing early refractory or progressive disease (PD) in such patients (Figure 1). 93 High-risk patients should be discussed with a CAR T-cell centre at first relapse and followed closely: at least 4-weekly face-to-face appointments in the first 3 months. Patients with significant constitutional symptoms showing no improvement after 4 weeks of ibrutinib should be considered for early re-imaging.…”

Section: Chimeric Antigen Receptor (Car) T-cell Therapymentioning

confidence: 99%

“…Our guidance proposes a risk‐based surveillance strategy for potential CAR‐T candidates at first relapse, with the goal of identifying those at high risk of early ibrutinib failure 91,97,98,114 and capturing early refractory or progressive disease (PD) in such patients (Figure 1). 93 …”

Section: Recommendationsmentioning

confidence: 99%

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Diagnosis and management of mantle cell lymphoma: A British Society for Haematology Guideline

Eyre,

Bishton,

McCulloch

et al. 2023

Br J Haematol

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The objective of this guideline is to provide healthcare professionals with clear guidance on the diagnosis and management of patients with mantle cell lymphoma. M ETHODOLOGYThis Guideline was compiled according to the BSH process at https:// b-s-h. org. uk/ media/ 16732/ bsh-guida nce-devel opmen t-proce ss-dec-5-18. pdf and represents best practice in both teaching and district hospitals in the United Kingdom. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate the levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http:// www. grade worki nggro up. org. Literature review detailsRecommendations included a systematic review of published English language literature from publication of previous British Society for Haematology (BSH) Management of Mantle Cell lymphoma Guidelines 2018 up to 02/2023. The search was limited to English language publications and conference abstracts. Titles/abstracts obtained were curated and manually reviewed by the writing group who conducted additional searches, using sub-section heading terms. In addition, there are some further pertinent references and a consensus of expert opinion where no published data are available. PubMed, MEDLINE, Embase, Cochrane databases and Web of Science were searched using the preliminary search terms: MCL OR Mantle Cell lymphoma OR aggressive Mantle Cell lymphoma OR indolent Mantle Cell lymphoma. Systematic reviews, meta-analysis including guidelines from other countries, prospective clinical trials,

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Section: Management At First Relapsementioning

confidence: 99%

Section: Chimeric Antigen Receptor (Car) T-cell Therapymentioning

confidence: 99%

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Diagnosis and management of mantle cell lymphoma: A British Society for Haematology Guideline

Eyre,

Bishton,

McCulloch

et al. 2023

Br J Haematol

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“…The presence of blastoid morphology was an independent risk factor for failure to reach infusion. Recent UK guidance focuses on detailed risk‐stratification of patients with MCL after first relapse with enhanced monitoring for patients with high‐risk features whilst on ibrutinib and referral for CAR T‐cell therapy at the earliest sign of BTKi failure 76 . This is particularly relevant for patients with TP53 mutations, where patients should be managed in expectation that CAR T‐cell therapy will be required and offers the best chance of durable disease control.…”

Section: Aggressive MCLmentioning

confidence: 99%

How I manage mantle cell lymphoma: indolent versus aggressive disease

et al. 2023

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Summary Mantle cell lymphoma (MCL) is a mature B‐cell lymphoma with a variable clinical course and historically poor prognosis. Management is challenging in part due to the heterogeneity of the disease course, with indolent and aggressive subtypes now well recognised. Indolent MCL is often characterised by a leukaemic presentation, SOX11 negativity and low proliferation index (Ki‐67). Aggressive MCL is characterised by rapid onset widespread lymphadenopathy, extra‐nodal involvement, blastoid or pleomorphic histology and high Ki‐67. Tumour protein p53 (TP53) aberrations in aggressive MCL are recognised with clear negative impact on survival. Until recently, trials have not addressed these specific subtypes separately. With the increasing availability of targeted novel agents and cellular therapies, the treatment landscape is constantly evolving. In this review, we describe the clinical presentation, biological factors, and specific management considerations of both indolent and aggressive MCL and discuss current and potential future evidence which may help move to a more personalised approach.

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“…Of note, only 60% of patients with initial approval went on to receive CAR‐T infusion, with the primary cause of failure progressive disease 6 . Attempting to deliver CAR‐T to patients with rapidly progressive disease is clearly a major issue and has been addressed in a recent British Society of Haematology clinical guideline 7 . Enhanced monitoring and bridging strategies aim to support the highest risk patients to CAR‐T infusion, but whether efficacy of Tecartus will be maintained is unknown and will be a key area to evaluate in future real‐world studies.…”

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confidence: 99%

Post‐BTK inhibitor mantle cell lymphoma: When is CAR‐T not the answer?

McCulloch

2023

Br J Haematol

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In a large multicentre retrospective real‐world analysis, Hess and colleagues describe outcomes in post‐Bruton tyrosine kinase inhibitor (BTKi) mantle cell lymphoma patients managed in clinical practice prior to availability of brexucabtagene autoleucel (Tecartus). Outcome data not only provide a useful benchmark for future studies but also highlight the great challenges that still lie ahead in managing this challenging patient cohort.Commentary on: Hess et al. Real‐world experience among patients with relapsed/refractory mantle cell lymphoma after Bruton tyrosine kinase inhibitor failure in Europe: The SCHOLAR‐2 retrospective chart review study. Br J Haematol 2022. doi: 10.1111/bjh.18519.

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Addendum to British Society for Haematology Guideline for the management of mantle cell lymphoma, 2018 (Br. J. Haematol. 2018; 182: 46–62): Risk assessment of potential CAR T candidates receiving a covalent Bruton tyrosine kinase inhibitor for relapsed/refractory disease

Cited by 5 publications

References 20 publications

Diagnosis and management of mantle cell lymphoma: A British Society for Haematology Guideline

Diagnosis and management of mantle cell lymphoma: A British Society for Haematology Guideline

How I manage mantle cell lymphoma: indolent versus aggressive disease

Post‐BTK inhibitor mantle cell lymphoma: When is CAR‐T not the answer?

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