Jia Ruan, MD, PhD, on Mantle Cell Lymphoma: Phase II Findings on Acalabrutinib/Lenalidomide/Rituximab

The purpose of the study is to evaluate the safety and efficacy of this triplet combination. This triplet combination is built upon our previous report of doublet, which is lenalidomide plus rituximab. It has shown very high response rate and durability of the response, so we would like to see if the addition of a next-generation BTK inhibitor would continue to improve efficacy meanwhile, also maintain or improve safety profile. The other purpose of the study is to evaluate the minimal residual disease status, which is a molecular response with the next-generation sequencing-based assay platform clonoSEQ to evaluate the quality of the response in a real-time base because there's a previous study that suggests the quality of the response measured by minimal residual disease correlate with progression-free survival. So, therefore, we want to see how our triplet combination would improve the response quality measured by minimal residual disease. And the last purpose of the study is to see, based on the MRD result, can we adjust our treatment strategy, particularly in terms of its intensity and duration, especially, in those patient who can achieve MRD-negative complete remission. The finding of our study has shown that this triplet combination is well tolerated with the expected side effects profile. In addition, it also seems to be highly effective measured by both the response rate using Lugano criteria, as well as minimal residual disease measured by clonoSEQ technology. So a hundred percent of our patients achieved response on study, and the Lugano complete remission rate was 83% measured by the clonoSEQ minimal residual disease, which we defined the threshold of less than one in a million. About 50% of our patient achieve MRD-negative remission after 12 cycles of treatment, and 67% achieved molecular remission in peripheral blood after 12 cycles of treatment, and 83% after 24 cycles of treatment on the triplet. In addition, we have also evaluated the possibility and the feasibility of de-escalation of our treatment after 24 cycles of triplet therapy by discontinuing acalabrutinib and lenalidomide for those patients in molecular remission. We're very pleased with our preliminary findings and we hope that the results of the study could further contribute to providing options for a patient who's seeking chemotherapy, free combinations with highly effective biological combinations. Furthermore, we're hoping to explore the feasibility of limiting the chronic use of biological agents, but use MRD as a evaluation point to guide our treatment strategy.