Molecular Monitoring Predicts Mantle Cell Lymphoma Relapse Months Before Imaging

Mantle cell lymphoma remains a clinically heterogeneous malignancy where patients frequently face poor outcomes after the failure of covalent Bruton tyrosine kinase inhibitors, with an estimated median progression-free survival of only 7.6 months (95% CI: 3.9, 14.6) on subsequent standard therapies [1, 2]. While CD19-directed chimeric antigen receptor (CAR) T-cell therapy has altered the treatment landscape for relapsed or refractory disease, a meta-analysis indicates that the pooled prevalence of relapse within 12 months of infusion remains high at 61% (95% CI: 43%, 78%) [3, 4]. Current surveillance relies heavily on periodic positron emission tomography-computed tomography (PET-CT) imaging, yet this modality often fails to correlate with long-term progression-free survival (p = 0.35) in the early post-infusion period [5, 6]. Management is further complicated by a 61.2% (95% CI: 54.2, 67.8) incidence of immune effector cell-associated neurotoxicity syndrome (a clinical spectrum of neurologic deficits ranging from confusion to seizures) following brexucabtagene autoleucel administration [6, 7]. To address the limitations of standard imaging, a recent study evaluates whether tracking measurable residual disease (the persistence of small numbers of cancer cells below the detection limit of conventional microscopy) using next-generation sequencing can provide a more sensitive surveillance tool to guide post-infusion care [5].