VIDEO: Immunotherapies, BTK inhibitors transforming mantle cell lymphoma field

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That is an important question because there have been dramatic changes in the recent number of years. Maybe for context, just to say, historically the strategy had been fitness versus unfit when one's looking at a patient. A very aggressive approach with high-dose chemotherapy, autologous stem cell transplant and maintenance therapy for younger patients, and a less aggressive, more kind of palliative approach with combination chemoimmunotherapy for older patients. In the last number of years, a bunch of factors have come into play, which I think are completely turning that on its head. And what I mean by that is BTK inhibitors have really shown significant benefit, particularly when combined with therapies or used in maintenance thereafter.

And that has really put the whole question of stem cell transplantation as to whether that's the appropriate strategy. Recent data at the most recent ASH meeting even said that if you get a good response to treatment utilizing the some of these newer agents after the induction and MRD negativity is confirmed, you probably will not benefit from an autologous transplant. So I think in the world now where BTK inhibitors are coming to the fore being used as induction and then as maintenance, how many people actually benefit from an autologous transplant is highly questionable.

The BTK inhibitors have made a huge difference to how we manage patients. And I think the second space where there's been a dramatic change has been immune approaches in the way of CAR-T cell. And now more recently, some data around bispecific antibodies. But certainly in the relapsed and refractory space, the use of CAR-T cell therapy has really been highly effective. And I think as we're moving forward, we are also learning that bispecific antibodies may have a role. So that wave as it were, is still in process, but I do believe that immunological approaches on top of the BTK approaches are completely changing how we think about mantle cell lymphoma.