Novel therapy for therapy‐resistant mantle cell lymphoma: Multipronged approach with targeting of hedgehog signaling

Mantle cell lymphoma (MCL) is one of the most aggressive B‐cell lymphomas with a median patient survival of only 5–7 years. The failure of existing therapies is mainly due to disease relapse when therapy‐resistant tumor cells remain after chemotherapy. Therefore, development and testing of novel therapeutic strategies to target these therapy‐resistant MCL are needed. Here, we developed an in vivo model of therapy‐resistant MCL by transplanting a patient‐derived MCL cell line (Granta 519) into NOD/SCID mice followed by treatment with combination chemotherapy. Cytomorphologic, immunophenotypic, in vitro and in vivo growth analyses of these therapy‐resistant MCL cells confirm their MCL origin and resistance to chemotherapy. Moreover, quantitative real‐time PCR revealed the upregulation of GLI transcription factors, which are mediators of the hedgehog signaling pathway, in these therapy‐resistant MCL cells. Therefore, we developed an effective therapeutic strategy for resistant MCL by treating the NOD/SCID mice bearing Granta 519 MCL with CHOP chemotherapy to reduce tumor burden combined with GLI‐antisense oligonucleotides or bortezomib, a proteosome inhibitor, to target therapy‐resistant MCL cells that remained after chemotherapy. This regimen was followed by treatment with MCL‐specific cytotoxic T lymphocytes to eliminate all detectable leftover minimal residual disease. Mice treated with this strategy showed a significantly increased survival and decreased tumor burden compared to the mice in all other groups. Such therapeutic strategies that combine chemotherapy with targeted therapy followed by tumor‐specific immunotherapy are effective and have excellent potential for clinical application to provide long‐term, disease‐free survival in MCL patients.