Mosunetuzumab With Response-Adapted Polatuzumab Vedotin and Obinutuzumab in Untreated Indolent B-Cell Non-Hodgkin Lymphoma
This is a really encouraging look at chemo-free frontline therapy for symptomatic or high-burden FL and MZL. Eight cycles of mosunetuzumab alone produced a 71% complete response (CR) rate, escalation to pola-obinutuzumab for PET-positive patients pushed CR to 86%, and 2-year progression-free survival (PFS) was 89% with no maintenance. Toxicity was impressively outpatient-friendly: CRS was all grade 1, no one needed tocilizumab, and there was no immune effector cell–associated neurotoxicity syndrome (ICANS), though the shingles and HSV reactivations make a good case for antiviral prophylaxis. It's a small single-center study with two CD20-negative relapses to keep in mind, but the ctDNA–PET concordance hints at an MRD-guided "treat less when you can" future.