Sonali M. Smith, MD

Sonali M. Smith, MD, of the University of Chicago Medicine, discusses the current understanding of mantle cell lymphoma (MCL) and how this understanding has evolved over recent years to understand different subsets of the disease that may require different frontline treatment for patients.

The standard of care in the frontline setting of MCL generally depends on the amount of a disease the patient presents with, the patient’s age, and their overall fitness. However, we have come a long way in our understanding of MCL, says Smith. It was first described and thought to be an aggressive disease in all patients. However, some patients present with more indolent MCL with an indolent disease course.

Smith says subsets of MCL include nodal, small volume or those with a low tumor mutational burden, or leukemic. Leukemic presents similar to chronic lymphocytic leukemia.

Overall, it is important to pull these patients aside in the frontline, Smith says. These patients can often be safely observed for a while without receiving initial frontline therapy, which physicians refer to as the “watch and wait” approach.

Videos

Sonali M. Smith, MD, discusses the current understanding of mantle cell lymphoma and how this understanding has evolved over recent years to understand different subsets of the disease that may require different frontline treatment for patients.

Exploring Subsets of Patients With Mantle Cell Lymphoma

Sonali M. Smith, MD, Elwood V. Jensen Professor in Medicine and director of the Lymphoma Program at the University of Chicago Medicine, discusses how to handle patients with follicular lymphoma (FL) when they relapse, especially if they are early progressors.

There are multiple options at the time of relapse for these patients, but Smith believes that the data in this area lacks understanding of how to sequence treatment. She says that she will usually pull aside patients with early progression, which are patients who progress within 24 months of their frontline chemoimmunotherapy because they have poor survival outcomes. Their 5-year overall survival (OS) is about 50%. She believes this patient population need extra attention. There are several clinical trials in this setting, some physicians will offer an autologous stem cell transplant, but she thinks these early progressors need better options.

For other patients with FL, there are options such as going back to chemoimmunotherapy, rituximab (Rituxan) alone, or the recently FDA-approved combination of rituximab and lenalidomide (Revlimid), based on data from the AUGMENT trial (NCT01996865). This was a phase III randomized trial for patients with relapsed/refractory FL, who were randomized to 1 year of rituximab and lenalidomide versus 1 year of rituximab monotherapy. Smith says it is interesting that there was an improvement in not only the complete response rate but also the OS, which is what led to its approval.

<< View more resources and information regarding follicular lymphoma

Sonali M. Smith, MD, discusses&nbsp;how to handle patients with follicular lymphoma when they relapse, especially if they are early progressors.<br />
&nbsp;

Sonali M. Smith, MD | Authors

Articles

Exploring Subsets of Patients With Mantle Cell Lymphoma

Options for Treating Relapsed/Refractory Follicular Lymphoma