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Sequencing Treatment Options in Mantle Cell Lymphoma

Simon Rule, MD, PhD
Published Online:5:35 PM, Fri July 26, 2019

Simon Rule, MD, PhD, a professor of clinical hematology on the faculty of medicine and dentistry at the University of Plymouth in the United Kingdom, discusses the current treatment approaches for patients with mantle cell lymphoma (MCL) in both the United Kingdom and the United States. He says treatment strategies are pretty well established on both sides of the Atlantic Ocean.

For young patients with MCL, the recommended frontline treatment is a high-dose cytarabine-based regimen followed by autologous stem cell transplant (SCT). Evidence for a rituximab (Rituxan) maintenance is also strong in this setting. Physicians should select their cytarabine regimen based on what they are comfortable with giving, says Rule.

For older patients over the age of 65 years old, Rule says the general standard of care is bendamustine- or CHOP-based regimen. Again, there is some evidence for debate in regard to a rituximab maintenance. Frail elderly patients, however, have no established standard of care.

For patients with relapsed disease, single-agent BTK inhibitors have become the standard of care. There is some discussion among physicians on the combination of BTK inhibitors plus rituximab in this setting, but generally, physicians are using ibrutinib (Imbruvica) as a single-agent. Rule says this is a highly active agent.

Beyond the second-line setting, treatment options in MCL are not curative, with the possible exception of the younger, fit patients that receive allogenic SCT. Rule says patient outcomes come down to how therapies are sequenced to maximize both quality of life and survival.
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