Lori A. Leslie, MD, discusses options for patients with relapsed/refractory mantle cell lymphoma.
Lori A. Leslie, MD, a medical oncologist at the John Theurer Cancer Center, discusses options for patients with relapsed/refractory mantle cell lymphoma (MCL).
Leslie says that this setting is rapidly evolving in a good way with many new targeted therapies, including cellular therapy entering as a treatment option. Usually the most important choice when a patient comes in with relapsed/refractory disease depends on what they received in the frontline setting and the length of their remission. If she had a patient who had already received chemoimmunotherapy and transplant and had a 10-year remission, she would treat them differently than a patient who was given chemoimmunotherapy and relapsed while still on maintenance treatment.
For a patient with relapsed MCL, whether they are higher-risk or not, the standard of care is to consider targeted therapies. This includes Bruton kinase inhibitors (BTK), venetoclax (Venclexta), lenalidomide (Revlimid) with rituximab (Rituxan), and bortezomib (Velcade)-based therapies. Bortezomib is not as preferred now that BTK inhibitors are available, according to Leslie.
Patients who have experienced multiple relapses have the option of anti-CD19 chimeric antigen receptor (CAR) T-cell therapy; Leslie thinks this is one of the most exciting things in that space at the moment. The recent data looking at this type of agent in patients with relapsed MCL who are resistant or refractory to BTK inhibitors have shown a high overall response rate and about two-thirds of patients achieving complete responses that seem durable.