MCL Progress: From No Standard of Care to Improved Outcomes
Prof Martin Dreyling discusses the shifting treatment landscape for patients with difficult-to-treat mantle cell lymphoma.
Mantle cell lymphoma (MCL), once considered a highly aggressive B-cell lymphoma with limited treatment options, has seen remarkable progress in the last 2 decades. In an interview with Targeted OncologyTM, Prof Martin Dreyling, head of the lymphoma program at the Department of Medicine III, LMU Hospital Munich, discusses how the treatment landscape has shifted and its significance for patients.
Initially, the lack of a standard of care hindered research. Today, MCL treatment involves chemoimmunotherapy combinations like R-CHOP and bendamustine-rituximab, often followed by high-dose therapy and stem cell transplant for younger patients.
A significant breakthrough has been the emergence of targeted therapies, including BTK inhibitors (ibrutinib, acalabrutinib, zanubrutinib), proteasome inhibitors (bortezomib), mTOR inhibitors (temsirolimus, everolimus), and BCL-2 inhibitors (venetoclax), which have improved outcomes, especially in relapsed/refractory settings and increasingly in frontline treatment. Immunotherapies like CAR T-cell therapy and bispecific antibodies offer new hope for patients with advanced disease.
Prognosis in MCL is influenced by factors like the MIPI score, genetic mutations (e.g., TP53), response to initial therapy, and patient characteristics. While MCL is generally not curable, these advancements have led to longer remissions, improved overall survival rates, and a better quality of life. The outdated perception of MCL as the "worst" B-cell lymphoma is increasingly inaccurate, reflecting the dynamic and optimistic progress in its management. Specialist care is crucial for patients to benefit from these evolving treatment strategies.
