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Sequencing of Novel Therapies for Mantle Cell Lymphoma

  • Lymphoma (JL Muñoz, Section Editor)
  • Published:
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Opinion statement

There is no standard approach to sequencing novel therapies in mantle cell lymphoma (MCL). For initial treatment, intensive induction chemotherapy followed by autologous stem cell transplant and rituximab maintenance remains our preferred approach in young, fit patients. We consider bendamustine plus rituximab or lenalidomide plus rituximab in patients who are ineligible for intensive chemotherapy-based approaches. Bruton’s tyrosine kinase inhibitors are our preferred class of agents to use in the second-line setting. When patients inevitably relapse on one of these agents, we proceed with chimeric antigen receptor T-cell (CAR T) therapy in eligible patients, often with the use of bridging therapy with corticosteroids, lenalidomide, or venetoclax. We treat patients who are ineligible for CAR T or clinic trial with venetoclax, lenalidomide, or proteosome inhibitor-based regimens, although efficacy is expected to be limited in this setting with a shortened duration of response to each subsequent line of therapy. Allogeneic stem cell transplant remains an option for carefully selected patients who progress after autologous stem cell transplant and CAR T. Clinical trials involving combinations of novel agents in early lines of therapy are ongoing, and new compounds with unique mechanisms of action are in development. The results of ongoing clinical trials with novel agents will further change the treatment landscape for patients with MCL in the coming years.

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  1. Department of Hematology and Medical Oncology, Winship Cancer Institute At Emory University, Atlanta, GA, USA

    Jason T. Romancik MD & Jonathon B. Cohen MD, MS

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Jason T. Romancik declares that he has no conflict of interest.

Jonathon B. Cohen receives research funding through grants from Takeda, Novartis, AstraZeneca, LAM Pharmaceuticals, Loxo Oncology, Bristol-Myers Squibb/Celgene, Genentech, and Bioinvent; and has received consulting fees from AstraZeneca, BeiGene, Aptitude Health, Adaptive Biotechnologies, AstraZeneca, Kite/Gilead, Adicet Bio, Janssen, and Pharmacyclics.

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Romancik, J.T., Cohen, J.B. Sequencing of Novel Therapies for Mantle Cell Lymphoma. Curr. Treat. Options in Oncol. 22, 118 (2021). https://doi.org/10.1007/s11864-021-00907-3

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