Dr Danilov on the Evolution of MCL Treatment

Alexey Danilov, MD, PhD, hematologist-oncologist, associate director, Toni Stephenson Lymphoma Center, professor, Division of Leukemia, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses the evolution of treatment for patients with mantle cell lymphoma (MCL).

In MCL, the treatment paradigm is undergoing significant changes, particularly with the exploration of non-chemotherapy options, even in the frontline setting, Danilov begins. Traditionally, the standard approach for previously untreated MCL has been chemotherapy combined with stem cell transplant, he says; however, it has become evident that a subset of patients, such as those with TP53 mutations, do not benefit from this conventional treatment. For these patients, it is crucial to perform screening before starting therapy, using methods such as next-generation sequencing to identify TP53 aberrations, he explains. These patients should ideally be enrolled in clinical trials or, at the very least, treated with non-chemotherapy options and spared from transplant, Danilov states.

Beyond this specific patient group, the field is evolving towards chemotherapy-free regimens for broader patient populations, Danilov continues. Ongoing studies are investigating the role of BTK inhibitors in combination with chemotherapy in the frontline setting for MCL, he emphasizes. These studies are also questioning the necessity of stem cell transplant for this patient population, according to Danilov. Although definitive answers are still pending, and stem cell transplant remains part of the standard therapeutic approach, there is a growing interest in shifting towards frontline BTK inhibitor–based and lenalidomide (Revlimid)–based combinations, Danilov elucidates.

The future of MCL treatment lies in the results of these numerous trials, he expands. Longer follow-ups and randomized studies are essential to determine whether patients truly fare better with chemotherapy-free options, Danilov says. As more data becomes available, it will be possible to better tailor treatments to individual patient needs, potentially moving away from chemotherapy and transplant for a larger number of patients with MCL, Danilov explains. This shift represents a promising development in the ongoing effort to improve outcomes and quality of life for this patient population, Danilov concludes.