Dr. Dean on the Evolution of Treatment Approaches in MCL

Robert Dean, MD, staff physician, Cleveland Clinic, discusses the evolution of treatment approaches in mantle cell lymphoma (MCL).

The treatment of MCL has evolved in a step-wise manner over the past 20 years, says Dean. Studies have shown the value of incorporating the monoclonal antibody, rituximab (Rituxan) into frontline therapy.

Frontline therapy now consists of 2 approaches depending on the patient’s performance status, explains Dean. Younger, fitter patients typically receive a more intensive regimen that consists of combination chemotherapy followed by consolidation with high-dose chemotherapy, an autologous transplant, and then rituximab maintenance. Patients who are older with a lower performance status will generally receive a less intensive upfront chemotherapy, such as bendamustine and rituximab, rituximab maintenance without consolidation, and an autologous transplant.

For both populations, incremental advances in frontline treatment approaches have improved outcomes, but patients still face a high rate of mortality at the time of relapse, says Dean. Although initial remissions and survival have improved, physicians have to work harder to bring more options to patients who relapse, concludes Dean.