Dr. Elhassadi on the Subtypes of MCL

Ezzat Elhassadi, MD, consultant hematologist, Hematology Services, University Hospital Waterford, discusses the subtypes of mantle cell lymphoma (MCL).

MCL is a spectrum of diseases, says Elhassadi. It is important to recognize that some patients with MCL present with indolent disease. The majority of these patients harbor a genetic alteration that sets them apart from more aggressive histologies that require immediate treatment. Patients with indolent disease do not need to be treated at the time of their diagnosis. Within MCL, the blastoid variant behaves differently than the classical one does. Moreover, the subset of patients with a very high Ki-67 behave differently than those with low Ki-67. In a study led by Elhassadi, he and fellow investigators demonstrated that the higher the Mantle Cell Lymphoma International Prognostic Index, the worse the outcome. This means that blastoid subtypes, patients with high Ki-67 and p53 disruption, need to be treated differently, explains Elhassadi.

Additionally, certain patients with classical MCL may be being overtreated. The current intervention is intensive induction therapy, autologous stem cell transplant, and rituximab (Rituxan) maintenance. However, a randomized trial will need to be conducted to prove this.