Dr. Goy on Treatment Options for Patients With MCL

Andre Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses treatment options for patients with mantle cell lymphoma (MCL).

Approximately 5% to 15% of patients have indolent disease. These are asymptomatic patients who have a high white count, splenomegaly, and minimal lymphadenopathy, if any, says Goy. These patients can be monitored over time. However, these patients can acquire a p53 abnormality, in which the disease can transform aggressively. Though rare, it can happen.

There are also patients who present with symptomatic disease who need treatment for classic MCL. In these cases, the age and fitness of the patient has to be taken into consideration, says Goy. Ki-67 status should also be factored into treatment decisions. If a patient is fit for dose-intensive therapy, they can receive the induction combination of cytarabine and rituximab (Rituxan) followed with or without high-dose therapy and transplant. Typically, these patients have good outcomes. Maintenance is also of benefit in younger patients, says Goy.

In older patients, bendamustine and rituximab (BR) has become the backbone of treatment. Ibrutinib (Imbruvica) or acalabrutinib (Calquence) can also be considered, dose depending. Additionally, the frontline combination of bortezomib (Velcade), rituximab, cyclophosphamide, doxorubicin, and prednisone, is gaining traction where the data are replacing bortezomib in the R-CHOP backbone. The results are impressive in terms of the complete response rate, durability, and survival advantage, says Goy. As such, this has become an option for older patients.