Dr. Leslie on Current Treatment Options for Relapsed/Refractory MCL

Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses current treatment options for patients with relapsed/refractory mantle cell lymphoma (MCL).

Relapsed/refractory MCL is a rapidly evolving field with many novel and targeted therapies, including cellular therapy, which has joined the treatment armamentarium, says Leslie. Typically, the most important questions to answer when a patient comes in with relapsed/refractory MCL are: What have they received as a frontline therapy and how long were they in remission?

For example, if a patient received chemoimmunotherapy and an autologous stem cell transplantat and experienced a 10-year remission, that patient would be treated differently than a patient who received chemoimmunotherapy and is relapsing while they are on maintenance rituximab (Rituxan).

For patients with a higher risk or is at risk for relapse, the standard of care is usually targeted therapies, which includes BTK inhibitors. There are emerging data looking at venetoclax (Venclexta) and lenalidomide (Revlimid) with rituximab in this group of patients. Bortezomib (Velcade)-based therapies are also used, but fall further down the preference list now that BTK inhibitors are available, adds Leslie.

There have been recent data examining anti-CD19 CAR T-cell therapy in patients with MCL and multiple relapses who are resistant or refractory to BTK inhibitors. The data show a very high overall response rate, with about two-thirds of patients achieving complete, durable responses. As more data emerge, hopefully anti-CD19 CAR T-cell therapy will become another standard option that is available outside of clinical trials for patients with relapsed/refractory MCL, concludes Leslie.