Dr. Rule on Standard of Care in MCL

Simon Rule, MD, PhD, professor of haematology, Plymouth University Medical School, discusses the standard of care for mantle cell lymphoma (MCL) in various patient subsets.

The treatment paradigm for MCL is fairly well-established, says Rule. Younger patients are typically treated with a high-dose cytarabine-based regimen, which is typically followed by an autologous stem cell transplant (ASCT), and the evidence for rituximab (Rituxan) maintenance is strong, he adds. There are many high-dose cytarabine-based regimens to choose from and decisions are ultimately based on provider comfort.

Older patients, typically over the age of 65, will receive bendamustine (Treanda) or R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)-based therapy. The argument can be made that rituximab may be used as maintenance with these 2 regimens as well, he adds. For the frail, elderly patients, there is no clearly defined standard of care.

In the relapsed setting, BTK inhibitors have become the clear standard of care for second-line therapy, says Rule, usually as single agents. Overall, patients are not typically cured through MCL treatment, with the exception of some young, fit patients who receive ASCT, he concludes.