Dr. Rule on Treatment of Young, Fit Patients With MCL

Simon Rule, MD, PhD, professor of hematology, Plymouth University Medical Center, discusses the treatment of young, fit patients with mantle cell lymphoma (MCL).

It is important to remember that chemotherapy works, Rule says. Just because there are newer treatment options emerging in MCL does not mean effective traditional strategies should be forgotten. The frontline standard of care for this patient population is a high-dose cytarabine-based regimen, although some patients benefit from no treatment at all. In young, fit patients who have low-volume disease and are asymptomatic, the watch and wait approach is effective, according to Rule.

There is a lot of excitement over new drugs in MCL, particularly the BTK inhibitors ibrutinib (Imbruvica) and acalabrutinib (Calquence). However, these agents will likely be more effective in the older, frailer patient population who typically have little benefit from chemotherapy. Rule concludes that physicians should be careful with utilizing new drugs early in a patient with a good prognosis.