Dr. Smith on Frontline Treatment Options in MCL

Sonali M. Smith, MD, Elwood V. Jensen Professor in Medicine, interim chief, Section of Hematology/Oncology, director, Lymphoma Program, University of Chicago Medicine, discusses frontline treatment options in mantle cell lymphoma (MCL).

The frontline standard of care for patients with MCL depends on their burden of disease, their age, and their overall fitness, says Smith.

Historically, MCL was thought to be a very aggressive disease, says Smith. However, a subset of patients with nodal disease or leukemic disease have a more indolent presentation and disease course. These patients can be safely observed for a period of time.

Young patients with classic MCL are often considered for aggressive induction therapy followed by autologous stem cell transplant (ASCT) and maintenance rituximab (Rituxan), explains Smith. Conversely, elderly patients or those who are unfit for intensive therapy tend to be given chemoimmunotherapy with maintenance rituximab.

It is not clear whether all patients with MCL should undergo ASCT; however, there is an ongoing trial investigating the role of minimal residual disease after induction therapy. The trial may shed light on the utility of BTK inhibitors in the frontline setting, concludes Smith.