Treatment of Relapsed/Refractory Mantle Cell Lymphoma

Patients with mantle cell lymphoma (MCL) whose disease relapses after standard chemoimmunotherapy with or without autologous stem cell transplant (SCT) typically receive a Bruton tyrosine kinase (BTK) inhibitor. A series of retrospective trials have shown that a BTK inhibitor has superior outcomes compared with repeat chemoimmunotherapy. However, it must be emphasized that some patients do respond well to repeat chemoimmunotherapy (e.g., BR [bendamustine plus rituximab] after R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone]/R-DHAP [rituximab, dexamethasone, cytarabine, and cisplatin]).[1] Because of the relatively short durations of third and subsequent remissions, consolidation therapy should be considered with allogeneic SCT, chimeric antigen receptor (CAR) T-cell therapy, or clinical trials of bispecific antibodies.[1] Patients with disease relapse who are considered to be at highest risk include those with refractory disease, blastoid morphology, a TP53 pathogenic variant, a Ki-67 level of at least 30%, or progression of disease within 24 months.[1,2]