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Treatment Landscape for Mantle Cell Lymphoma

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Published on September 16, 2021

Treatments for Newly Diagnosed and Relapsed MCL

What treatments are available for individuals with mantle cell lymphoma (MCL)? Keep watching to hear Brian Hill, MD, PhD, of the Cleveland Clinic Taussig Cancer Institute, discuss how treatment for MCL is not standardized across the country, but patients have a variety of options both at the time of diagnosis and during relapse.

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Transcript | Treatment Landscape for Mantle Cell Lymphoma

Dr. Hill: Yeah, so for mantle cell lymphoma, again, it's a little bit of a hybrid story from the two other common lymphomas we just talked about, with follicular lymphoma and diffuse large B-cell. It's similar in the sense that like follicular lymphoma, we have very good frontline treatments for mantle cell lymphoma.

What Treatments Are Available for Newly Diagnosed MCL Patients?

Dr. Hill: The frontline treatments are not really standardized across the country, some centers use bendamustine-Rituxan (Bendeka-rituximab) just by itself. Other places are using bendamustine-Rituxan with high doses of cytarabine (Cytosar-U), which usually requires a couple nights in the hospital to administer. And those treatments work well, although they don't get rid of the mantle cell lymphoma forever.

After the chemotherapy, many times younger patients under the age of 60, 65, would be recommended to go through something called high-dose chemotherapy with transplant to keep the mantle cell lymphoma in remission for longer. That's being studied now in a major study across the country to determine if we really need to put every patient through transplant because after the transplant or after the chemotherapy, either way, you're going to be getting a maintenance treatment with Rituxan by itself every two months, a single dose. And that can go on for two or three years.

How Is Relapsed Mantle Cell Lymphoma Treated?

Dr. Hill: If and when down the road, the mantle cell lymphoma relapses, or comes back as it usually does, then we have oral medications called BTK inhibitors. There's three out there, ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa). They're all oral, they're all generally well tolerated and very effective in that setting. But again, they're not going to get rid of the problem completely. And so the other thing that we've been talking about as we did with DLBCL is CAR T-cell therapy, which is FDA-approved for mantle cell lymphoma in relapse. And despite the side effects, it may be worth strongly considering, or at least consulting with a specialized center that can offer CAR T-cell therapy for you for mantle cell in relapse. It's a really a good option because it has a high likelihood of working. And despite the side effects, is probably worth doing in most cases.

There's a lot of new things out there coming, but most of those are through clinical trials. So like always, I would ask any patient with lymphoma to ask their treating oncologist if they are aware of clinical trials. Sometimes you can get access to the newest treatments through clinical trials, and definitely something at least asking about at all times.

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