Treatment for patients with relapsed/refractory mantle cell lymphoma: European-based recommendations

Abstract

Patients with mantle cell lymphoma (MCL) usually respond to initial combination chemotherapy, but the disease inevitably relapses and often follows an aggressive course. Here, clinical study results published since 2008 for patients with relapsed/refractory MCL were reviewed to compare available evidence for treatment guidance. Most trials identified were non-randomized, phase II studies performed at a limited number of sites, and many evaluated MCL as one of multiple non-Hodgkin lymphoma subtypes. Additional randomized, comparative trials are needed. Treatment selection generally depends on patient need, age and fitness, time of relapse, and line of therapy. Combination regimens typically produce higher response rates than single agents, and adding rituximab generally improves outcomes. The inclusion of ibrutinib, lenalidomide, temsirolimus, and bortezomib, represents an important advance for patients ineligible for, unable to tolerate, or failing high-intensity combination chemotherapy. A high need for effective treatments in relapsed/refractory MCL remains, particularly for elderly and frail patients.

Mantle cell lymphoma presenting as bilateral adrenal huge masses

“…Patients with MCL usually respond to initial combination chemotherapy, but the disease inevitably relapses and often follows an aggressive course 18. In a recent study, Le Gouill et al recommended that four courses of dexamethasone, high-dose cytarabine and cisplatin plus ASCT, without total body irradiation followed by RM (one infusion every 2 month for 3 years) is a new standard of care for young patients with MCL 19…”

Past, Present, and Future of Rituximab—The World’s First Oncology Monoclonal Antibody Therapy

“…Mantle cell lymphoma is a moderately aggressive lymphoma that comprises 2–4% of all NHL and has a median OS of 3–5 years ( 17 ). MCL is technically classified as an indolent lymphoma; but it usually has an aggressive clinical course and is incurable, despite an initial response to either dose-intense chemotherapy or combination therapy ( 34 ). Although rituximab has proven beneficial as a maintenance therapy, R-CHOP achieves a relatively short median PFS of 16–17 months ( 17 , 34 , 35 ).…”

“…MCL is technically classified as an indolent lymphoma; but it usually has an aggressive clinical course and is incurable, despite an initial response to either dose-intense chemotherapy or combination therapy ( 34 ). Although rituximab has proven beneficial as a maintenance therapy, R-CHOP achieves a relatively short median PFS of 16–17 months ( 17 , 34 , 35 ). Several chemotherapeutic regimens are recommended to treat MCL, including bendamustine, CHOP, high-dose cytarabine, or fludarabine-based regimens ( 34 ).…”

Updates from the 2017 American Society of Hematology Annual Meeting: Practice-Changing Studies in Relapsed and Refractory Mantle Cell Lymphoma

“…Despite the availability of a number of therapies in the first-line setting, patients inevitably relapse and require additional therapies 1 . Worldwide, four agents are now approved for the treatment of relapsed or refractory (rr) mcl, including bortezomib (Velcade: Takeda Pharmaceutical Company, Osaka, Japan) 4 , lenalidomide (Revlimid: Celgene Corporation, Summit, NJ, U.S.A.) 5 , and ibrutinib (Imbruvica: Pharmacyclics Sunnyvale, CA, U.S.A.) 6 in the United States, and lenalidomide 5 , temsirolimus (Torisel: Pfizer, New York, NY, U.S.A.), 7 and ibrutinib 8 in Europe.…”

“…Existing data suggest a very poor median overall survival (os) of 3-5 years 1,2 , which has recently improved in the era of novel therapies. In younger (less than 60-65 years) fit patients, standard induction therapy is high-dose chemoimmunotherapy, with consolidation using high-dose therapy, followed by autologous stem-cell transplantation and maintenance rituximab 1,3 . In elderly patients (60 -65 years of age and older), or in those ineligible for transplantation, bendamustine-rituximab is the recommended treatment option, followed by rituximab maintenance.…”