Treatment of Mantle Cell Lymphoma in the Frontline Setting: Are We Ready for a Risk-Adapted Approach?

Abstract

Mantle cell lymphoma (MCL), a type of B-cell non-Hodgkin lymphoma characterized by the t(11;14)(q13q32) translocation, is a clinically heterogenous disease which can range from indolent to highly aggressive. Numerous prognostic factors have been identified, including blastoid histology, the Mantle Cell Lymphoma International Prognostic Index (MIPI) score, high proliferation index, p53 deletions and/or mutations, complex karyotype, minimal residual disease, and several others. However, using these prognostic factors to guide treatment selection has largely remained elusive. Given the heterogeneous behavior of this disease and varying patient characteristics, we suggest that the time has come for a more risk-adapted approach to this disease. In this article, we review the numerous prognostic factors that have been described for MCL, both at the time of diagnosis and following first-line treatment. We then propose a risk-adapted approach to first-line therapy for MCL, which would reserve intensive therapy for the highest risk patients and spare others excessive toxicity.

Frontline Therapy in Mantle Cell Lymphoma: When Clinical Trial and Real-World Data Collide

“…In addition, there are a plethora of prognostic factors that have been identified in MCL including the MIPI score, proliferation index, complex karyotype, gene expression profile, KMT2D mutations, other molecular aberrations, and minimal residual disease (MRD). 14 However, few if any of these have yet been proven useful in selection of specific treatments. Finally, there is great variation in patients with MCL with regard to age and comorbidities which has a significant impact on treatment selection.…”