Dr. Rule on Watching and Waiting Approach For MCL Subset

Simon Rule, MD, PhD
Published: Tuesday, Oct 02, 2018



Simon Rule, MD, PhD, professor of hematology, Plymouth University Medical School, United Kingdom, discusses the “watch and wait” approach for a subset of patients with mantle cell lymphoma (MCL).

Importantly, this does not disadvantage patients, Rule says. In fact, for patients who are asymptomatic with low-volume disease, the watch and wait approach is the right thing to do. There is no benefit to treating patients early on in their disease if they have a good prognosis. While this may seem counterintuitive because MCL is such an aggressive cancer, it is inevitable for these patients to relapse once they are treated. Relapsed/refractory MCL is often harder to manage, so putting off treatment for as long as possible likely helps patients live longer, Rule says.

There is an ongoing trial in the United Kingdom looking at this approach. Any newly diagnosed patient with MCL goes into a biobank and researchers follow the course of their disease. Of the patients who were clinically eligible to be watched and waited on, over 30% did not progress after 1 year. Rule says this is important because hematologists won’t know if a patient’s disease is indolent if they treat them right away.


Simon Rule, MD, PhD, professor of hematology, Plymouth University Medical School, United Kingdom, discusses the “watch and wait” approach for a subset of patients with mantle cell lymphoma (MCL).

Importantly, this does not disadvantage patients, Rule says. In fact, for patients who are asymptomatic with low-volume disease, the watch and wait approach is the right thing to do. There is no benefit to treating patients early on in their disease if they have a good prognosis. While this may seem counterintuitive because MCL is such an aggressive cancer, it is inevitable for these patients to relapse once they are treated. Relapsed/refractory MCL is often harder to manage, so putting off treatment for as long as possible likely helps patients live longer, Rule says.

There is an ongoing trial in the United Kingdom looking at this approach. Any newly diagnosed patient with MCL goes into a biobank and researchers follow the course of their disease. Of the patients who were clinically eligible to be watched and waited on, over 30% did not progress after 1 year. Rule says this is important because hematologists won’t know if a patient’s disease is indolent if they treat them right away.

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