Simon Rule, MD, PhD, professor of hematology, Plymouth University Medical School, discusses the treatment paradigm in mantle cell lymphoma (MCL).
The treatment paradigm of MCL is fairly well established. The field is in general agreement that cytarabine is a key drug in this disease. Furthermore, there is no argument regarding the role of rituximab (Rituxan) or the early use of a BTK inhibitor such as ibrutinib (Imbruvica). However, there has been some discussion about the optimal treatment approach for a patient with p53-mutated disease, specifically in a young patient in whom upfront allogeneic stem cell transplant is recommended rather than autologous stem cell transplant. Most are in agreement that an allogeneic transplant is preferable to an autologous transplant.
There is also discussion about moving newer agents into the frontline setting. There's a general consensus in MCL, unlike other lymphomas, that there's going to be a clear shift toward a chemotherapy-free treatment paradigm when new data emerge, says Rule, particularly in terms of combinations like ibrutinib and venetoclax (Venclexta), which appear to be the most exciting.