Updates in the Treatment of B-cell Lymphoma: Focus on Mantle Cell Lymphoma, Follicular Lymphoma, and Marginal Zone Lymphoma - Episode 6
Closing out their discussion on mantle cell lymphoma, expert panelists share clinical pearls for practicing community physicians.
Bijal D. Shah, MD, MS: I want to turn to the group. What pearls can we leave those treating mantle cell lymphoma to help guide them clinically? What’s something that we can leave them with so that they say, “Aha, this is the next thing that I need to make sure I do the next time I see a patient with mantle cell?” Because it is still a relatively rare disease. Most physicians in the community, they see less than a dozen or so a year, if that.
Ian W. Flinn, MD, PhD: I think one thing is to make sure that your pathologists are checking for TP53 mutations. It’s amazing to me how often I see patients in consultation and that hasn’t been done. Thus, I think it really behooves us to make sure that happens. It doesn’t always guide exactly what we’re going to do in that setting, but it’s certainly an important piece of information, as it relates to the prognosis of the patient and how it may guide therapy in the future.
Caron A. Jacobson, MD, MPH: I think we’ve talked about a lot of incredible advances in mantle cell lymphoma in the past year or two, or maybe three. But I think we really can’t underscore how pivotal CAR [chimeric antigen receptor] T-cell therapy has been for mantle cell lymphoma. And of course, the follow-up is too short to really know if its natural history changing, as Ian had pointed out. But with the data we have so far, we know that we’re getting the deepest and most durable remissions with any salvage therapy for our patients. To that I would say referring patients in at first relapse to see if they would be suitable for consideration of going to CAR T-cell therapy right away versus being able to tee them up after their first salvage regimen I think is really important.
Michael Wang, MD: I would like to echo Dr Jacobson’s point. I really think that the future for mantle cell lymphoma is bright, and many patients live for many years, even with the diagnosis. But overall, mantle cell lymphoma is still very rare. In the community, doctors may not see many of them, and most of the clinical trials are in the tertiary centers, in the academic centers. Hence, when you are diagnosed with mantle cell lymphoma, please seek a second opinion. Many scholars, investigators like me, we like to collaborate with the community doctors. We would make some suggestions, this therapy is available at home when you go home, and there’s a constant collaboration. You will get to see all the novel options. You will also get the convenience of cutting down the travel to the center, so please come to see one of the doctors in the academic centers and have your lymphoma doctors collaborate.
Brian T. Hill, MD, PhD: I would agree with everything that was said. The one good thing that’s come out of the COVD-19 pandemic is the increasing use of virtual medicine. For patients who can’t or won’t travel; there are barriers to travel, particularly in certain geographic areas. It’s maybe costly or unrealistic to travel to a referral center, but even then, e-consults are increasingly being used. Pathology review doesn’t require travel. Thus, getting the opinion, insight, and recommendations from a specialist early would be my recommendation, even if the patient stays at home for treatment, which is actually ideal for everyone. That way we can ensure the patients get the best outcome.
Bijal D. Shah, MD, MS: Great. Thank you so much.
Transcript edited for clarity.