Dr. Kahl on Patient Selection for Intensive Vs Non-Intensive Treatment in MCL

Brad S. Kahl, MD, professor of medicine, Department of Medicine, Oncology Division, Medical Oncology, Washington University School of Medicine in St. Louis, discusses patient selection for intensive vs non-intensive treatment strategies in mantle cell lymphoma (MCL).

Typically, younger, more fit patients with MCL are considered for intensive treatment regimens, Kahl says. Although a reasonable cut-off for intensive therapy is age 65, some younger patients are not fit for intensive regimens and some older patients could easily tolerate intensive regimens. Therefore, individualized treatment selection is critical in this patient population, Kahl adds.

Intensive treatment regimens are typically comprised of high-dose cytarabine­-containing induction therapy followed by autologous stem cell transplant followed by maintenance rituximab (Rituxan). This 12-month course of treatment is difficult for patients to tolerate, so appropriate patient selection is key, Kahl explains. However, patients who can tolerate the therapy often derive prolonged remissions lasting a median of 7 to 9 years.

Older or unfit patients should not be considered for intensive treatment strategies because their quality of life and outcome will be negatively affected. Instead, non-intensive options, such as bendamustine plus rituximab, should be utilized, Kahl concludes.