The Changing Landscape in Mantle Cell Lymphoma - Episode 1

Incidence and Clinical Presentation of MCL


Ian Flinn, MD: Mantle cell lymphoma is a B-cell non-Hodgkin lymphoma with historically poor long-term survival compared with other B-cell malignancies. The type of treatment depends on multiple factors, including the stage of the disease, the age of the patient, and the patient’s overall health. Recent approvals of BTK [Bruton tyrosine kinase] inhibitors have changed the treatment landscape of mantle cell lymphoma.

Today I am joined by a group of my colleagues who are renowned experts in the field of lymphoma research. We will discuss an overview of mantle cell lymphoma focusing on recent approvals of targeted agents, and we’ll highlight the studies from the 2019 ASH [American Society of Hematology] Annual Meeting.

I am Dr Ian Flinn, director of the Lymphoma Research Program at the Sarah Cannon Research Institute in Nashville, Tennessee.

Today, I am joined by Dr Javier Munoz, director of Cancer Immunotherapy at Banner MD Anderson Cancer Center in Gilbert, Arizona; Dr Tycel Phillips, assistant professor at the University of Michigan, in Ann Arbor; and Dr Bijal Shah, associate professor of Moffitt Cancer Center in Tampa, Florida.

Thank you, and let’s begin.

Bijal, mantle cell lymphoma is a relatively rare disease. In our clinic, we see many patients, but for the average community oncologist, it’s a relatively rare disease and presents in a somewhat unique manner. Can you walk us through some of that?

Bijal Shah, MD: Absolutely. It makes up around 3% to 5% of B-cell non-Hodgkin lymphomas, and that’s going to count for somewhere around 3000 cases a year. In terms of presentation, it is variable. We’ve spent a bit of time discussing that in terms of review articles in past publications. Speaking specifically, they’re heterogeneous presentations. In some cases, we’ll see the classical high-grade lymphoma presentations—B-cell symptoms, night sweats, fevers, losing weight, massive adenopathy. Other cases are completely asymptomatic.

One of the unique things that I’ve seen over the years has been this spectrum of insect bite hypersensitivity. I don’t know if you’ve seen that in your practice, but they are these little itchy red bumps that itch until you scratch the head off. I’ve seen that now in upwards of 20% or so of the patients with mantle cell lymphoma who have come in. It’s one of those unique things that I’ve seen mainly in patients with mantle cell lymphoma, and occasionally in patients with CLL [chronic lymphocytic leukemia] over the years. Otherwise, I think it’s our classic spectrum of ranging from low-grade presentations in the asymptomatic patient— maybe mild splenic enlargement—to the patient with very aggressive disease.

Ian Flinn, MD: When it was first described, we thought, “Oh, there’s this uniquely horrible prognosis,” but there are really a variation of presentations. I’m impressed over the years by the number of patients who have colonic involvement. Javier, what’s your take on this? Some people routinely do colonoscopies on everyone with mantle cell lymphoma. Is that something you do in your practice, or is it just on a case-by-case basis?

Javier Munoz, MD, MS, FACP: Great point. I echo previous comments. Most patients with mantle cell lymphoma are going to present with advanced disease—Stage IV—due to involvement of bone marrow or the gastrointestinal tract.

I do not necessarily perform scopes in all of my patients. I do perform them when I’m thinking the patient may have stage I or stage II disease, and perhaps we need to do a more localized type of treatment. However, when it comes to mantle cell lymphoma, that will be a minority of patients.

Ian Flinn, MD: OK.

Transcript Edited for Clarity