Mantle cell lymphoma: therapeutic options in transplant-ineligible patients

Abstract

Management of patients with newly diagnosed mantle cell lymphoma (MCL) depends on the age and fitness of the patient. For younger patients, the commonly accepted standard of care is a high-dose cytarabine-based induction chemotherapy followed by autologous stem cell transplantation (ASCT). In newly diagnosed patients with MCL ineligible for intensive therapy and ASCT, the standard-of-care has generally been R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), followed by rituximab, maintenance. In recent years, bendamustine-based therapy has been increasingly adopted for older MCL patients and more recently, vincristine has been replaced by bortezomib in the R-CHOP combination as VR-CAP for previously untreated patients. Novel targeted agents now offer more promise than traditional chemotherapy or immunochemotherapy for both previously treated and untreated disease, and should also improve outcomes for older MCL patients. Here, we review standard therapies currently in use and novel agents that may soon be available for MCL patients and particularly for those unsuitable for ASCT.

Keywords:

• Acalabrutinib
• bendamustin
• bortezomib
• elderly
• mantle cell lymphoma
• immunochemotherapy
• ibrutinib
• lenalidomide
• venetoclax
• VR-CAP
• temsirolimus

Acknowledgments

We thank Edward Lowczowski from the Medical University of Lodz for editorial assistance.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2019.1605511.

Additional information

Funding

This work was supported in part by the grant from Medical University of Lodz (No 503/1-093-01/503-11-004-18), Poland. TR received research grants from Celgene, Hoffmann-La Roche, GlaxoSmithKline, Abbvie, Acerta and Novartis, travel grant from Hoffmann-La Roche and Janssen, honoraria for scientific advisory board and payment for lectures from Celgene, Hoffmann-La Roche, Janssen and Abbvie. PS received research grant, travel grant and payment for lectures from Hoffmann-La Roche and travel grant from Takeda. PR received research grant from Janssen and Celgene. MD received honoraria for scientific advisory board from Acerta, Bayer, Clegene, Gilead, Janssen, Novartis, Roche and Sandoz, support of academic trials from Celgene, Janssen, Mundipharma, Roche and speaker's honoraria from Bayer, Celgene, Gilead, Janssen, Roche.