Clinical management of mantle cell lymphoma in the elderly

ABSTRACT

Introduction: Mantle cell lymphoma (MCL) is a disease with an indolent histology, but mostly aggressive clinical course. While treatment can yield more promising results in younger patients, the disease is most diagnosed at a median age of approximately 70 years, and treatment in this group still presents a major challenge for oncohematologists. Unfortunately, due to comorbidities and poorer general status, the implementation of intensive treatment approaches with the cytarabine-based regimens and autologous stem cell transplantation is generally not possible, and the disease remains incurable, especially in elderly patients.

Areas covered: In this paper, the authors discuss the therapeutic options available for older patients with MCL in the first line and relapsed/refractory settings, indicating new therapeutic options, which may achieve longer remissions and overall survival.

Expert opinion: Although great progress has been made in the treatment of MCL in recent years, there remains a need for new treatment lines which can allow improved patient outcomes. Novel agents targeting altered the signal transduction pathways in MCL cells may offer more promise than traditional chemotherapy or immunochemotherapy and are currently being tested in clinical trials.

KEYWORDS:

• Mantle cell lymphoma
• MCL
• elderly
• chemotherapy
• immunochemotherapy
• novel targeted treatment

Article highlights

• MCL is a disease with an indolent histology and heterogenous, mostly aggressive, clinical course.

• Adequately used prognostic factor systems in together with an appropriate performance status test helps in choosing the most optimal treatment of MCL.

• Implementation of intensive treatment approaches with the cytarabine-based regimens and autologous stem cell transplantation is generally use for younger, fit patients with MCL.

• Maintenance therapy with rituximab seem to be promising additional treatment in MCL.

• For older patients with MCL in the first line and relapsed/refractory settings, indicating regimens such as BR, R-CHOP or VR-CAP are alternative types of management.

• Novel agents targeting altered the signal transduction pathways in MCL cells such as immunomodulatory agent, lenalidomide, in combination with BR, inhibitors of B-cell receptor signaling, as well as inhibitors of PI3K, BTK, Syk, or cyclin-dependent kinase may offer more promise than traditional chemotherapy or immunochemotherapy, and are being tested in clinical trials.

Acknowledgments

The authors thank to Mr Edward Lowczoski for linguistic correction of the manuscript.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by Grants from the Medical University of Lodz, Poland [grant numbers 503/1-093-01/503-11-004-18 and 503/8-093-01/503-81-001-18].