VIDEO: Methods for approaching mantle cell lymphoma treatment

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So if I'm seeing a patient with a new diagnosis of mantle cell lymphoma, the first thing I'm looking at is the disease characteristics. So, what's the patient's tumor burden? Do they have a lot of disease? Do they have a little disease? Sometimes patients have a very low amount of disease and no symptoms. The disease was just found incidentally. And so, occasionally, maybe 1 out of 10 times, your patient could actually start out on just observation. That doesn't happen super often, and more patients need to start on treatment right away. So, if I do have a patient who clearly needs to start on treatment, then the next thing I'm thinking through is, is this patient a candidate for an intensive strategy? Or are they better off with a non-intensive approach? And that'll really be a function of the patient's age and their fitness. A rule of thumb is, like, age 65. So if I have patients who are 65 and under, and fit, we're generally looking at more intensive treatment strategies. The induction therapy will usually contain high dose cytarabine. We usually will pursue autologous stem cell transplantation, once the patient has completed their induction strategy. And we know that patients who go through this type of strategy tend to get longer first remissions. If I have a patient who is older, or maybe has comorbidities, that make them not a great candidate for such intensive treatment strategies, then I'm usually offering them something a little easier and gentler. Like, a typical choice would be bendamustine rituximab regimen, which is given for six cycles. And it's relatively easy for patients to get through that. And then we usually follow it up with, like, two years of maintenance rituximab therapy. So, if I have a newly diagnosed patient, the first decision is, do they need treatment now? Yes? No? And then, if they do, then I have to decide on age and fitness. Are they candidate for an intensive strategy? Or are they better off with a non-intensive strategy? And, of course, if we have an appropriate clinical trial option, then that will be offered to the patient as well. If I have a patient with relapsed mantle cell lymphoma, then I'm looking at, "Okay, what therapies have they had?" "How did they respond to those therapies?" If they haven't had a BTK inhibitor, that's usually the direction we go as the therapy of choice in the relapse setting. If they failed a BTK inhibitor, then often we're looking at brexucabtagene autoleucel, which is a CAR T-cell therapy for relapsed mantle cell lymphomas. It's FDA approved, and quite effective. So, those are the considerations that come into play when I'm seeing a patient with relapsed mantle cell lymphoma. And of course, we'll look at clinical trial options for them too.