Discussing mantle cell lymphoma

Patient pathway

This is an overview of the patient pathway, from symptoms to potential treatments, which may be helpful for your patients who want to know what their journey may look like.

Treatment options

Although there is no standard of care for MCL, a range of treatment options are well established for patients.^[1]

Aggressive chemo-immunotherapy regimens, followed by autologous stem cell transplantation and maintenance immunotherapy, are the most commonly used approach in younger, fit patients^[1]^[2]^[3]
Chemo-immunotherapy, followed by immunotherapy maintenance, is most commonly used in older patients^[1]^[2]
For frail patients, a less-intense chemo-immunotherapy regimen may be considered, aiming primarily at symptom control^[1]^[2]^[3]
– Targeted therapy exhibiting a low toxicity profile may also be suitable in this population^[1]^[2]^[3]

Recently, there has been a shift in the treatment landscape in MCL to include the use of chemotherapy-free treatments with orally administered targeted agents in certain circumstances.^[1]^[2]^[3]^[4]

Unfortunately, despite the improvement in response durations with currently available therapies, patients will inevitably relapse.^[2]^[3]

What to discuss with your patient with MCL

Symptoms

Key symptoms your patients should be aware of include[^5]:

Fever

Abdominal pain

Bleeding

Fatigue

Atypical lymphocytes

Hepatomegaly

Itching

CNS involvement

Unintentional weight loss

Enlarged spleen

Night sweats

Causes and diagnosis

Your patients might be eager to know the cause of MCL, but while the cause is unknown, they can be made aware of the risk factors. These include^[5]

Infection with certain viruses or bacteria
A weakened immune system
Autoimmune disease
History of cancer
Having a close blood relative with MCL

Diagnosis through a biopsy may be intimidating for patients, so it is important to reassure them that it is performed under general or local anaesthetics.^[6]

Staging and treatment

Your patients will want to know what treatments are available to them. It is important to make them aware that some treatment options are more intensive than others, and that treatment choice can depend on what type of MCL they have, their age and fitness, and quality of life considerations. The aim of treatment is to achieve a balance between efficacy outcomes and toxicity.^[7]

After treatment

Patients will need to expect follow-up appointments after treatment to check their response to therapy, monitor their recovery and treat any delayed side effects.^[6]