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Find out what your next steps should be in planning your patient’s treatment.
MCL follows an aggressive course, and relapse is inevitable, even after intense chemoimmunotherapy.[1][2] With each successive relapse, MCL becomes harder to treat.[2]
Management strategies for MCL are patient- and disease stage–specific, and aim to achieve balance between efficacy outcomes and toxicity.[3] Whilst treatment strategies should consider key patient considerations, such as age, fitness, tumour burden, and clinical presentation, they must also account for younger patients’ desire to preserve fertility.[3] Although the boundaries are not clear-cut, intensive therapies in this framework are generally reserved for younger and fitter patients, and non-intensive therapies for older or more frail patients.[3]
MCL is responsive to a variety of initial therapies, but conventional chemotherapy regimens achieve relatively short-term remissions.[4] Studies show that aggressive therapies in younger patients with symptomatic MCL may improve the outcomes.[5]
A ‘watch and wait’ strategy for patients who are asymptomatic, have a low MIPI, or who are elderly should be considered due to a poor prognosis and lack of curative treatments.[4]
Guideline therapy recommendations should be considered in conjunction with local practices and available treatment options.
Have a look at this short 4-minute video to learn more about the increasingly detailed definition of MCL over time, the advances in understanding and management of the disease and the constantly evolving therapeuticoptions.
CP-299788, approved on 11/05/2022
Symptomatic Aggressive, symptomatic, high-risk disease | Asymptomatic Asymptomatic/indolent disease or elderly/frail |
Patient factors
|
Consider watch and wait. |
The treatment offered to patients will differ depending on the stage of their disease.[3] This staging is carried out according to a modified version of the Ann Arbor system and is known as the Lugano classification.[1]
The Lugano classification stages a patient’s disease according to the number of sites involved and where the disease is located.[1]
Stage I
Disease is located within a single lymph node region or extranodal organ.[1]
Stage II
Disease is found on the same side of the diaphragm in ≥2 lymph node regions, or presence of localised involvement of an extranodal site.[6]
Stage III
Disease is present on both sides of the diaphragm or in nodes above the diaphragm with spleen involvement.[1]
Stage IIIE
Includes Stage III alongside localised involvement of an extranodal site.[7]
Stage IIIs
Includes Stage III alongside involvement of the spleen.[7]
Stage IV
Disease is widespread, located in the lymph nodes and other parts of the body.[1][7] Localised involvement of the liver or bone marrow.[7]
The classification of MCL and MIPI-c grading will guide the next stage in disease management.[8] At the point of diagnosis, approximately 70% of patients are symptomatic and require immediate therapy.[9]
Asymptomatic/indolent patients[9]
Can be watched without any compromise to long-term outcome
Symptomatic/aggressive disease[9]
Treatment choice is based on patient’s age and fitness
Emerging strategies seek to incorporate newer, targeted therapies into frontline treatment and use prognostic markers.[5]
CLL=chronic lymphocytic leukaemia; LDH=lactate dehydrogenase; MCL=mantle cell lymphoma; MIPI-c=combined MCL International Prognostic Index.
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