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. With each successive relapse, MCL becomes harder to treat.
Management strategies for MCL are patient- and disease stage–specific, and aim to achieve balance between efficacy outcomes and toxicity. 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. 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.
MCL is responsive to a variety of initial therapies, but conventional chemotherapy regimens achieve relatively short-term remissions. Studies show that aggressive therapies in younger patients with symptomatic MCL may improve the outcomes.
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.
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
Aggressive, symptomatic, high-risk disease
Asymptomatic/indolent disease or elderly/frail
Consider watch and wait.
The treatment offered to patients will differ depending on the stage of their disease. This staging is carried out according to a modified version of the Ann Arbor system and is known as the Lugano classification.
The Lugano classification stages a patient’s disease according to the number of sites involved and where the disease is located.
Disease is located within a single lymph node region or extranodal organ.
Disease is found on the same side of the diaphragm in ≥2 lymph node regions, or presence of localised involvement of an extranodal site.
Disease is present on both sides of the diaphragm or in nodes above the diaphragm with spleen involvement.
Includes Stage III alongside localised involvement of an extranodal site.
Includes Stage III alongside involvement of the spleen.
Disease is widespread, located in the lymph nodes and other parts of the body. Localised involvement of the liver or bone marrow.
The classification of MCL and MIPI-c grading will guide the next stage in disease management. At the point of diagnosis, approximately 70% of patients are symptomatic and require immediate therapy.
Can be watched without any compromise to long-term outcome
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.
CLL=chronic lymphocytic leukaemia; LDH=lactate dehydrogenase; MCL=mantle cell lymphoma; MIPI-c=combined MCL International Prognostic Index.
This site has been developed by Janssen-Cilag International NV. Janssen-Cilag International NV is the responsible editor of this document.