Expert Guidance and Clinical Resources to Improve the Care of Patients With Mantle Cell Lymphoma

Introduction

In this module, Tycel Phillips, MD, discusses the clinical evidence for the treatment of mantle cell lymphoma (MCL) in both the frontline and the relapsed/refractory (R/R) settings.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking on any of the slide thumbnails in the module alongside the expert commentary.

Please note that Decera Clinical Education plans to measure the educational impact of this activity. Some questions are asked twice: once at the beginning of the activity, and once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your individual responses will not be shared. Thank you in advance for helping us assess the impact of this education.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many people with MCL do you provide care for in a typical month?

A.
1-4
B.
5-10
C.
11-15
D.
16-20
E.
>20
F.
Not applicable

For those who practice in academic or community settings, please indicate your practice setting:

A.
Academic
B.
Community
C.
Not applicable

A 73-year-old man presents with lymphadenopathy and left upper quadrant pain. Lymph node biopsy shows MCL, Ki-67 60%, TP53 mutation–negative disease. Staging revealed diffuse enlarged lymph nodes, bone marrow, and enlarged spleen (stage IVa).

In your current practice, which of the following would you recommend as the optimal first-line treatment for this 73-year-old man?

A.
Acalabrutinib plus bendamustine/rituximab (BR) (x 6 cycles) with maintenance rituximab and acalabrutinib
B.
BR induction (x 6 cycles) without maintenance
C.
Rituximab plus cyclophosphamide/doxorubicin/vincristine/prednisone (R-CHOP)
D.
Watch and wait

Which transplant-eligible patient with MCL would be the most appropriate candidate for the BOVen regimen (zanubrutinib/obinutuzumab/venetoclax) as first-line therapy?

A.
Mantle Cell Lymphoma International Prognostic Index (MIPI) low risk
B.
TP53 mutated
C.
Blastoid variant histology
D.
Ki-67 10% to 30%

A 67-year-old man was diagnosed with MCL at age 62 but had no significant comorbidities. As frontline therapy, he received BR for 6 cycles followed by rituximab maintenance for 2 years. He experienced relapse at age 63 with diffuse lymphadenopathy. At that time, he was treated with ibrutinib (560 mg) for 2 years. Now, he has a diffuse relapse with pancytopenia, and bone marrow–positive disease with extensive lymphadenopathy.

What would you recommend as the optimal next-line treatment for this 67-year-old patient?

A.
Acalabrutinib
B.
Brexucabtagene autoleucel (brexu-cel)
C.
Lenalidomide plus rituximab
D.
Mosenutuzumab plus polatuzumab vedotin

What were the key results of the phase III ECHO trial testing acalabrutinib plus BR vs placebo plus BR for patients with previously untreated MCL?

A.
Similar median PFS and OS
B.
Significantly improved median PFS only
C.
Significantly improved median OS only
D.
Significantly improved median PFS and OS

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