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Tx Selection and Optimization in MCL

CME

Optimizing Mantle Cell Lymphoma Care: Case-Based Guidance From EU Experts

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Released: May 29, 2026

Expiration: November 28, 2026

Mats Jerkeman
Mats Jerkeman, MD, PhD
CME/CE Information

Activity

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Course Completed

New in MCL 2026: European Perspective

In the frontline setting, the ECHO regimen of acalabrutinib plus BR and the TRIANGLE regimen of ibrutinib plus alternating R-CHOP/R-DHAP with or without ASCT are now approved by the EMA for patients with MCL.22,40 In the R/R setting, there are now 2 EMA-approved CAR T-cell therapies (brexucabtagene autoleucel and lisocabtagene maraleucel).25,27 Acalabrutinib and pirtobrutinib are also approved options in the R/R setting for our patients with MCL.22,33 Even though sonrotoclax is not yet approved by the EMA, it recently received FDA approval as monotherapy for patients with R/R MCL.36

Of importance, treatment discussions with patients and their caregivers should include discussion about enrollment in ongoing trials of novel agents. To this end, eligible patients with R/R MCL can be enrolled on the randomized phase III CELESTIAL-RRMCL trial of sonrotoclax plus zanubrutinib vs placebo plus zanubrutinib (NCT06742996). Access to glofitamab is also possible because eligible patients with R/R MCL can be enrolled on the ongoing phase III GLOBRYTE trial (NCT06084936).

Future Directions and Personal Insights

The treatment outcome for patients with MCL has improved considerably over the last 2 decades, and the treatment landscape continues to expand. In MCL, there have been many major therapeutic advancements with the addition of several novel drug classes such as BTK-directed therapies, BCL2 inhibitors, and CAR T-cell therapy. However, CIT remains the backbone of first-line therapy for patients with MCL in the European Union. With the introduction and incorporation of anti-CD20 antibodies (rituximab and obinutuzumab), covalent BTK inhibitors, noncovalent BTK inhibitors, and CAR T-cell therapies, the prognosis for many patients with MCL has significantly improved.

Today, covalent BTK inhibitors are now approved for use in the first-line setting, either alone or in combination with CIT. The treatment of patients with R/R disease remains a clinical challenge, especially because patients experience a decreasing duration of response after each relapse. After disease progression on a BTK inhibitor–based treatment, the prognosis for patients becomes particularly unfavorable.

CAR T-cell therapy and pirtobrutinib have important roles in the R/R MCL setting after progression on a covalent BTK inhibitor. It is my hope that glofitamab will soon emerge with an indication for patients with R/R MCL and possibly become a new treatment option for R/R MCL in the near future. We eagerly await the results from ongoing trials, especially the phase III trials investigating glofitamab-based and sonrotoclax-based therapies, as well as results from the MANGROVE trial investigating zanubrutinib with rituximab vs BR in newly diagnosed MCL.

In conclusion, the management of patients with MCL continues to have a bright future with several promising agents, combinations, and strategies on the horizon.

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