Izidore S. Lossos, MD, professor, director, Lymphoma Program Head of hematological malignancies site disease group, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses research questions in the field of mantle cell lymphoma (MCL).

Many unanswered questions in the field center around patients with high-risk disease—specifically, how to treat patients with blastoid variant MCL, explains Lossos. This is a rare and aggressive variant of MCL with a median survival of 6 to 12 months, and currently, there is no standard of care for these patients.

Another unanswered question is whether transplant is necessary in younger patients. Investigators from The University of Texas MD Anderson Cancer Center are leading an ongoing study combining hyper-CVAD with ibrutinib (Imbruvica) to try to improve outcomes without transplant. In elderly patients, identifying the least toxic therapy that will prolong survival is critical. As it stands, the median survival of this disease is 7 years, which leaves room for improvement, adds Lossos. Investigational strategies include the use of cyclin dependent kinase inhibitors, although the data are fairly preliminary.

Videos

Dr. Lossos on Research Questions in MCL

Izidore S. Lossos, MD, professor, director, Lymphoma Program Head of hematological malignancies site disease group, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses treatment approaches for patients with mantle cell lymphoma (MCL).

In MCL, treatment approaches are dependent on the age and fitness of the patient, explains Lossos. Young fit patients may receive either AraC (Cytarabine)-based chemotherapy followed by transplant or aggressive chemotherapy without transplant. However, to date, only 1 randomized trial has demonstrated the superiority of transplant versus no transplant in terms of progression-free survival and overall survival benefit, says Lossos. More aggressive regimens may obviate the need to transplant, he adds.

In the elderly population, transplant is not recommended, and the field is moving away from using chemotherapy-based regimens in these patients. Follow-up data were presented on the use of lenalidomide (Revlimid) and rituximab (Rituxan; R

) and showed that the regimen can induce long-term responses and remissions comparable to what could be achieved with a chemotherapy-based regimen. In the relapsed population, the addition of venetoclax (Venclexta) to BTK inhibitors seems to be very promising, concludes Lossos.

Izidore S. Lossos, MD

Articles

Dr. Lossos on Research Questions in MCL

Dr. Lossos on Treatment Approaches in MCL