Mats Jerkeman, MD is a Professor of Oncology, Lund University.

Dr Jerkeman on Symptom Identification for Earlier MCL Diagnosis

"The typical symptoms of MCL are [similar to those seen] with other lymphomas. It’s [commonly characterized by] enlarged lymph nodes, but MCL can also include gastrointestinal symptoms because MCL often involves the bowel. To differentiate [MCL] from CLL, flow cytometry of the blood is needed."

Mats Jerkeman, MD, head of Medical Oncology at Lund University and a principal investigator at Lund University Cancer Centre in Sweden, outlined symptoms that may warrant patient referral for further evaluation and facilitate the diagnosis of mantle cell lymphoma (MCL).

To ensure an earlier, more accurate diagnosis of MCL, Jerkeman emphasized the importance of recognizing the unique symptoms of this disease, which often mirror those of other lymphomas. He shared that the disease is commonly characterized by enlarged lymph nodes. Moreover, MCL often involves the bowel, meaning that patients could also present with gastrointestinal symptoms such as diarrhea or abdominal discomfort, Jerkeman highlighted. MCL may also present as lymphocytosis, which could be asymptomatic and appears very similar to chronic lymphocytic leukemia (CLL), he asserted.

To ensure an earlier or more accurate diagnosis and to differentiate MCL from CLL, flow cytometry of the blood is needed, Jerkeman said. Patients exhibiting either enlarged lymph nodes or lymphocytosis should be promptly referred to an expert hematologist or oncologist for comprehensive workup and evaluation, Jerkeman concluded.

, Jerkeman and colleagues presented long-term follow-up from the Nordic phase 2 MCL2 (ISRCTN87866680) and MCL3 (NCT00514475) trials evaluating frontline treatment with rituximab (Rituxan) and intensive chemotherapy. At a median follow-up of 18 years, 35% of patients (n = 319) were still in first complete remission (CR1) at last follow-up. Although excess mortality was noted compared with the general Nordic population, survival appeared to plateau for patients younger than 50 years, suggesting that this younger group might experience no excess mortality.

Jerkeman concluded that although therapeutic progress has been made in MCL overall, patients with high-risk genetic and histologic features remain underserved.

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Mats Jerkeman, MD, discusses essential symptoms of MCL warranting referral for earlier diagnosis. 

 Dr Jerkeman on Symptom Identification for Earlier MCL Diagnosis

Jerkeman

“The prognosis of patients with MCL is very dependent on the biology of the tumor and the genetics of the tumor.”

Mats Jerkeman, MD, a professor in the Department of Oncology at Lund University, underscored the importance of recognizing the biological heterogeneity within mantle cell lymphoma (MCL) and the unmet need for effective therapeutic strategies in patients with high-risk disease.
Jerkeman explained that prognosis in MCL is closely tied to the underlying genetics and histology of the tumor, with certain subgroups facing markedly inferior outcomes despite advances in therapy. Patients whose tumors harbor 

 mutations, display blastoid histology, or demonstrate high proliferative activity are particularly vulnerable to relapse, Jerkeman noted. Although current treatment strategies, including chemoimmunotherapy, BTK inhibitors, and cellular therapies, have improved outcomes for many patients, their efficacy in this biologically aggressive subset remains limited.

Jerkeman emphasized that no consensus standard of care has been established for patients with high-risk MCL, reflecting the difficulty of managing these subgroups with currently available therapies. Although some of thesepatients may achieve durable remissions with novel agents, the overall prognosis remains poor, particularly in the relapsed or refractory setting. He stressed that relying on treatment strategies extrapolated from lower-risk populations fails to adequately address the unique challenges presented by high-risk disease biology.

Looking ahead, Jerkeman highlighted the need to prioritize the high-risk MCL population in clinical trial design and translational research. He underscored the importance of molecular characterization and targeted trial development to better define therapeutic options for high-risk patients. Investigating novel targeted therapies, immunotherapy combinations, and rational sequencing strategies will be essential to overcoming the resistance mechanisms associated with adverse biology.

In his view, advancing care for high-risk MCL requires a shift toward biology-driven clinical research. By focusing on the molecular and genetic determinants of aggressive disease, investigators may develop treatment strategies tailored to these patients rather than continuing to apply regimens effective only in standard-risk settings.

Mats Jerkeman, MD, discusses the importance of conducting further research to classify the biological heterogeneity within MCL.

Dr Jerkeman on the Importance of Recognizing the Biological Heterogeneity Within MCL

“This is a sign of what we call functional or clinical cure, and we actually believe that a high proportion of patients [with MCL] are cured with this treatment.”

Mats Jerkeman, MD, a professor in the Department of Oncology at Lund University in Sweden, discussed long-term outcomes from the phase 2 Nordic MCL2 (ISRCTN87866680) and MCL3 (NCT00514475) trials, which evaluated intensive, first-line induction chemoimmunotherapy regimens followed by consolidation with high-dose chemotherapy and autologous stem cell transplantation (ASCT) in younger patients with mantle cell lymphoma (MCL).

The analysis assessed whether survival outcomes in the trial population approached those of an age- and sex-matched general population from the Nordic countries. Jerkeman noted that, at a median follow-up of 18 years, no survival plateau was observed in the overall cohort; excess mortality was present even in patients who remained in first remission for more than 15 years after treatment, indicating that MCL continues to confer a long-term survival disadvantage at the population level.

Subgroup analyses revealed that patients aged 50 years or younger at diagnosis demonstrated a different survival pattern. In this patient subset, no excess mortality was observed compared with the matched general population, suggesting the potential for functional, or clinical, cure in selected patients. Jerkeman added that approximately 25% of all trial participants remained alive and in their first complete remission after 20 years, underscoring the durability of responses achievable with this treatment approach.

Overall, data from the MCL2 and MCL3 trials, which are counted among studies with the longest follow-up in MCL, emphasize both the curative potential of intensive frontline therapy and the ongoing need for vigilance in long-term survivors. Jerkeman explained that the persistence of excess mortality in the broader population reinforces the importance of continued surveillance, even for patients in prolonged remission, and underscores the need to address late relapses and long-term treatment-related toxicities.

Mats Jerkeman, MD, discusses the use of induction chemoimmunotherapy followed by high-dose chemotherapy and ASCT in younger patients with MCL.

Mats Jerkeman, MD

Articles

Dr Jerkeman on Symptom Identification for Earlier MCL Diagnosis

Dr Jerkeman on the Importance of Recognizing the Biological Heterogeneity Within MCL

Dr Jerkeman on Induction Chemoimmunotherapy Followed by High-dose Chemo and ASCT in Younger Patients With MCL