Dr. Dean on Challenges in the MCL Paradigm

Robert Dean, MD, staff physician, Cleveland Clinic, discusses challenges in the mantle cell lymphoma (MCL) paradigm.

Many patients with MCL will progress over the course of treatment. Though chimeric antigen receptor (CAR) T-cell therapy has shown promising curative potential in other hematologic malignancies, its role in MCL is unclear. For select patients, allogenic bone marrow transplant or allogeneic stem cell transplant has proven beneficial. It is not advisable for the majority of patients, says Dean, due to the inherent risks of the procedure.

In the case of a younger, fit patient who has an appropriate donor and has previously received treatment with a BTK inhibitor, a CAR T-cell therapy clinical trial is recommended. Preliminarily, it seems to be an active therapeutic strategy, explains Dean. Though the short-term toxicities are not trivial, the longer-term toxicity profile is more favorable than what is seen historically with allogeneic transplant, adds Dean. Excluding that as an option, allogeneic transplant is a suitable option that can be discussed with a young and otherwise healthy patient.