Dr Epstein-Peterson on the Treatment of Transplant-Eligible and -Ineligible Patients with MCL

Zachary Epstein-Peterson, MD, attending physician, Memorial Sloan Kettering Cancer Center, discusses available treatment approaches for patients with mantle cell lymphoma (MCL) who are both transplant eligible and ineligible.

Patients with MCL who are transplant eligible traditionally tend to be younger, have high performance status, and display fewer comorbid conditions, according to Epstein-Peterson; these patients do not typically harbor TP53 mutations. Recent advancements in the treatment landscape of MCL have allowed for patients up to 65 years of age to undergo autologous stem cell transplantation (ASCT), Epstein-Peterson says.

Although cytarabine and high-dose therapy may be considered for these patients, the majority will receive induction therapy with rituximab (Rituxan) and cytarabine-based chemoimmunotherapy, Epstein-Peterson notes. Rituximab, dexamethasone, cytarabine, and oxaliplatin (R-DHAX ) is the most common choice of therapy, he specifies. Once these patients begin to show chemosensitivity, they will be referred to ASCT. This is followed by high-dose therapy and autologous stem cell rescue, and rituximab maintenance therapy will be considered, Epstein-Peterson explains.

Unlike transplant-eligible patients, ineligible patients are a more heterogeneous population, Epstein-Peterson adds. Several viable options exist for these patients. The most prescribed frontline regimen for patients aged 65 or older who are transplant ineligible is bendamustine plus rituximab (BR) followed by rituximab maintenance therapy, Epstein-Peterson notes.

Another viable option is the combination of rituximab and lenalidomide (Revlimid). This option is advantageous for patients who hope to avoid intensive chemotherapy or reduce the time spent in the hospital, Epstein-Peterson says. In previous research, this regimen has been shown to elicit favorable response rates, duration of response, and progression-free survival, Epstein-Peterson concludes.