An intensive therapy approach is typically recommended for patients younger than 65 years of age with mantle cell lymphoma (MCL), says Brad S. Kahl, MD. A variety of reasonable intensive strategies, such as R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) with alternating DHAP (dexamethasone, high-dose cytarabine, and cisplatin) are available for this group.

Patients with MCL who achieve adequate response rates may be candidates for autologous stem cell transplantation. Although this strategy does not appear to be curative, the average duration of remission is 4 to 5 years, says Kahl.

Patients who are not candidates for intensive strategies due to their age or comorbidities may receive a variety of non-intensive regimens with good activity. In his practice, Kahl utilizes bendamustine and rituximab for 6 cycles followed by 2 years of rituximab maintenance therapy for this patient population. An ongoing clinical trial is evaluating this combination with the proteasome inhibitor bortezomib. Additionally, lenalidomide is being evaluated in combination with rituximab as a maintenance strategy, notes Kahl.