Treatment options for patients with relapsed or refractory MCL

This article reviewed different treatment options for patients with relapsed (cancer recurrence) or refractory (does not respond to treatment) mantle cell lymphoma (MCL).

Chemoimmunotherapy is the typical first-line (primary) treatment for patients with MCL. 80 – 90% of patients respond to treatment, but many patients eventually relapse.

As more treatments are given, patients with relapsed or refractory MCL experience increasingly shorter remissions (disappearance of all signs of cancer). Eventually, the disease may progress and become more aggressive. Treatment for these patients remains challenging.

The most common chemoimmunotherapy regimen for relapsed or refractory MCL is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Single agents such as bendamustine (Treanda), cytarabine (Ara-C), or fludarabine (Fludara) are also commonly combined with rituximab (Rituxan). These regimens are recommended for first relapses in younger patients and elderly patients who do not have comorbidities (additional diseases or medical conditions).

Targeted therapies can be used as a monotherapy or in combination with other treatments. In the U.S., ibrutinib (Imbruvica), lenalidomide (Revlimid), and bortezomib (Velcade) are FDA-approved for relapsed or refractory MCL. Targeted therapy combined with rituximab is recommended for second relapses in younger patients and elderly patients who do not have comorbidities.

For frail, elderly patients, the main treatment goal is to improve quality of life. Treatment options for these patients are limited. Low-dose chemotherapy is recommended, though targeted therapy with or without rituximab may also be used.

This article reviewed different treatment options for patients with relapsed or refractory MCL. These included chemoimmunotherapy and targeted therapies.

Most of these results are from phase 2 studies. Larger studies are needed to compare the effectiveness of combination chemotherapies and targeted therapies for relapsed or refractory MCL.