No todo linfoma de células del manto requiere tratamiento inmediato. Un subgrupo diferenciado se presenta de forma asintomática con características que indican un curso más indolente, lo que orienta hacia un enfoque cuidadosamente estructurado que difiere sustancialmente de los protocolos estándar del LCM.
Este protocolo se aplica a pacientes con linfoma de células del manto asintomático que presentan el siguiente perfil de bajo riesgo:
Esta constelación de características define una forma indolente del LCM. La presentación también puede incluir un patrón similar al MALT, con enfermedad predominantemente extranodal, Ki-67 bajo y morfología clásica.
DOI: 10.1002/hem3.70233
Although definitions vary in the literature, "indolent" MCL is often characterized by a leukemic presentation, SOX11 negativity, and low proliferation index (Ki‐67), although an indolent "MALT‐like" form of mostly extranodal disease, again with low Ki67% and classical morphology, is also recognized.
Asymptomatic MCL patients with low‐risk features managed by a watch‐and‐wait strategy should be monitored initially every 3 months, and then every 3–6 months by physical examination, imaging (as clinically required), blood counts, and biochemistry [V, B].
Early intervention with targeted therapy should be performed only in the context of prospective clinical trials [II, C].
At clinical progression, treatment will be initiated as for other MCL as below [V, B].
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