This protocol applies to fit younger patients — typically up to 65 years — with advanced-stage mantle cell lymphoma who are suitable for intensive therapy, but whose initial induction did not reach the required depth of response.
Fit younger patient (typically up to 65 years) with advanced-stage mantle cell lymphoma, suitable for intensive or dose-intense therapy. Most trial populations included patients up to 65 years, though fit patients over 65 may also be managed along these lines.
The prior induction — R-CHOP-Ibrutinib alternating with R-DHAP (or R-DHAOx), followed by ibrutinib and rituximab maintenance — did not achieve its target outcome: complete response with molecular (NGS-based) remission postinduction. Non-achievement of this endpoint is the trigger for escalation to the current protocol.
When the prior cBTKi-based induction has not achieved the required molecular response, an approach incorporating rituximab and high-dose cytarabine-containing induction is among the options considered in this setting. The complete consolidation strategy, eligibility criteria, and maintenance sequencing are available in the full structured protocol.
DOI: 10.1002/hem3.70233
Most trials in this population included patients up to 65 years, but we advise fit patients >65 years also to be treated according to the following (Figure 1).
Fit younger patients should be treated with R‑CHOP‑Ibrutinib/R‑DHAP or R‑DHAOx induction, followed by 2 years of ibrutinib and 3 years of rituximab maintenance [I, A].
If cBTKi are not available in the first‑line treatment, rituximab and high‑dose cytarabine‑containing induction and ASCT consolidation may be applied, followed by 3 years of rituximab maintenance [I, B].
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