Treatment of Mantle Cell Lymphoma in Patients Over 65 or with Comorbidities Unfit for Intensive Therapy
This protocol covers first-line management of mantle cell lymphoma (MCL) in a specific population: patients typically older than 65 years, and younger patients whose comorbidities render them unsuitable for intensive treatment regimens.
Clinical scenario
Older MCL patients — typically those above 65 years of age — and younger patients with comorbidities who are unfit for intensive therapies form a distinct treatment population. Age and fitness assessment drive regimen selection in this group, with conventionally dosed approaches preferred over intensive chemotherapy.
Treatment approach
First-line treatment in this population centres on R-chemotherapy-based regimens and/or targeted agents, with maintenance therapy considered following induction. For very frail patients, palliative approaches may also be appropriate. The complete regimen selection, sequencing, and maintenance criteria are detailed in the full protocol.
References
DOI: 10.1002/hem3.70233
- Older MCL patients, typically defined as individuals older than 65 years, and younger patients with comorbidities who are unfit for intensive therapies have been treated with conventionally dosed ICT regimens.
- Patients ≥ 65–70 years unsuitable for intensive therapy should receive one of the following regimens:
- R‐chemotherapy: options include BR, VR‐CAP, R‐CHOP [I, B], R‐BAC [III, B].
- BR‐acalabrutinib [I, B].
- Continuous cBTKi plus rituximab induction and 2‐year rituximab maintenance (not approved by EMA or FDA) [I, B].
- Offer maintenance rituximab for at least 2 years after the following first‐line induction regimens.
- In very frail patients, palliative radiotherapy at low doses (2 Gy × 2) may be effective in reducing symptoms, both in newly diagnosed patients and at relapse.
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