Treatment of Relapsed or Refractory Mantle Cell Lymphoma
Clinical Scenario
This protocol covers patients with mantle cell lymphoma (MCL) whose disease has relapsed or become refractory after prior treatment. Therapy selection in this setting requires careful evaluation of which treatments the patient has already received.
Patient Population
Patients with relapsed or refractory MCL. The approach differs based on prior exposure to targeted agents and cellular therapies. For patients who have not previously received a BTK inhibitor (BTKi-naïve), distinct post-first-line options apply.
Treatment Approach (Overview)
Treatment selection depends on what therapies the patient has already received. Following prior cellular therapy, targeted agents are among the options; following prior targeted therapy, cellular approaches may be considered. In eligible patients, allogeneic transplantation is also evaluated.
The complete algorithm — all options, sequencing, and supporting evidence grades — is available in the full protocol.
References
- DOI: 10.1002/hem3.70233
- For BTKi-naïve patients with relapsed MCL, a cBTKi ± venetoclax (the latter not EMA- or FDA-approved) should be offered as standard post-first-line immunochemotherapy for:
- Treatment options post anti-CD19 CAR-T therapy include pirtobrutinib [III, B] and immunochemotherapy [IV, B].
- Treatment options post-pirtobrutinib include anti-CD19 CAR-T therapy [IV, B] and immunochemotherapy [IV, B].
- AlloSCT should be considered in younger, fit patients with relapsed MCL in cases where anti-CD19 CAR-T therapy is unavailable or has failed [IV, B].
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