title: Lifting the mantle: Unveiling new treatment approaches in relapsed or refractory mantle cell lymphoma.
abstract: The management of relapsed/refractory mantle cell lymphoma (MCL) remains a clinical challenge. A standard second-line treatment for relapsed/refractory MCL does not exist. Management of relapsed/refractory MCL requires an individualized treatment approach, incorporating factors such as: functional status, prior treatments, response to prior therapies, and disease biology. Generally, there are two categories of salvage therapy; the first, non-cross-resistant cytotoxic chemotherapeutic agents and, the second, pathway-targeted agents. For transplant eligible patients, the optimal therapy usually consists of salvage, remission re-induction phase followed, whenever possible, by a consolidation phase. Bendamustine and/or high dose cytarabine plus rituximab based chemotherapy represent the most common salvage therapy with an overall response rate of 70-80%. Consolidation with a reduced intensity conditioning allogeneic stem cell transplantation represents the only potentially curative treatment. Overall survival ranges from 30% to 50% at 5 years with this approach. For transplant ineligible patients, ibrutinib is the most effective treatment with an overall response rate of almost 70% and median response duration of 17.5 months. Lacking an effective consolidation, this approach is not considered curative. In this review we characterize the main therapeutic approaches available in this setting and summarize our preferred clinical treatment approach.
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Universita' degli Studi di Milano, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mussetti
authors.affiliation: Weill Cornell Medical College, New York, NY, USA; Department of Medicine, Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Parastoo B
authors.initials: PB
authors.lastname: Dahi
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA. Electronic address: sauterc@mskcc.org.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Sauter
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D019468:Disease Management; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000473:pathology* / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome
keywords: Allogeneic hematopoietic cell transplantation; Autologous hematopoietic cell transplant; Bendamustine; Bortezomib; Ibrutinib; Mantle cell lymphoma; Relapsed/refractory