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Tx Selection and Optimization in MCL

CME

Treatment Selection and Optimization in MCL From a European Union Perspective

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Released: April 15, 2025

Expiration: October 14, 2025

Mats Jerkeman
Mats Jerkeman, MD, PhD
CME/CE Information

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Introduction

In this module, Mats Jerkeman, MD, PhD provides a European perspective on the current treatment algorithm, guidelines, and evidence-based approaches for the optimal integration of available treatments into the management of patients with mantle cell lymphoma (MCL) with careful consideration of patients’ age, fitness level, presence of high-risk features, preexisting comorbidities, and concomitant medications.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. A few questions will be asked twice: once at the beginning of the activity and then again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many people with MCL do you provide care for in a typical month?

A 61-year-old man presents with lymphadenopathy and left upper quadrant pain. Lymph node biopsy shows MCL, diffuse variant, Ki-67 10%, TP53–mutation negative disease. Staging revealed diffuse enlarged lymph nodes, bone marrow, and enlarged spleen (stage IVa). The patient does not have any cardiac-related disease.

In your current practice, what would you recommend as the optimal first-line treatment for this 61-year-old man?

A 72-year-old man with uncontrolled hypertension, atrial fibrillation and diabetes was diagnosed with MCL 5 years ago. At initial diagnosis, staging revealed stage III disease with largest lymph node 4 cm, and biopsy revealed Ki-67 30%; TP53 mutation is negative. He received the Nordic regimen followed by ASCT with carmustine/etoposide/cytarabine/melphalan (BEAM) and maintenance rituximab for 3 years. Now, at age 72, he has experienced disease progression; imaging reveals disease above and below the diaphragm.

At this time, which treatment would you initiate for this 72-year-old patient?

A 75-year-old man recently initiated acalabrutinib after experiencing disease progression on  immunochemotherapy induction followed by 3 years of rituximab maintenance therapy. Three days after the initiation of acalabrutinib, he starts complaining of headaches.

Which of the following would you educate this patient to avoid for managing headaches that he may experience when starting treatment with acalabrutinib?

A 79-year-old man was diagnosed with MCL at age 74. His relevant medical history includes mild congestive heart failure, hypertension, and obesity. As frontline therapy, he received BR x 6 cycles followed by rituximab maintenance x 2 years. He experienced relapse at age 77 with diffuse lymphadenopathy. At that time, he was treated with ibrutinib (560 mg) x 2 years. Now, he has a diffuse relapse with pancytopenia, and bone marrow–positive disease with extensive lymphadenopathy.

In your current practice, what would you recommend as the optimal next-line treatment for this 79-year-old patient?

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