Time to tailor treatment for mantle cell lymphoma
Patients with mantle cell lymphoma are currently treated largely based on age, even though the disease can range from slow-growing to highly aggressive. In a new article, Ingrid Glimelius and her co-authors suggest that it is time to let the biology of the tumour guide treatment – and to provide more effective interventions at an early stage to those at highest risk, whilst allowing patients with a more indolent form of the disease to avoid unnecessarily intensive treatment.
Photo: Mikael Wallerstedt
Mantle cell lymphoma is a form of lymph node cancer with a highly variable course. Some patients may live for a long time with a slow-growing disease, whilst others experience a relapse at an early stage despite intensive treatment.
Traditionally, the choice of treatment has been guided primarily by the patient’s age and whether they are deemed capable of withstanding intensive chemotherapy and stem cell transplantation. However, in recent years, our understanding of the biology of the disease has increased significantly, and several new targeted therapies and immunotherapies have become available.
High-risk patients can be identified at the time of diagnosis
In a review article in The Lancet Haematology, Ingrid Glimelius and her co-authors argue that this should now affect the way treatment is planned already at the time of diagnosis. They propose a future treatment approach in which patients are divided into groups with low risk, standard risk, high risk and ultra-high risk disease.
For patients at high or ultra-high risk, new targeted therapies and T cell-directed immunotherapy, such as CAR-T or bispecific antibodies, may need to be used earlier in the course of the disease and are already being studied as part of first line treatment.