NCCN Guidelines for Patients® | Mantle Cell Lymphoma

24 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2019 3  Treatment guide Initial treatment Initial treatment The options for initial treatment are listed in Guide 2. Initial treatment is often given in phases. The first phase is called induction treatment. The goal is to greatly reduce the amount of cancer. The second phase of treatment is started after a complete response is achieved. You may receive either consolidation or maintenance treatment. The goal of consolidation is to enhance the results of induction treatment. The goal of maintenance is to increase the amount of time until the cancer comes back. If you receive consolidation treatment, you will likely receive maintenance treatment as a third phase of treatment. Stages I and II Research on treatment for stages I and II is very limited. Involved-site radiation therapy (ISRT), less intense chemoimmunotherapy, or both may control cancer growth. If ISRT doesn’t achieve a complete response, you may receive chemoimmunotherapy. In rare cases, treatment may not be needed right away. Instead, a watch-and-wait approach is used to decide when to start treatment. This approach is also called observation. Stages II bulky, III, IV The best treatment for advanced disease is unknown. More research comparing treatments is needed. Currently used treatments are discussed in this section. Treatment options are partly based on how fast the cancer is growing. Advanced MCL is described as either fast growing (aggressive) or slow growing (indolent). Most people have fast-growing MCL. Fast growing A clinical trial may be an option. Ask your doctor if there’s a clinical trial that is right for you. NCCN experts strongly advise a clinical trial for cancers with TP53 mutations. Outside of a clinical trial, your treatment will depend on if you can have an autologous stem cell transplant. Not everyone can have a transplant. It is an intense treatment, so it may be harmful to some people. If an autologous transplant is planned, you will first receive intense chemoimmunotherapy. After a complete response, you may get a transplant for consolidation treatment. After the transplant, rituximab will be re-started for maintenance treatment. You’ll receive it every 8 weeks for 3 years. If an autologous transplant is not planned, you will receive less intense chemoimmunotherapy. After a Guide 2. Initial treatment Stages I and II What are the options? • ISRT • Chemoimmunotherapy with ISRT • Chemoimmunotherapy • Watch and wait in certain cases Stages II bulky, III, IV What are the options? • Clinical trial • Chemoimmunotherapy followed by autologous transplant and maintenance rituximab • Chemoimmunotherapy ± maintenance rituximab • Watch and wait for slow-growing cancers