NCCN Guidelines for Patients® | Mantle Cell Lymphoma

25 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2019 3  Treatment guide Initial treatment complete response, rituximab may be re-started for maintenance treatment. It improves results of some induction regimens. Slow growing Doctors have found some markers of slow growth. The most common marker is an IGHV mutation that is linked to low or absent SOX11 levels. Other slow-growing cancers have normal SOX11 levels and may be present only in the gut, bone, or blood. Some people with slow-growing MCL do not need treatment right away. Instead, a watch-and- wait approach is used to decide when to start treatment. One reason to begin treatment is when cancer symptoms start. When treatment is needed, your doctor may reassess certain cancer features. He or she may assess if the cancer is now growing faster. The cancer may be biopsied again and tested for TP53 mutations. For TP53 -mutated MCL, the best treatment is unknown. NCCN experts recommend a clinical trial. Other options are intense or less intense chemoimmunotherapy. After intense chemoimmunotherapy, you may receive an autologous transplant and rituximab maintenance. Some people receive rituximab maintenance after less intense chemoimmunotherapy. IN DEPTH: Induction chemoimmunotherapy Chemoimmunotherapy consists of multiple drugs. The regimens can be very complex. Ask your doctor about the details of your treatment. Which drugs will be given and at what doses? On which days will treatment be given? How many weeks will treatment last? Intense regimens are used to treat stage II bulky, III, and IV if 1) a transplant is an option or 2) the cancer is slow growing and TP53 negative. Preferred regimens • RDHA + (carboplatin, cisplatin, or oxaliplatin) • RCHOP + RDHAP • NORDIC regimen • HyperCVAD Other regimens • Bendamustine + rituximab Less intense regimens are used to treat 1) stage I and II, or 2) stage II bulky, III, and IV if a transplant is not an option. Preferred regimens • Bendamustine + rituximab • VR-CAP • RCHOP • Lenalidomide + rituximab • Modified rituximab-HyperCVAD if 66 years of age and older Other regimens • RBAC