NCCN Guidelines for Patients® | Mantle Cell Lymphoma

26 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2019 3  Treatment guide Second-line treatment Second-line treatment Options for second-line treatment are listed in Guide 3 . A clinical trial may be an option. Ask your doctor if there’s a clinical trial that is right for you. Radiation therapy may be used to treat a cancer within a lymph node or other small area. Otherwise, second-line regimens are used. They may consist of one or more of these drugs: kinase inhibitor, immunomodulator, chemotherapy, or rituximab. Your doctor may advise getting an allogeneic transplant for consolidation. It may extend how long the cancer stays in remission. Good results are more likely if prior chemotherapy worked well. An allogeneic transplant is an intense treatment, but you may be able to have reduced-intensity conditioning. Guide 3. Second-line treatment What are the options? • Clinical trial • Radiation therapy ◦◦ For stages I and II, ISRT may be used • Second-line regimens IN DEPTH: Second-line regimens Doctors plan treatment partly based on how long it takes for the cancer to relapse after induction treatment. A short response is shorter than the average time. A long response is longer than the average time. Ask your doctor what the average response time is for your induction treatment. Short response Preferred regimens • Acalabrutinib • Ibrutinib ± rituximab • Lenalidomide ± rituximab • Venetoclax Other regimens • Ibrutinib, lenalidomide, rituximab • Venetoclax + ibrutini b Long response Preferred regimens • Bendamustine ± rituximab • Bortezomib ± rituximab Other regimens • Kinase inhibitors used for short responses • Bendamustine, bortezomib, rituximab • PEPC ± rituximab • RCHOP • VRCAP • Second-line treatment for diffuse large B-cell lymphoma