patient care perspectives

Recommended Follow-up After Initial Treatment for Mantle Cell Lymphoma

by John M. Pagel, MD, PhD

Overview

The ideal approach to patient follow-up after the initial treatment of mantle cell lymphoma (MCL) may be based on a combination of patient-, disease-, and treatment-related factors. Patients with aggressive disease and those treated with intensive chemoimmunotherapy may benefit from more frequent follow-up, while those receiving less intensive treatment may require less frequent monitoring.

Expert Commentary

John M. Pagel, MD, PhD

Chief of Hematologic Malignancies
Center for Blood Disorders and Stem Cell Transplantation

Swedish Cancer Institute

Seattle, WA


“The first remission is the most important remission for patients with MCL because a prolonged first remission will translate to the best survival advantage.”

John M. Pagel, MD, PhD

We typically follow patients after initial treatment for MCL with a restaging assessment and an evaluation relatively quickly, usually within the first 2 months of treatment. These assessments include a physical examination, laboratory studies, and imaging studies. Many people feel strongly that positron emission tomography scans have a very significant role in assessing response in these patients. In rare cases, we might follow up and restage with endoscopy, as MCL often involves the gastrointestinal tract.

We use many of the findings from the initial follow-up to determine the next treatment steps. Autologous hematopoietic stem cell transplantation is very widely used in patients as consolidation in the very first remission, for those who can tolerate it. When patients start to relapse after initial treatment, we need to think about second-line options, which now include chimeric antigen receptor T-cell therapies. The first remission is the most important remission for patients with MCL because a prolonged first remission will translate to the best survival advantage. Even if we are not curing patients, we want to extend that first remission for as long as possible, and that is why we often consider consolidation with transplantation with or without maintenance therapy in patients in first remission.

During the first year after initial treatment, we follow patients every 2 to 3 months. During the second year, it might be every 3 to 4 months. In subsequent years, for patients who are doing well and for those with very indolent disease, it might be every 6 months. It depends on the patient’s individual clinical characteristics and tumor biology. Intensive follow-up may be more appropriate in those who have received R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) or a cytarabine-containing regimen, and perhaps less critical in those who have received bendamustine and rituximab. We know that aggressive relapses can occur early, so we watch patients more closely during the period immediately following initial treatment.

References

Gerson JN, Handorf E, Villa D, et al. Survival outcomes of younger patients with mantle cell lymphoma treated in the rituximab era. J Clin Oncol. 2019;37(6):471-480. doi:10.1200/JCO.18.00690

Lokhande L, Kuci Emruli V, Kolstad A, et al. Immune-related protein signature in serum stratify relapsed mantle cell lymphoma patients based on risk. BMC Cancer. 2020;20(1):1202. doi:10.1186/s12885-020-07678-4

Wang M, Munoz J, Goy A, et al. KTE-X19 CAR T-cell therapy in relapsed or refractory mantle-cell lymphoma. N Engl J Med. 2020;382(14):1331-1342. doi:10.1056/NEJMoa1914347

More in Mantle Cell Lymphoma

Thumb

Mantle Cell Lymphoma

Exploring the Potential Use of Chimeric Antigen Receptor T-Cell Therapy to Treat Mantle Cell Lymphoma

Patient Care Perspectives by Brad Kahl, MD

Preliminary reports suggest that chimeric antigen receptor (CAR) T-cell therapy may be a useful option for the treatment of patients with relapsed ...READ MORE

Thumb

Mantle Cell Lymphoma

Management of Toxicities in Patients Being Treated for Mantle Cell Lymphoma

Patient Care Perspectives by Thomas J. Kipps, MD, PhD

Consideration of patient characteristics and the toxicity profiles of individual agents provides a rational approach to managing treatment-related ...READ MORE

Thumb

Mantle Cell Lymphoma

Potential Role of BCL-2 Inhibition in the Treatment of Mantle Cell Lymphoma

Clinical Topic Updates by Brad Kahl, MD

BCL-2 inhibition may represent a promising strategy for overcoming resistance to conventional therapies in patients with mantle cell lymphoma (MCL).READ MORE

More In Oncology

Non-Small Cell Lung Cancer

Biomarkers for Response to Immune Checkpoint Inhibition

Clinical Topic Updates
by Bruce E. Johnson, MD

Non-Small Cell Lung Cancer

Newer Targets and Therapies for Non–Small Cell Lung Cancer

Expert Roundtables
by Jeffrey Crawford, MD; Bruce E. Johnson, MD; and Gregory J. Riely, MD, PhD