patient care perspectives
Recommended Follow-up After Initial Treatment for Mantle Cell Lymphoma
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.
Chief of Hematologic Malignancies
Swedish Cancer Institute
“The first remission is the most important remission for patients with MCL because a prolonged first remission will translate to the best survival advantage.”
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.
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