<p>The targeted therapies used to treat mantle cell lymphoma (MCL) are associated with adverse events that can negatively impact a patient’s quality of life (QOL) and ability to perform daily activities. Measuring symptom scores and using them to create an individualized and multidisciplinary treatment plan may help improve patients’ sense of well-being.</p>

QOL is a very important aspect to evaluate in patients with MCL during follow-up. Since a majority of these patients are aged 65 years and older, addressing their QOL needs becomes an important parameter. QOL can be scored using various measures that assess factors such as symptoms, functional status, performance status, emotional distress, and fatigue. QOL is important to measure in patients on targeted therapies because a subset of these individuals experience adverse effects on various BTK inhibitors and discontinue treatment. Symptoms that can compromise a person’s QOL include fatigue, palpitations, hypertension, atrial fibrillation, skin rashes, tingling and numbness in the hands and feet, memory disturbances, brain fog, and headaches. These symptoms can also affect a patient’s adherence to treatment. So, treatment selection, including the type of BTK inhibitor that is chosen, should be individualized to each patient, considering their age, performance status, comorbidities, and symptom score. In older patients, we also assess for comorbidities, cardiopulmonary function, and bone strength, and, in very frail patients, we also recommend doing a geriatric consultation for a comprehensive review of the patient’s clinical profile.

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I recommend discussing the side-effect profiles of targeted therapies prior to treatment initiation in all patients with MCL. An assessment of their comorbidities, performance status, and QOL needs prior to treatment is a critical factor. Moreover, tolerability of various side effects can differ from patient to patient. For example, someone with mild fatigue may be able to perform daily activities and may have no compromise in their daily functioning. However, another patient may say that their mild fatigue is intolerable and that they are ready to switch to another targeted therapy agent or decrease the dose of their current medication. In such cases, we try to manage the adverse effects by using strategies such as decreasing the dose, monitoring the patient for worsening fatigue, and monitoring them for their treatment response. Some patients may experience more severe side effects that render them unable to perform their daily activities and maintain a good QOL. In such cases, my general approach is to stop the agent, and then, after the patient recovers from these symptoms, restart treatment by beginning with a dose reduction while monitoring treatment response. If the side effects continue to occur despite these measures, we will discontinue that agent and switch to another available option.

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It is very important to use a multidisciplinary approach while caring for patients with MCL who may have a compromised QOL at the time of therapy initiation. At The University of Texas MD Anderson Cancer Center, we have various resources available to support such needs in the form of the Fatigue Clinic, the Supportive Care Center, the Cardiopulmonary Center, and the Geriatrics Clinic. We generally incorporate these multidisciplinary teams into the treatment of most of our patients to monitor them and ensure that they maintain their QOL.