Romancik Jason T, Cohen Jonathon B
Department of Hematology and Medical Oncology, Winship Cancer Institute At Emory University, Atlanta, GA, USA.
Curr Treat Options Oncol. 2021 Nov 23;22(12):118. doi: 10.1007/s11864-021-00907-3.
There is no standard approach to sequencing novel therapies in mantle cell lymphoma (MCL). For initial treatment, intensive induction chemotherapy followed by autologous stem cell transplant and rituximab maintenance remains our preferred approach in young, fit patients. We consider bendamustine plus rituximab or lenalidomide plus rituximab in patients who are ineligible for intensive chemotherapy-based approaches. Bruton's tyrosine kinase inhibitors are our preferred class of agents to use in the second-line setting. When patients inevitably relapse on one of these agents, we proceed with chimeric antigen receptor T-cell (CAR T) therapy in eligible patients, often with the use of bridging therapy with corticosteroids, lenalidomide, or venetoclax. We treat patients who are ineligible for CAR T or clinic trial with venetoclax, lenalidomide, or proteosome inhibitor-based regimens, although efficacy is expected to be limited in this setting with a shortened duration of response to each subsequent line of therapy. Allogeneic stem cell transplant remains an option for carefully selected patients who progress after autologous stem cell transplant and CAR T. Clinical trials involving combinations of novel agents in early lines of therapy are ongoing, and new compounds with unique mechanisms of action are in development. The results of ongoing clinical trials with novel agents will further change the treatment landscape for patients with MCL in the coming years.
对于套细胞淋巴瘤（MCL）的新型治疗方案排序，目前尚无标准方法。对于初始治疗，在年轻、身体状况良好的患者中，强化诱导化疗后进行自体干细胞移植和利妥昔单抗维持治疗仍是我们的首选方法。对于不符合基于强化化疗方案的患者，我们考虑使用苯达莫司汀加利妥昔单抗或来那度胺加利妥昔单抗。布鲁顿酪氨酸激酶抑制剂是我们在二线治疗中首选使用的一类药物。当患者不可避免地对其中一种药物复发时，对于符合条件的患者，我们会采用嵌合抗原受体T细胞（CAR T）疗法，通常会联合使用皮质类固醇、来那度胺或维奈克拉进行桥接治疗。对于不符合CAR T治疗或临床试验条件的患者，我们用维奈克拉、来那度胺或基于蛋白酶体抑制剂的方案进行治疗，尽管预计在此情况下疗效有限，且后续每一线治疗的反应持续时间会缩短。异基因干细胞移植仍是自体干细胞移植和CAR T治疗后病情进展的精心挑选患者的一种选择。涉及早期治疗中新型药物联合使用的临床试验正在进行中，具有独特作用机制的新化合物也在研发中。正在进行的新型药物临床试验结果将在未来几年进一步改变MCL患者的治疗格局。
