According to the NCCN guidelines, chemoimmunotherapy is a recommended option for patients without a TP53 mutation who are not candidates for ASCT. Clinical trials are preferred where possible for those harboring a TP53 mutation. ASCT has not been shown to be beneficial in these patients, and chemoimmunotherapy, while an option, is suboptimal.
Currently, CAR T therapy is typically an option in the third-line setting after chemoimmunotherapy and Bruton's tyrosine kinase inhibitor therapy for fit patients, per the same guidelines. However, the treatment landscape is rapidly evolving, and earlier use of CAR T has been suggested for certain patients. In a recent literature review conducted by M. Al-Mansour, a treatment algorithm was proposed that included CAR T therapy as a second-line option for unfit patients. Additionally, international practice guidelines suggest that CAR T may also be considered for patients with TP53 mutation second line.
Radiation therapy may be an option in patients with early-stage disease or in the palliative care setting.
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Cite this: Ann S. LaCasce. Fast Five Quiz: Non-Hodgkin's Lymphoma: Mantle Cell Lymphoma Practice Essentials - Medscape - May 22, 2023.