Skill Checkup: A 62-Year-Old Man With Lumps on His Neck and Under His Arm

Ann S. LaCasce, MD, MMSc


May 25, 2023

This newly diagnosed patient, who is young and fit and has stage II bulky, classical TP53 wild-type disease, is a candidate for high-dose therapy followed by autologous stem cell rescue (HDT/ASCR). As such, a more aggressive chemoimmunotherapy approach is warranted. The NCCN guidelines recommend induction therapy in order to potentially eliminate MCL cells when they are most vulnerable, before their exposure to any therapeutic agents. This strategy aims to reduce the chance for secondary resistance and cause long-term remissions. However, trials are being conducted to assess the role of modern immunochemotherapy regimens or Bruton's tyrosine kinase (BTK) inhibitors with or without autologous stem cell transplantation. Alternatively, the patient could be enrolled in a clinical trial. Prophylaxis for tumor lysis syndrome should also be considered.

Conventional chemoimmunotherapeutic regimens, as well as the combination of an immunomodulator and an anti-CD20 agent, are both preferred options for less aggressive disease in patients who are not candidates for HDT/ASCR. Anti-CD20 alone is typically not used in induction therapy option for MCL.


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