Tandem Meetings 2026 | Frontline treatment in mantle cell lymphoma: defining the optimal approach

I think mantle cell really is a unique hybrid of some of our other lymphomas. I mentioned that there has been new data to incorporate BTK inhibitors with chemoimmunotherapy backbones in frontline treatment of mantle cell. And I think maybe the next incremental step is for us to define, do we need the chemotherapy alone? Can we really address the needs of frontline therapy without chemotherapy? And so there are some ongoing trials in that respect as well. 

I think what makes mantle cell uniquely different than other B-cell lymphomas is even though it is a rare disease, we see a lot of heterogeneity. So for example, we have really what we would consider ultra high-risk patients, those with P53 aberration, high Ki-67 cytogenetics that are complex. And those patients really are not served well by chemoimmunotherapy and typically combinations of either doublet or triplet-based novel therapies are preferred. 

On the other hand, we do have patients that can also present with indolent mantle cell lymphoma that may not need initial therapy and can be safely observed, but at the time that therapy is needed, typically is treated much like standard risk mantle cell lymphoma. 

And then lastly, I will say, mantle cell lymphoma, while we can achieve very deep responses with frontline therapy, we can sometimes induce complete responses where the patient is in remission for many years. We know that it is a disease that can come back even a decade or more later. And so to date, we don’t really have curative therapies for mantle cell lymphoma in the frontline setting, and so we really have to think about long, long-term follow-up data from frontline clinical trials to help best define the optimal approach.

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