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EHA 2025 | Managing patients with MCL who relapse with CNS involvement
In this interview, Christopher D’Angelo, MD, University of Nebraska Medical Center, Omaha, NE, briefly outlines the optimal management of patients with mantle cell lymphoma (MCL) who relapse with central nervous system (CNS) involvement. He suggests a cytoreductive approach, followed by potential intrathecal chemotherapy, and finally consolidation with CAR T-cell therapy if possible. This interview took place at the 30th Congress of the European Hematology Association (EHA) in Milan, Italy.
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Transcript
Certainly a frontier in managing mantle cell lymphoma when it involves the CNS tract. So we will usually try to cytoreduce those patients and kind of just get a better response with methotrexate. That has worked well in our hands for that. For people with parenchymal disease, there is always an option to consider focal radiation, depending on how emergently patients need that kind of therapy...
Certainly a frontier in managing mantle cell lymphoma when it involves the CNS tract. So we will usually try to cytoreduce those patients and kind of just get a better response with methotrexate. That has worked well in our hands for that. For people with parenchymal disease, there is always an option to consider focal radiation, depending on how emergently patients need that kind of therapy. We kind of do a one-two punch, so to speak, where we’ll start with some kind of cytoreduction. If there’s a lot of intrathecal involvement or sort of CSF involvement, we’ll use intrathecal therapy. And then we will like to consolidate those patients with CAR T-cells. We know that CAR T-cells are active in that space and can get into there. So we tend to try to cytoreduce first, and then when we feel like we’ve got a kind of a good space, also simultaneously preparing them for CAR T-cell therapy.
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Disclosures
Consulting: Abbvie, Beigene, ADC Therapeutics, Genmab, BMS; Research: BMS, Abbvie-Genmab, Beigene, Fate Therapeutics, Genentech, Curis Inc.
