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SOHO 2026 | Selecting patients with newly diagnosed MCL for chemotherapy-free treatment
Jonathon Cohen, MD, MS, Emory University School of Medicine, Atlanta, GA, shares advice on which patients with newly diagnosed mantle cell lymphoma (MCL) may be considered for a chemotherapy-free treatment approach. Dr Cohen notes that combining a BTK inhibitor, venetoclax, and obinutuzumab has shown promise, and highlights that a chemotherapy-free approach could be considered for patients who are medically ineligible for chemotherapy due to comorbidities or age. This interview took place at the 14th Annual Meeting of the Society of Hematologic Oncology (SOHO 2026) in Houston, TX.
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Transcript
So I think if you have a patient with mantle cell lymphoma and they’re eligible for a clinical trial using a chemo-free approach, I think that’s very reasonable and very appropriate for any patient for whom they qualify. Outside of the setting of a clinical trial, in my own practice, the main places where I think about a chemo-free approach would be, number one, those patients who have a TP53 mutation...
So I think if you have a patient with mantle cell lymphoma and they’re eligible for a clinical trial using a chemo-free approach, I think that’s very reasonable and very appropriate for any patient for whom they qualify. Outside of the setting of a clinical trial, in my own practice, the main places where I think about a chemo-free approach would be, number one, those patients who have a TP53 mutation. And so this is something that I recommend be checked in every patient if you have tissue and are able to check it, because we know that patients with a TP53 mutation do not experience prolonged remissions with chemotherapy and are in need of a different approach. And we now at least have some prospective data suggesting that a chemo-free approach combining a BTK inhibitor, BCL2 inhibitor venetoclax, and obinutuzumab, or what we call the BOVen regimen, has been found to be quite promising and is currently listed in the NCCN guidelines. The other time when I typically will avoid chemotherapy would primarily be a patient who is medically not eligible to receive chemotherapy due to comorbidities or age. And in that case, I sometimes will think about a CD20 antibody combined with a BTK inhibitor, although we don’t know definitively that that results in longer remissions in most cases. If a patient is not able to get chemotherapy, I think that’s a very reasonable option. Outside of that, for a fit patient with more traditional mantle cell lymphoma, I still am incorporating chemotherapy as part of my induction outside of the setting of a trial.
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