Module Abstract

New Options for the Treatment of Relapsed Mantle Cell Lymphoma

Abstract

During the past 10 years, significant progress has been made in the treatment of mantle cell lymphoma (MCL). The improvements in MCL therapeutic outcomes over time are likely in part, a result of improved second-, third-, and fourth-line therapies. New therapies are continually being developed for this disease. For example, bortezomib, a proteasome inhibitor that has been approved by the US FDA for MCL based on efficacy in the PINNACLE trial (a 32% response rate and a median time to progression of 12.4 months). Bendamustine is a novel alkylating agent that has shown promising phase II data for the treatment of relapsed MCL in combination with rituximab. Since conventional chemotherapy does not yet offer a cure for MCL, both autologous and allogeneic stem cell transplantation are being examined for their potential. These procedures are associated with short-term morbidity and particularly in the case of allogeneic transplantation risks vs host disease and infectious complications that increase the potential mortality for this approach. The results of early studies with lenalidomide are encouraging, with a 53% response rate seen in a phase II study, in this difficult-to-treat population. mTOR inhibition with agents such as temsirolimus may also be an effective strategy and is in phase II testing. Novel agents such as purine analogues (cladribine), microtubule stabilizers (ixabepilone), and emerging combination treatment regimens (eg, with rituximab) continue to undergo clinical evaluation for the treatment of relapsed/refractory MCL.