Management of Mantle Cell Lymphoma in the Elderly: Current and Potential Strategies
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Mantle cell lymphoma is a distinct subtype of B-cell non-Hodgkin lymphoma, accounting for 3–10 % of all non-Hodgkin lymphoma cases. The median age at diagnosis is nearly 70 years. The prognosis of patients is based on the Mantle Cell Lymphoma International Prognostic Index, which is calculated on the basis of four independent prognostic factors (age, performance status, serum lactate dehydrogenase and leukocyte count). Treatment of elderly patients with de novo untreated mantle cell lymphoma is based on rituximab combined with chemotherapy. The most commonly used regimen is the classical CHOP21 (cyclophosphamide, doxorubicin, vincristine and prednisone) regimen. Bendamustine is also an option, especially for patients with cardiac comorbidities. In elderly patients who are relatively young and fit, an approach based on treatment usually used for younger patients, with cytarabine-based induction followed by autologous stem cell transplantation, should be discussed. Treatment of relapsing patients is based on the use of newer effective drugs, including bortezomib, lenalidomide and thalidomide, and mammalian target of rapamycin (mTOR) inhibitors, such as temsirolimus. These drugs are often combined with rituximab and can be prescribed in combination with chemotherapy. Promising new drugs are Bruton tyrosine kinase inhibitors and other inhibitors of the phosphoinositide 3-kinase (PI3K)–mTOR–protein kinase B (AKT) pathway. Despite these new advances, mantle cell lymphoma remains an incurable disease, and further basic and clinical research is warranted.
Funding and Conflict of Interest Disclosure Statements
There was no funding for the preparation of this manuscript. Marguerite Vignon and Marie-Dominique Venon have no conflicts of interest to declare. Olivier Hermine has received consulting fees or honoraria from Celgene, Johnson & Johnson, Roche and Pfizer; support for travel to meetings for the study, manuscript preparation or other purposes from Celgene and Roche; and payment for lectures, including service on speakers’ bureaus from Johnson & Johnson. Richard Delarue has received payment for lectures from Sandoz, Roche, Pfizer and Celgene. He served as a member of a data and safety monitoring board of a study sponsored by Millenium. He has also received travel support from Celgene, Novartis, Roche and Mundipharma.
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