John Leonard, MD, Provides an Overview of MCL and Indolent MCL
In the second installment of this 3-part podcast series, John Leonard, MD, Physician and Professor, Weill Cornell Medicine and NewYork-Presbyterian Hospital, provides an overview of mantle cell lymphoma (MCL) and indolent MCL.
MCL accounts for about 5% to 10% of lymphomas and has a male predominance and median age is in the 60s.
Mantle cell historically was treated less aggressively in older people based on ability to tolerate treatment and more aggressively in younger patients based on, largely, ability to tolerate treatment.
There were some data that suggested that intensive treatment approaches were reasonable in improving at least progression-free survival. There was some sense that overall survival might be improved by aggressive treatment approaches, like autotransplant as part of consolidation in first remission.
I think that's coming into question a little bit more because of the fact that patients with mantle cell who get aggressive therapy may do better because they're getting aggressive therapy, they may do better because they're able to get aggressive therapy so that there's selection bias in the choice of treatment, so that remains an issue of some active debate.
I think that we have learned more and more and I think that it's an important issue not yet widely appropriate, let's say, to select therapy but we think that now mantle cell is much more heterogeneous than it was previously assessed. There are subsets of patients with MCL at diagnosis or treatment that have mutations, or, less importantly, deletions of P53. That's a group of patients that tend to have particularly unfavorable disease and a less favorable outcome with standard therapies. We're trying to learn in that subset of highly aggressive or more likely to be highly aggressive MCL whether those patients should receive novel agents, novel approaches, and that's really a work in progress.
The majority of patients do very well with chemotherapy based approaches of various types. Sometimes with autotransplant, sometimes without. It depends a little bit on the response to treatment, the comorbidities of the patients, and the wishes of the patients to undergo more aggressive therapy.
And then roughly 10% of patients, maybe a little more, maybe a little less, have what is more indolent MCL, often acting and presenting more like indolent lymphoma or presenting more like chronic lymphocytic leukemia, where the patients have lower tumor burden disease, minimal symptoms, and in those cases we now know that while we don't have a great way to predict who's going to go a long period of time with indolent disease, certainly by clinical factors there are some people who can be observed for a period of time and do well. And in some cases can go months and even several years in some instances without needing any therapy at all before the disease reaches a point where therapy is indicated.
And so, I think we're learning that mantle cell is more heterogeneous than we thought, and I think we're trying both on clinical factors and biologic factors to be more rational in how we approach patients and how we choose therapy.