What Clinicians Want to Know About the Management of Relapsed/Refractory Mantle Cell Lymphoma
Oct 19, 2023
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Dr Toby A Eyre and Dr Brad S Kahl discuss the management of relapsed/refractory mantle cell lymphoma, including treatment options like BTK inhibitors and CAR T-cell therapy, ongoing clinical trials, toxicity analysis of BTK inhibitors, use of MRD in clinical practice, combination treatment, and side effect management.
Opting for a BTK inhibitor is favored as second-line treatment for relapsed mantle cell lymphoma, considering other options like allogeneic transplant and CAR-T cell therapy.
Localized mantle cell lymphoma can be effectively managed with radiotherapy, especially in the eyelids.
Adverse effects of acalabrutinib like fatigue and headache can be managed effectively, but switching to alternative BTK inhibitors may be necessary in severe cases.
Deep dives
Choosing BTK Inhibitors as Treatment for Relapsed Mantle Cell Lymphoma
When deciding between rechallenging with standard chemotherapy or opting for a BTK inhibitor as second-line treatment for relapsed mantle cell lymphoma, the use of a BTK inhibitor is generally favored. The BTK inhibitor of choice will depend on available options, with perturbtinib showing promising results in terms of tolerability and efficacy. However, considering other treatment options such as allogeneic transplant and CAR-T cell therapy, as well as enrolling patients in clinical trials, should also be considered in the overall treatment plan.
Localized Mantle Cell Lymphoma and Treatment in the Eyelids
Localized mantle cell lymphoma, particularly in the eyelids, may be effectively managed with radiotherapy. Radiotherapy is a suitable treatment option for localized disease and has shown positive results. Furthermore, patients experiencing relapse within a couple of years after frontline therapy should be promptly treated with a BTK inhibitor, such as a covalent BTK inhibitor, considering other potential treatment options like CAR-T cell therapy, allogeneic transplant, or enrolling in clinical trials.
Adverse Effects of Acalabrutinib, Fatigue, and Headache
Adverse effects associated with acalabrutinib, such as fatigue and headache, can be managed effectively. Fatigue is a potential side effect of acalabrutinib, while headache is a common toxicity that can be alleviated with caffeine consumption. Headaches often resolve within a month of treatment initiation. However, if a patient experiences severe fatigue that affects their daily activities and a reduction in acalabrutinib dosage does not resolve the issue, considering switching to an alternative BTK inhibitor, like zanabrutinib or pertainibutinib, might be warranted.
Administering CAR-T Cell Therapy and BTK Inhibitors in Older Patients
Deciding between CAR-T cell therapy and BTK inhibitors for older patients should be based on an individualized assessment considering physiological fitness, motivation, social factors, and ease of administration. While there is no specific age cutoff for CAR-T cell therapy, older patients may have less physiological reserve and may be more susceptible to significant toxicities. Therefore, it is crucial to carefully evaluate the patient's overall health and discuss the potential benefits and risks of each treatment option to make an informed decision.
Maintenance BTK Therapy, T-Cell Function, and Ki-67 Biomarker
Using BTK inhibitors as maintenance therapy after chemotherapy may be a suitable approach in treating mantle cell lymphoma. BTK inhibitors, such as acalabrutinib or pertainibutinib, offer a tolerable and easily administered treatment option. However, the improvement of T-cell function by BTK inhibitors is still an open question, and further research is needed. Also, the Ki-67 biomarker, which indicates the tumor's proliferation rate, plays a role in guiding treatment decisions. Lower Ki-67 levels are associated with better responses to therapy, whereas higher Ki-67 levels may necessitate alternative treatment approaches.
Dr Toby A Eyre from the Oxford University Hospitals NHS Foundation Trust in Oxford, United Kingdom, and Dr Brad S Kahl from Siteman Cancer Center in St Louis, Missouri, discuss the management of relapsed/refractory mantle cell lymphoma.
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