Mantle cell lymphoma - Current standards of care and future directions

Over the past decade we have seen significant changes in the biological characterization and strategies for treatment of mantle cell lymphoma (MCL). MCL is heterogeneous a disease, and so are the people that have it; although guidelines are appropriate, therapeutic approaches must be individualized based on a variety of factors. In this review, we summarize data on the range of therapeutic options, from observation in patients with slowly progressive low-tumor-burden MCL, to bendamustine-based regimens in typical MCL, to high-dose cytarabine-based regimens in young, fit patients. The management of previously treated MCL is evolving with the availability of new agents and more changes are expected. Several recent and ongoing clinical trials have the potential to provide new options for patients and are discussed as future directions. Additionally, prognostic tools, measurement of minimal residual disease, and assessment of toxicity are already common research tools and may soon impact therapeutic strategies as a standard of care. Indeed, there has never been a time that management of MCL was as complicated while the promise for real improvements in outcomes is so great.