A rapid progression from classical mantle cell lymphoma to a blastoid variant

Area of Science:

• Hematology
• Oncology
• Clinical Case Studies

Background:

• Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma.
• The blastoid variant of MCL is associated with a more aggressive clinical course and poorer prognosis.

Observation:

• An 82-year-old male with classical MCL progressed to the blastoid variant with central nervous system (CNS) involvement.
• Initial treatment with oral chemotherapy (PEP-C) and ibrutinib failed to control the disease.

Findings:

• Despite intensive salvage therapy including high-dose cytarabine, rituximab, and intrathecal methotrexate, the patient experienced refractory disease progression.
• The case illustrates the challenges in treating advanced blastoid MCL, particularly with CNS dissemination.

Implications:

• Blastoid MCL, especially with CNS involvement, presents a significant therapeutic challenge with a dismal outcome.
• There is a critical need for novel therapeutic strategies and effective CNS prophylaxis in managing aggressive MCL variants.
• Individualized treatment approaches are essential for patients with refractory or advanced-stage MCL.