Advancing Mantle Cell Lymphoma Risk Assessment: Navigating a Moving Target

Mantle cell lymphoma (MCL) is a B-cell malignancy characterized by t(11;14)(q13;q32) translocation and heterogeneous clinical behavior. Advances in risk stratification enabled the distinction of conventional MCL (cMCL) from non-nodal MCL (nnMCL) subtypes, which presents with distinct biological and clinical features. Prognostic tools such as MIPI/MIPI-c, Ki-67 expression, and TP53 mutation/deletion status have enhanced risk assessment, while new genomic alterations including 17p deletion, CDKN2A loss are emerging as a new prognostic factors. Above all, TP53 disruption remains the major adverse factor, associated with poor outcomes despite new combination therapies. Although recent clinical trials are exploring innovative targeted strategies, the effective management of high-risk MCL remains challenging till now. Minimal residual disease (MRD) monitoring is now emerging as a dynamic prognostic tool, offering potential for treatment adaptation. The integration of molecular and clinical predictors into personalized therapeutic strategies along with MRD monitoring could represent the basis of the future algorithm of MCL management.