Mantle cell lymphoma: how to clarify the confusion around first-line treatment?

First-line treatment strategies for mantle cell lymphoma (MCL) have greatly improved in recent years. High dose cytarabine, autologous stem cell transplantation for eligible patients and anti-CD20 maintenance therapy for all patients, have contributed to enhanced results, establishing a standard of care with unprecedented long-term outcome. Recently, a growing number of effective options such as Bruton's tyrosine kinase (BTK) inhibitors, combinations of targeted therapies, and immunotherapies, have emerged, leading to confusion regarding the optimal first-line approach.

BTK inhibitors have reshaped MCL treatment landscape, optimizing outcomes and minimizing toxicity. They will now be essential to first-line treatment strategy for young patients, challenging the traditional role of autologous stem cell transplantation. Moreover, targeted therapies have opened new prospects on chemo-free treatments for older patients.

The variety of treatment options will enable tailoring therapy. Prognostic stratification at diagnosis is crucial, paving the way for personalized treatment. This underscores the need for clear guidelines to navigate the complexities of available therapies and ensure effective treatment selection.