Emerging first-line treatment approaches for mantle cell lymphoma

Treatment of mantle cell lymphoma (MCL) is evolving rapidly. In the front-line setting important recent developments include (1) approval of the BTK inhibitor (BTKi) acalabrutinib in combination with the chemoimmunotherapy, (2) evidence that the BTKi ibrutinib given with induction chemotherapies and during maintenance phase is highly effective, (3) BTKi without chemotherapy has produced promising results, (4) BCL2 inhibitor venetoclax and BTKi can be combined to effectively treat high risk MCL with TP53 alterations, and (5) consolidation with autologous stem cell transplant (ASCT) may not provide additional efficacy benefit for patients who have received highly effective first-line treatments but may be associated with substantial toxicities. These results support a concerted effort to bring BTKi to the first-line treatment of MCL. This review focuses on key clinical trials that provide the above insights and provides a succinct review of relevant historical regimens to guide oncologists in the management of untreated MCL.