Mantle Cell Lymphoma in Geriatric Patients: Biologic Risk Stratification, Fitness-Adapted Strategies, and Unmet Needs

Area of Science:

• Hematology
• Oncology
• Geriatrics

Background:

• Mantle cell lymphoma (MCL) presents significant biological and clinical heterogeneity.
• Older adults with MCL face challenges due to aging, comorbidities, and chemotherapy intolerance.
• Geriatric vulnerabilities increase toxicity and mortality risks in this population.

Purpose of the Study:

• To review contemporary therapeutic strategies for older and less fit patients with MCL.
• To identify feasible and effective treatment options considering geriatric assessment.
• To guide optimal management and future research directions for MCL in older adults.

Main Methods:

• Structured literature review of English-language studies.
• Databases searched: PubMed, Embase, and Cochrane Library.
• Inclusion criteria: Studies published between January 2000 and November 2025.

Main Results:

• Bendamustine-based chemoimmunotherapy with rituximab maintenance is a feasible frontline option.
• Second-generation Bruton tyrosine kinase inhibitors (BTKis) are valid for treatment-naïve and relapsed MCL, especially in high-risk patients.
• Combination therapy with BTKis and BCL2 inhibitors shows promise for TP53-mutated MCL, requiring further trials.

Conclusions:

• Optimal MCL management in older adults necessitates individualized, fitness-adapted strategies.
• Integrating biological risk and geriatric assessment is crucial for treatment selection.
• Developing well-tolerated regimens and rational sequencing is essential for improving patient outcomes.