Evolution of mantle cell lymphoma therapy: advancing frontline precision

Frontline treatments for mantle cell lymphoma were historically dictated by age and fitness for intensive chemoimmunotherapy and autologous stem cell transplantation. While yielding high response rates, these approaches are associated with treatment-related morbidity and disease relapse. The therapeutic landscape is trending toward biological precision. This review highlights the timely frontline integration of novel targeted agents that directly challenge the need for traditional consolidative transplants while de-escalating or even sparing chemotherapy. Measurable residual disease is increasingly used to identify early relapses and inform the duration and individualization of therapy. By integrating targeted and immune-engaging therapeutics with optimized maintenance to deepen responses and prolong survival, these advancements aim to maximize long-term remission while minimizing toxicity.