Treatment of Mantle Cell Lymphoma in Asia: Updated Consensus from the Asian Lymphoma Study Group

This paper reports up-to-date expert consensus from the Asian Lymphoma Study Group (ALSG) on treatment recommendations for mantle cell lymphoma (MCL) in Asia.

A closed session meeting of the ALSG was convened in August 2025 to discuss MCL management practices in Asia. Consensus recommendations from that meeting are summarized here, and take into consideration international guidelines, the current treatment landscape in Asia, and global and Asia-specific literature.

In Asia, effective MCL management is limited by difficulties in accessing Bruton's tyrosine kinase inhibitors (BTKi) and other novel agents. For patients with indolent and stage I/II disease, active surveillance and involved-site radiotherapy (with/without immunochemotherapy), respectively, can be considered. In advanced MCL, less intensive immunochemotherapy is recommended for elderly, unfit patients; young, fit patients typically receive aggressive cytarabine-based regimens prior to consolidation autologous hematopoietic stem cell transplantation (HSCT). If accessible, covalent BTKi (cBTKi) can be integrated into the first line, and clinical trial enrollment is strongly encouraged for patients with high-risk features. Rituximab maintenance with/without cBTKi is recommended following first-line treatment. In the relapsed/refractory (R/R) setting, cBTKi are more widely used, and novel agents like non-covalent BTKi and chimeric antigen receptor T-cell therapies can be considered where available. Allogeneic HSCT is an option for high-risk or R/R transplant-eligible patients.

These recommendations aim to guide MCL management in Asia. Given the heterogeneity of the disease, diverse healthcare systems, and variable treatment access across the region, there is no one-size-fits-all approach and resource-stratified approaches should be considered.