Approaches to the management of relapsed/refractory mantle cell lymphoma: navigating an increasingly complex therapeutic landscape

Introduction: Mantle cell lymphoma (MCL) represents a distinct subtype of mature B-cell lymphoma, considered incurable with a pattern of recurrent relapses and suboptimal responses to subsequent therapies that portends poorer prognosis with each recrudescent disease.

Areas covered: Covalent and non-covalent Bruton tyrosine kinase inhibitors (BTKi) have transformed the relapsed/refractory (R/R) MCL landscape as monotherapy but may emerge to be more effective as combinations with B-cell lymphoma-2 (BCL-2) inhibitors and immunotherapy. Immune-leveraging therapies, including chimeric antigen receptor (CAR) T-cell therapy and T-cell engaging antibodies are gaining momentum, with the former demonstrating durable responses in a subset of patients while the latter being evaluated in various combination regimens. Allogeneic hematopoietic stem cell transplants remain a potentially curative option for selected patients.

Expert opinion: This review seeks to navigate this increasingly complex therapeutic landscape while providing a suggested treatment and sequencing algorithm that may be tailored to individual patients.