How do you approach front line treatment for TP53 mutated mantle cell lymphoma?

For patients with TP53 mutations based on the information presented by Eskelund et al. and previous experience. Given the knowledge that the mutation is a dominant negative which eliminates and functional activity of the tumor suppressor it stands to reason that an durable response with chemotherapy...

Both R2 and I+R (or acala+R) are reasonable front-line approaches. Both approaches are tougher in those with proliferative bulky nodal disease (ki67>50%). We still can get responses, but is less common, and particularly for I+R, remissions tend to be shorter. If in this situation I would look at R2 ...