How would you approach mantle cell lymphoma in very elderly patients?

For patients who are very elderly, my approach depends on the patient's performance status, other comorbidities, disease features/disease behavior, and indications for treatment. There are patients with MCL who can be observed at diagnosis (those with leukemic non-nodal disease but also those with l...

Broad question. Briefly, if fit for therapy, I think there are chemotherapeutic options, inclusive of cytarabine and autoSCT consolidation, that can provide durable disease benefit. But, important to consider disease burden and proliferative status, as well as TP53 mutation status, before embarking ...

For my very elderly, unfit patients with TP53 wild-type MCL, I would prefer BR or Acala-R rather than the BR-acala triplet. The rationale is that we don't necessarily know if sequencing BTKi 2nd line after BR in the frontline is necessarily inferior in this population, and ECHO did not show an OS be...

Newer BTK (acalabrutinib or zanubrutinib) + rituximab without chemo — generally speaking, and based so far on nonrandomized data. If high-risk molecular features, I would still consider off label addition of BCL2 antagonist (AVR or BOVEN) in this group, but this needs caution and very close monitori...

TP53 sequencing at diagnosis in all MCL patients is essential, as it separates first-line regimen selection into distinct TP53 wild-type and TP53-mutated pathways.

The preferred regimens for TP53-mutated disease are venetoclax/zanubrutinib + obinutuzumab. For those not suitable for aggressive inducti...