How would you structure your monitoring for a low-risk leukemic TP53-negative mantle cell lymphoma with 5% MCL cells detected in both peripheral blood and bone marrow, mild splenomegaly, and no lymphadenopathy or B symptoms?

This appears to be the prototypical indolent patient for whom observation would be ideal. For these patients, there isn’t a truly validated period of monitoring. I have typically extrapolated from follow-up from other chronic diseases, with a plan to extend follow-up intervals over several years. In this case, an exam and labs every 3 months for the first year, then every 4 months, then every 6 months thereafter.

As these are non nodal patients, I don’t plan to heavily image them given the limited utility. Disease progression can generally be sufficiently monitored based on exam (spleen size), symptoms (normally related to spleen size), and labs.

I agree with Dr @Dr. First Last - I focus on clinical and laboratory monitoring and see patients every 3-6 months, depending on their CBC trends and their absolute lymphocyte counts.