How would you treat a BTKi naive p53 mutated MCL in 1st relapse with disease noted both systemically and in the CNS?  

This is a case where I would likely still use ibrutinib. We know from years of experience that it gets into the CNS, and it's an incredibly effective drug in MCL. Zanu and acala should get into the CNS, but the companies have limited PK data for CNS penetration. The harder question (I think) is whet...