How would you treat a younger patient with relapsed mantle cell lymphoma after treatment with hyperCVAD?

In front line therapy for MCL patients, induction followed by ASCT should be the standard of care followed by rituximab maintenance and follow up for MRD.

In relapsed MCL, after anthracycline and cytrabine containing therapy, BTK inhibitors appear to be the most affective agents.

Results of a pooled analysis (Rule et al) of 370 patients demonstrated CR in 26.5% with a mPFS of 13.0 months. The results in the second line setting were even more encouraging with a mPFS of 33.6 months and those who achieved a CR had a mPFS of 46.2 months . The median overall survival was 26.7 months with 37% of patients alive at 5 years. The median duration of follow-up was 41.1 months and the median treatment exposure was 11.1 months. Ibrutnib does penetrate the ...

Agee with @Dr. First Last. The only confounder being that in some cases patients treated with R-HyperCVAD do not proceed to stem cell transplantation in first remission. In those cases you could consider salvage with another chemotherapeutic again (R-DHAP/DHAOx) to induce remission and consolidate with transplant in 2nd remission.