Mantle Cell Lymphoma: Relapsed/Refractory

Although MCL usually responds well to initial treatment, patients do tend to relapse or become refractory.

The term “relapsed” refers to disease that reappears or grows again after a period of remission.

The term “refractory” is used to describe when the lymphoma does not respond to treatment (meaning that the cancer cells continue to grow) or when the response to treatment does not last very long.

For patients who relapse or become refractory, secondary therapies may be successful in providing another remission.

Like other forms of non-Hodgkin lymphomas (NHL), there is no consensus on the best treatment for relapsed or refractory MCL; however, there are an increasing number of treatment options available for these patients. The type of treatment recommended for any individual patient depends on several factors, including the timing of the relapse, the patient’s age, extent of disease, overall health, and prior therapies received.

The following agents have been approved by the FDA for treatment of relapsed or refractory MCL:

• Acalabrutinib (Calquence)
• Bortezomib (Velcade) with or without rituximab
• Brexucabtagene Autoleucel (Tecartus)
• Lenalidomide (Revlimid) with or without rituximab
• Zanubrutinib (Brukinsa)

Although not approved in combination, bortezomib and lenalidomide may be used with rituximab (Rituxan). Additional agents and regimens that are commonly used for the treatment of relapsed/refractory MCL include:

• Bendamustine (Treanda) +/- rituximab
• Combination chemotherapy +/- rituximab

Stem cell transplant (SCT) can be effective in patients with relapsed or refractory MCL. There are two types of SCTs: allogeneic (in which patients receive stem cells from another person) and autologous (in which patients receive their own stem cells). Autologous SCT is generally considered after initial therapy rather than in relapse, but may be an option for medically fit patients who have shown a good response to treatment of their relapsed MCL. In the case of younger, medically fit patients, intensive chemotherapy followed by allogeneic stem cell transplantation is a higher risk, but potentially a curative option.

To learn more about relapsed/refractory MCL, download the Mantle Cell Lymphoma Relapsed/Refractory Fact Sheet.