Mantle Cell Lymphoma

Carla Casulo, MD

Assistant Professor of Medicine and Oncology, Lymphoma Program, Wilmot Cancer Institute, University of Rochester, Rochester, NY

Question 1

A 47-year-old man with newly diagnosed mantle cell lymphoma (MCL) presents for evaluation. He has no other past medical history. He works as a mechanic. On exam he has multiple abnormal lymph nodes palpable in the neck, axillae, and groin. Computed tomography (CT) scan demonstrates diffuse lymphadenopathy. He is found to have stage III disease involving multiple lymph nodes in the cervical, mediastinal, and inguinal areas. Bone marrow biopsy is negative for involvement. His white blood cell (WBC) count is elevated, he has an abnormal lactate dehydrogenase (LDH) level, and he feels poorly. His Mantle cell lymphoma International Prognostic Index (MIPI) score is high risk. Lymph node biopsy reveals sheets of medium-sized lymphocytes that are clonal, CD20+, CD5+, and CD23, and cyclin D1 stains strongly.

What is the preferred approach to treatment?

  •   R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine,
    prednisone) for 6 cycles followed by observation
  •   Bendamustine and rituximab for 6 cycles followed by maintenance rituximab
  •   Observation
  •   R-CHOP induction followed by a cytarabine-based conditioning regimen,
    high-dose chemotherapy, and autologous stem cell transplant (autoSCT)

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