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Recent advances in the first-line treatment of mantle cell lymphoma

Mantle cell lymphoma (MCL) is a rare B-cell lymphoma, with a median survival of only three to four years. In recent years, the development of new drugs and therapeutic strategies appeared to have improved the outcomes. This review focused on the most important new strategies for untreated MCL patients. Given the heterogeneous clinical evolutions between patients, several prognostic factors have been identified. These factors, as well as the identification of indolent and aggressive MCL, are useful to propose a risk-adapted therapeutic strategy. The prognostic impact and the practical applications of minimal residual disease (MRD) will be addressed. Overall, induction by combining rituximab with cytarabine, followed by consolidation with autologous stem cell transplant had been shown to have benefits for MCL younger patients. However, almost all MCL patients will relapse over time. The addition of rituximab as maintenance therapy for these patients had been shown to improve overall survival. Achievement of complete response with negative MRD and/or negative PET scan while reducing toxicity would be the future therapeutic objective. In this perspective, targeted therapies, alone or in combination as induction or maintenance therapy, are currently being tested earlier in the disease course.