Considering Chemotherapy and Improving QOL in Mantle Cell Lymphoma Care

During a visit to Yale Cancer Center in New Haven, Connecticut, CancerNetwork® met with Shalin Kothari, MD to discuss key considerations for tailoring therapeutic strategies to specific patients with mantle cell lymphoma (MCL) while preserving quality of life.

Kothari, an assistant professor of Medicine (Hematology) at Yale University, emphasized understanding the biology of each patient’s disease and discerning whether they harbor features such as TP53 mutations or complex karyotypes. These markers, he described, may make it less suitable to use chemotherapy.

Regarding the sequencing of therapy, Kothari noted that it is important to combine BCL-2 inhibitors with BTK inhibitors in the relapsed/refractory setting. Additionally, he said that it is a “big factor” in his approach to avoid using additional chemotherapy among those with chemotherapy-refractory disease, as repeated use may further diminish patient quality of life.

Transcript:

The most important thing is to make sure that we understand the biology of the disease. First, [it is important to] figure out whether a particular mantle cell lymphoma is a high-risk phenotype, which includes TP53 mutation, sometimes even deletion, complex karyotype, very high, Ki-67, or blastoid or pleomorphic variants. Those are all the reasons to either not use chemotherapy or to have that high-low threshold to switch to novel drugs, even if you are using it initially for debulking for the first 1 or 2 cycles.Eventually, it’s important to move to more novel approaches that typically works best for high-risk diseases.

Then, the other thing is to make sure that people are lining up therapies appropriately. I would say that in this current era, it’s important to, for example, add BCL-2 inhibitors in the relapsed/refractory setting to a BTK inhibitor and be ready with clinical trials as needed. For quality-of-life issues with mantle cell lymphoma, I would go back to the same thing where if somebody has a chemotherapy-refractory phenotype, then using more chemotherapy typically just leads to further reduction in quality of life. It would be a big factor in my approach.