High-Risk Mantle Cell Lymphoma: Definition, Current Challenges, and Management
Cet article décrit les caractéristiques du lymphome à cellules du manteau à haut risque de récidive, identifie les facteurs associés au pronostic et propose une démarche pour la prise en charge de la maladie
The field of mantle cell lymphoma (MCL) is undergoing a transformation, both in terms of our understanding of its underlying pathobiology and prognostic factors and in terms of newer treatments. These simultaneous biologic and therapeutic developments provide the elements to rationally develop strategies to potentially achieve cure; however, patients with high-risk MCL pose a major challenge to achieving this goal. The treatment approaches in MCL are gradually evolving from total reliance on chemoimmunotherapy to the incorporation of highly effective nonchemotherapeutic targeted therapies (ie, ibrutinib,1 acalabrutinib,2 zanubrutinib,3 and venetoclax4). Recently, the US Food and Drug Administration (FDA) approval of the anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy brexucabtagene autoleucel (KTE-X19) has been a landmark advance in MCL.5 However, patients with disease refractory to newer treatments have no established effective therapies, exhibit poor outcomes (median survival, 3-10 months),6,7 and represent an urgent and an unmet clinical need. This article aims to provide an insight into the clinical management of high-risk MCL in 2020.
Journal of Clinical Oncology , résumé, 2019