NOTE
🌱 created from: mantle cell lymphoma
nccn_flowchart_of_mantle_cell_lymphoma
workup of mantle cell lymphoma
Aggressive induction therapy
Preferred regimens (in alphabetical order)
- LyMA regimen: RDHA (rituximab, dexamethasone, cytarabine) + platinum (carboplatin, cisplatin, or oxaliplatin) x 4 cycles followed by RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) for non-PET CR
- NORDIC regimen: Dose-intensified induction immunochemotherapy with rituximab + cyclophosphamide, vincristine, doxorubicin, prednisone (maxi-CHOP) alternating with rituximab + high-dose cytarabine
- Rituximab, bendamustinec followed by rituximab, high-dose cytarabinee
- TRIANGLE regimen: Alternating RCHOP + covalent BTKig/RDHA (rituximab, dexamethasone, cytarabine) + platinum (carboplatin, cisplatin, or oxaliplatin) (category 2A for ibrutinib; category 2B for acalabrutinibj or zanubrutinib)
- HyperCVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with high-dose methotrexate and cytarabine) + rituximabd (NOTE: There are conflicting data regarding the need for consolidation with HDT/ASCR) • RBAC500 (rituximab, bendamustine,c cytarabine)
Less aggressive induction therapy
- Bendamustine + rituximab
- VR-CAP (bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone) • RCHOPf
- Lenalidomide (continuous) + rituximab Other recommended regimen
- Acalabrutinibg,j (continuous) + rituximab
MAINTENANCE AFTER HDT/ASCR OR AGGRESSIVE INDUCTION THERAPY
- Covalent BTKig x 2 yearsh (category 2A for ibrutinib; category 2B for acalabrutinib or zanubrutinib) + rituximab every 8 weeks x 3 years
MAINTENANCE AFTER LESS AGGRESSIVE INDUCTION THERAPY
Rituximab every 8 weeks for 2–3 years following RCHOP (category 1) or Bendamustine + rituximab Maintenance rituximab following VR-CAP or RBAC500 has not been evaluated