Table of contents
Mantle cell lymphoma
What's new
Updated 2023 BSH guidelines for the diagnosis and management of mantle cell lymphoma.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of mantle cell lymphoma are prepared by our editorial team based on guidelines from the British Society for Haematology (BSH 2024,2018), the American Society for Clinical Pathology (ASCP/CAP 2021), the European Society for Blood and Marrow Transplantation (EBMT/CIBMTR/ASTCT 2021), the American Society of Blood and Marrow Transplantation (ASBMT/EBMT/CIBMTR 2019), and the ...
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Classification and risk stratification
Diagnostic investigations
Initial evaluation: as per BSH 2024 guidelines, obtain clinical assessment, blood tests including a CBC, blood film, routine biochemistry (including uric acid and LDH), and screening for HBV, HCV, and HIV infections.
B
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Imaging for staging
Diagnostic procedures
Biopsy: as per BSH 2024 guidelines, perform bone marrow biopsy with or without aspiration if required for formal staging or to evaluate cytopenias before treatment, as PET/CT has low sensitivity to detect bone marrow involvement.
B
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FNA
Ancillary testing
Lumbar puncture
Medical management
General principles: as per BSH 2018 guidelines, take into account the following when deciding on the treatment of patients with MCL:
clinical presentation (with recognition of the indolent form)
proliferation index
clinical risk scores (such as the sMIPI and MIPI-C)
performance status.
B
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Induction therapy
Maintenance therapy
Therapeutic procedures
Stem cell transplantation: as per BSH 2024 guidelines, consider offering allo-SCT in fit patients with an appropriate donor following immunochemotherapy, covalent Bruton TKI, and CAR T-cell therapy failure.
C
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CAR T-cell therapy
Specific circumstances
Elderly patients, geriatric assessment: as per BSH 2024 guidelines, consider obtaining a formal frailty assessment in potentially frail patients.
C
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Elderly patients (diagnostic evaluation)
Elderly patients (chemoimmunotherapy)
Elderly patients (stem cell transplantation)
Elderly patients (assessment of QoL)
Patients with indolent MCL
Patients with CNS MCL
Patient education
Follow-up and surveillance
Assessment of treatment response
As per BSH 2018 guidelines:
Obtain conventional CT for the assessment of treatment response.
B
Do not obtain 18F-FDG-PET or evaluation of minimal residual disease status for the assessment of treatment response outside a clinical trial.
D
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Management of relapse (systemic therapy)
Management of relapse (CAR T-cell therapy)
Management of relapse (allo-SCT)