Treatment Options

Understand Your Treatment Journey

Induction therapy is the first and most intensive phase of treatment. The goal is to knock the cancer down as hard and fast as possible — ideally getting you into remission (no detectable cancer). Think of it as the initial attack.

Consolidation comes after remission is achieved. Even when tests show no cancer, some cells may still be lurking. Consolidation therapy is a follow-up round of treatment meant to wipe out those remaining cells and lock in the remission. Think of it as making sure the job is done.

Maintenance therapy is a longer-term, lower-intensity treatment given after consolidation. The cancer is under control, but maintenance keeps it that way — suppressing any regrowth over months or years. Think of it as ongoing patrol duty.

This analogy might be helpful: induction is putting out the fire, consolidation is dousing the embers, and maintenance is the smoke alarm keeping watch afterward.

Common MCL Treatment Options

Allogeneic Stem Cell Transplant (Allo SCT)

A stem cell transplant that uses stem cells from a donor rather than your own cells. The donor may be a sibling, family member, or unrelated volunteer who is a close tissue match.

Unlike an autologous stem cell transplant (Auto SCT), an Allo SCT not only replaces the bone marrow but also provides a new immune system that can help recognize and attack remaining lymphoma cells. This is called the graft-versus-lymphoma effect.

An Allo SCT can offer the possibility of long-term disease control and, in some cases, may be considered potentially curative. However, it also carries significant risks, including infections, organ complications, and graft-versus-host disease (GVHD), a condition in which donor immune cells attack the patient’s tissues.

For these reasons, Allo SCT is generally reserved for select patients, often after relapse or when other treatment options have been exhausted.

Also called: Allo transplant, Allogeneic transplant, Allo SCT.

Autologous Stem Cell Transplant

Historically, many younger fit patients received intensive induction therapy followed by an autologous stem cell transplant to prolong remission.

The role of transplant is evolving rapidly as newer targeted therapies and results from studies such as TRIANGLE become available.

B/R (Bendamustine + Rituximab)

Often called “BR.”

A commonly used frontline treatment combining chemotherapy (bendamustine) and immunotherapy (rituximab). BR is generally considered less intensive than some other MCL treatment approaches and has been widely used in both younger and older patients.

Bispecific Antibodies

A newer type of immunotherapy that helps T-cells recognize and attack lymphoma cells.

These therapies are becoming increasingly important in relapsed MCL and are a major area of ongoing research.

BOVen

A chemotherapy-free treatment approach that combines:

• Obinutuzumab (Gazyva)
• Venetoclax (Venclexta)
• Zanubrutinib (Brukinsa)

BOVen has generated significant interest, particularly for patients with TP53-mutated MCL, because it relies on targeted therapies and immunotherapy rather than traditional chemotherapy.

BTK Inhibitor-Based Therapy

Targeted therapies that block Bruton’s Tyrosine Kinase (BTK), including:

• Acalabrutinib (Calquence)
• Ibrutinib (Imbruvica)
• Pirtobrutinib (Jaypirca)
• Zanubrutinib (Brukinsa)

Ibrutinib, Acalabrutinib, and Zanubrutinib are called covalent Bruton Tyrosine Kinase (BTK) inhibitors. Covalent means that the drug binds permanently to a location on the BTK enzyme and blocks the function of the enzyme. Pirtobrutinib is a non-covalent BTK inhibitor which doesn’t permanently bind and can work when the covalent BTK inhibitors no longer function.

These drugs are widely used in relapsed MCL and are increasingly being incorporated into frontline treatment approaches.

CAR-T Cell Therapy

A cellular therapy in which a patient’s own T-cells are collected, engineered to recognize lymphoma cells, and infused back into the patient.

Tecartus (brexucabtagene autoleucel) was the first CAR-T therapy approved for mantle cell lymphoma and has produced durable remissions in many patients with relapsed disease. Breyanzi (lisocabtagene maraleucel, or liso-cel) has also received FDA approval for relapsed or refractory MCL.

Hyper-CVAD

An intensive chemotherapy regimen that combines multiple chemotherapy drugs with rituximab. Historically used in younger and fitter patients with MCL and often followed by stem cell transplant. It is associated with more side effects than many newer treatment approaches.

Nordic Regimen (Nordic Protocol)

A treatment strategy developed by the Nordic Lymphoma Group.

Typically combines alternating cycles of:

• High-dose cytarabine (Ara-C)
• R-Maxi-CHOP

followed by autologous stem cell transplant in eligible patients. The Nordic approach helped establish the importance of high-dose cytarabine in frontline treatment for younger fit patients with MCL.

R-CHOP

A combination of:

• Cyclophosphamide
• Doxorubicin
• Prednisone
• Rituximab
• Vincristine

Historically one of the most widely used lymphoma treatment regimens. In mantle cell lymphoma it is often used as part of larger treatment strategies rather than by itself.

TRIANGLE

A recent international clinical trial that evaluated adding a BTK inhibitor (ibrutinib) to intensive frontline treatment approaches for younger patients with newly diagnosed MCL.

Induction: Patients receive 6 cycles of chemotherapy, alternating between two regimens (R-CHOP and R-DHAP), combined with ibrutinib taken daily throughout.

Maintenance: After induction, ibrutinib is continued for up to 2 years to keep the cancer in check.

Why no stem cell transplant? Adding a stem cell transplant (ASCT) to this regimen did not improve outcomes but did cause more serious side effects. As a result, the ibrutinib-based approach without transplant is now the preferred standard for many younger, otherwise healthy MCL patients.

The TRIANGLE study has influenced current thinking about whether some patients may be able to avoid stem cell transplant while still achieving excellent outcomes. The trial continues to shape modern treatment discussions among MCL specialists.