First-Line Therapy, Autologous Stem Cell Transplantation, and Post-Transplant Maintenance in the Management of Patients Newly Diagnosed with Mantle Cell Lymphoma

Guideline Objective:

To provide guidance based on the available evidence with respect to the best practices for the first-line therapy, conditioning regimen, timing of autologous stem cell transplantation (ASCT), and maintenance therapy for patients with mantle cell lymphoma (MCL).

Patient Population:

Patients with newly diagnosed MCL who are eligible for ASCT.

Intended Guideline Users:

This recommendation report is targeted for physicians and medical teams who see, evaluate, and treat patients with MCL (transplant and non-transplant teams). This guidance may also inform funding decision for Ontario Health (CCO) (e.g., supporting best regimens in quality-best procedures [QBP] or through other mechanisms).

Research Questions:

1. For patients with newly diagnosed MCL who are eligible for ASCT, what is the preferred induction regimen (dose/schedule/frequency)?
2. For patients with MCL who achieved partial or better response to induction therapy, does the addition of ASCT lead to longer and better PFS/OS in comparison to those who do not receive ASCT? If so,
   1. What is the preferred conditioning regimen for those undergoing ASCT?
   2. What is the most appropriate timing for mobilization prior to ASCT (ideal number of induction chemotherapy cycles prior to stem cell collection and stem cell transplantation)?
3. For patients with MCL in remission after ASCT, does the addition of rituximab/IFN- alpha maintenance therapy lead to longer and better PFS/OS in comparison to those who do not receive maintenance therapy? If so, what is the preferred maintenance therapy in this population?