Background: In Ontario, no clearly defined standard of care for the management of mantle cell lymphoma (
mcl) has been developed, and substantial variability from centre to centre is evident. This guidance document was prompted by the need to harmonize practice in
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Background: In Ontario, no clearly defined standard of care for the management of mantle cell lymphoma (
mcl) has been developed, and substantial variability from centre to centre is evident. This guidance document was prompted by the need to harmonize practice in Ontario with respect to first-line, conditioning, and post-transplantation maintenance therapy for patients newly diagnosed with transplantation-eligible
mcl.
Methods: The
medline and
embase databases were systematically searched from January 2013 to January 2020 for evidence, and the best available evidence was used to draft recommendations relevant to first-line therapy, autologous stem-cell transplantation, and post-transplantation maintenance in the management of transplantation-eligible newly diagnosed
mcl. Final approval of this guidance document was obtained from the Stem Cell Transplant Advisory Committee.
Recommendations: These recommendations apply to all cases of transplantation-eligible newly diagnosed
mcl: (1) Alternating cycles of
r-chop (rituximab plus cyclophosphamide–doxorubicin–vincristine–prednisolone) and
r-dhap [rituximab plus dexamethasone–high-dose cytarabine–cisplatin] is the recommended first-line treatment for symptomatic patients newly diagnosed with
mcl before autologous stem-cell transplantation (
asct). (2) Rituximab plus hyperfractionated cyclophosphamide–vincristine–doxorubicin–dexamethasone (
r–hyper
cvad), alternating with methotrexate and cytarabine, is not recommended for the treatment of patients with newly diagnosed
mcl. (3)
beam (carmustine–etoposide–cytarabine–melphalan),
beac (carmustine–etoposide–cytarabine–cyclophosphamide), and total-body irradiation–based regimens are reasonable conditioning options for patients with
mcl who have responded to first-line therapy and who are undergoing
asct. (4) Maintenance therapy with rituximab is recommended for patients with newly diagnosed
mcl who have undergone
asct.
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