Treatment of mantle cell lymphoma in older adults

Mantle cell lymphoma (MCL) predominantly affects older adults, with a median age at diagnosis of 70 years. A frequently aggressive yet incurable lymphoma, the goal of therapy for MCL is to turn a potentially life-threatening illness into a chronic disease with prolonged periods of remission. Large randomized trial data supports the standard treatment in younger patients of cytarabine-based induction followed by autologous stem cell transplant. Most patients will not be eligible for this intensive approach based on older age, comorbidities, and functional status, making the geriatric assessment an essential step in choosing the appropriate strategy. For these older patients, an increasing number of chemotherapy and non-chemotherapy based therapies are available that allow oncologists to better tailor treatment to the fitness of the patient. We will review treatment options for older patients with MCL in the first line and relapsed/refractory settings, highlighting the available evidence for providing longer progression-free intervals while also minimizing the adverse effects of unduly aggressive treatment.