Mantle Cell Lymphoma

Regimen Options

Last Updated: 02/07/2025 See Details

NOTE: FOR RITUXIMAB, THE USE OF A BIOSIMILAR OR THE REFERENCE PRODUCT IS ON PATHWAY

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Initial Therapy	R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone)	Intermediate	High	NCCN Guidelines® for B-Cell Lymphomas V.2.2017. Kluin-Nelemans HC, et al. N Engl J Med. 2012;367(6):520-31. Lenz G, et al. J Clin Oncol. 2005;23(9):1984-92.
	R-DHAP (rituximab, dexamethasone, cytarabine and carboplatin or cisplatin)	High	High	NCCN Guidelines® for B-Cell Lymphomas V.2.2023. Delarue R et al. Blood . 2013 Jan 3;121(1):48-53. Tessoulin B et al. Ann Hematol . 2017 Jun;96(6):943-950.
	LyMA regimen (RDHA: rituximab, dexamethasone, cytarabine) + platinum (carboplatin, cisplatin, or oxaliplatin) x 4 cycles followed by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)	High	High	NCCN Guidelines® for B-Cell Lymphomas V.5.2023. Tessoulin B et al. Bone Marrow Transplantation volume 56, pages1700–1709 (2021)
	bendamustine and rituximab	Intermediate	Moderate	NCCN Guidelines® for B-Cell Lymphomas V.2.2017. Robinson KS, et al. J Clin Oncol. 2008;26(27):4473-9. Flinn IW, et al. Blood. 2014;123(19):2944-52.
	modified HyperCVAD and rituximab	High	Moderate	NCCN Guidelines® for B-Cell Lymphomas V.2.2017. Romaquera JE, et al. J Clin Oncol. 2005;23(28):7013-23. Romaquera JE, et al. Leuk Lymphoma. 2000;39(1-2):77-85.
Consolidation/Maintenance	rituximab every 8 weeks for 2–3 years following R-CHOP or bendamustine + rituximab (BR)	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.2.2017. Damon LE, et al. J Clin Oncol. 2009;27(36):6101-8.
Subsequent Therapy	bendamustine and rituximab	Intermediate	Moderate	NCCN Guidelines® for B-Cell Lymphomas V.2.2017. Robinson KS, et al. J Clin Oncol. 2008;26(27):4473-9. Flinn IW, et al. Blood. 2014;123(19):2944-52.
	R-DHAP (rituximab, dexamethasone, cytarabine and carboplatin or cisplatin)	High	High	NCCN Guidelines® for B-Cell Lymphomas V.1.2025. Hermine O, et al. Lancet. 2016;388(10044):565-75. Delarue R, et al. Blood. 2013;121(1):48-53. Le Gouill S, et al. N Engl J Med. 2017;377(13):1250-1260.
	acalabrutinib	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.1.2025. Wang, M et al. Leukemia 2019 Nov;33(11):2762-2766. Gouill SL et al. Haematologica. 2023 Jul 20;109(1):343–350.
	zanubrutinib	Low	Low	NCCN Guidelines® for B-Cell Lymphomas V.1.2025. Song Y et al. Blood (2022) 139 (21): 3148–3158. Song Y et al. Clin Cancer Res (2020) 26 (16): 4216–4224.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care.

Initial Therapy

Evolent Pathways

R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

R-DHAP (rituximab, dexamethasone, cytarabine and carboplatin or cisplatin)

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

LyMA regimen (RDHA: rituximab, dexamethasone, cytarabine) + platinum (carboplatin, cisplatin, or oxaliplatin) x 4 cycles followed by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

bendamustine and rituximab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

modified HyperCVAD and rituximab

Febrile Neutropenic Risk

high

Emetogenic Risk

moderate

References

Consolidation/Maintenance

Evolent Pathways

rituximab *every 8 weeks for 2–3 years following R-CHOP or bendamustine + rituximab (BR)*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Subsequent Therapy

Evolent Pathways

bendamustine and rituximab

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

R-DHAP (rituximab, dexamethasone, cytarabine and carboplatin or cisplatin)

Febrile Neutropenic Risk

high

Emetogenic Risk

high

References

Evolent Pathways

acalabrutinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

zanubrutinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

	Regimen	Alternative	References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Subsequent therapy	venetoclax with or without rituximab	Alternatives: bendamustine + rituximab (BR)

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Subsequent therapy

Regimen

** venetoclax with or without rituximab **

Pathways and Low-Value Regimens

Mantle Cell Lymphoma