Mantle cell lymphoma (MCL) may be 1 of the few cancers for which multiple chemotherapy and nonchemotherapy regimens are considered as standard. Despite the significant activity of chemotherapy in the first-line setting and beyond, its limitations are reflected in the relatively poor ultimate outcomes of patients with MCL treated in the real world. Patients with highly proliferative MCL and those with TP53 mutations tend to respond poorly despite intensive cytotoxic therapies. Patients with comorbidities and those who are geographically isolated may not have access to the regimens that may appear most promising in clinical trials. Thoughtfully directed, nonchemotherapy agents might overcome some of the factors associated with a poor prognosis, such at TP53 mutation, and might resolve some of the challenges related to the toxicity and deliverability of standard chemotherapy regimens. Several clinical trials have already demonstrated that combinations of nonchemotherapy plus chemotherapy drugs can impact outcomes, whereas data with nonchemotherapy agents alone or in combination have suggested that some patients might be well suited to treatment without chemotherapy at all. However, challenges including chronic or unexpected toxicities, the rational vs practical development of combinations, and the financial acceptability of new strategies abound. The nonchemotherapy era is here: how it unfolds will depend on how we meet these challenges.

中文翻译：

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套细胞淋巴瘤无化疗策略的潜力

套细胞淋巴瘤 (MCL) 可能是少数几种将多种化疗和非化疗方案视为标准的癌症之一。尽管化疗在一线及以后的环境中具有显着的活性，但其局限性反映在现实世界中 MCL 患者相对较差的最终结果中。尽管进行了密集的细胞毒治疗，但具有高度增殖性 MCL 和 TP53 突变的患者往往反应不佳。患有合并症的患者和地理上孤立的患者可能无法获得在临床试验中最有希望的治疗方案。精心指导的非化疗药物可能会克服一些与不良预后相关的因素，例如 TP53 突变、并且可能解决与标准化疗方案的毒性和可递送性相关的一些挑战。几项临床试验已经证明，非化疗加化疗药物的组合会影响结果，而单独或联合使用非化疗药物的数据表明，一些患者可能很适合完全不进行化疗的治疗。然而，包括慢性或意外毒性、组合的合理与实际发展以及新策略的财务可接受性等挑战比比皆是。非化疗时代已经到来：它如何展开将取决于我们如何应对这些挑战。而单独或联合使用非化疗药物的数据表明，一些患者可能非常适合完全不进行化疗的治疗。然而，包括慢性或意外毒性、组合的合理与实际发展以及新策略的财务可接受性等挑战比比皆是。非化疗时代已经到来：它如何展开将取决于我们如何应对这些挑战。而单独或联合使用非化疗药物的数据表明，一些患者可能非常适合完全不进行化疗的治疗。然而，包括慢性或意外毒性、组合的合理与实际发展以及新策略的财务可接受性等挑战比比皆是。非化疗时代已经到来：它如何展开将取决于我们如何应对这些挑战。