Expert Panel Updates Consensus on Mantle Cell Lymphoma Care Using Pan-Asian Data

Access to Bruton tyrosine kinase (BTK) inhibitors and other novel agents still varies widely across Asia, prompting a panel of hematology-oncology experts to update their region-specific treatment recommendations for mantle cell lymphoma (MCL), according to a consensus statement published in Cancer Research and Treatment.¹

Mantle cell lymphoma accounts for only a small share of non-Hodgkin lymphoma cases but has historically carried a worse prognosis than other common B-cell lymphomas, making access to effective novel agents especially consequential for patients across a region with widely varying health systems.

Treatment Access Varies Widely Across a Diverse Region

The Asian Lymphoma Study Group (ALSG) first published consensus recommendations for MCL management in Asia in 2020, built around the then-emerging role of ibrutinib in relapsed or refractory disease. Since that publication, additional covalent and non-covalent BTK inhibitors, CAR T-cell therapies, and other novel agents have reached some, but not all, of the health systems the group represents, and the panel said disease heterogeneity and variable regional access to newer therapies made an update necessary. Covalent BTK inhibitors, which include ibrutinib, acalabrutinib, and zanubrutinib, bind their target irreversibly, while newer noncovalent BTK inhibitors, such as pirtobrutinib, are designed to retain activity after a tumor develops resistance to a covalent BTK inhibitor.²

The updated consensus, reached during a closed-session ALSG meeting in August 2025, draws on international treatment guidelines, the current treatment landscape across the region, and recent global and Asia-specific literature. Its 16 authors are affiliated with institutions across 12 countries and territories, including Singapore, Japan, China, Hong Kong, the Republic of Korea, and several Southeast Asian nations.¹

For indolent or stage I/II disease, the panel recommended active surveillance or involved-site radiotherapy, with or without immunochemotherapy, rather than immediate systemic treatment. For advanced disease in elderly or unfit patients, it recommended less intensive immunochemotherapy, while young and fit patients with advanced disease should receive aggressive cytarabine-based induction followed by consolidation with autologous stem cell transplant.

In the first-line setting, the panel said a covalent BTK inhibitor can be integrated into treatment where accessible, and it strongly encouraged enrolling patients with high-risk features in clinical trials. After first-line treatment, it recommended rituximab maintenance, with or without a covalent BTK inhibitor.

Later-Line Options Expand but Remain Access-Dependent

For relapsed or refractory disease, the panel recommended covalent BTK inhibitors as the most widely used option, with non-covalent BTK inhibitors and CAR T-cell therapies to be considered where they are available. Allogeneic stem cell transplant remained an option the panel reserved for high-risk or transplant-eligible patients with relapsed disease.

The panel noted that CAR T-cell therapy in particular remains concentrated in major academic centers across the region, so eligibility in practice often depends as much on geography as on a patient's disease biology.

“There is no one-size-fits-all approach, and resource-stratified approaches should be considered,” the panel wrote. It added that “clinical trial enrollment is strongly encouraged for patients with high-risk features.”

Because this is a consensus statement rather than a systematic review or original trial, the recommendations reflect the panel's synthesis of existing guidelines and literature rather than new comparative data, and they explicitly scale treatment intensity to what is locally available rather than to a single preferred regimen. The group did not report a formal methodology for resolving disagreement among its 16 authors or state how recommendations would be revisited as new agents reach additional markets.

For clinicians across Asia's varied health systems, the update offers a framework for matching MCL treatment intensity to what is actually accessible locally, rather than defaulting to guidance written around health systems with uniform access to the newest agents. Community oncologists in lower-resource settings may find the panel's stepwise approach more actionable than guidance that assumes uniform access to the newest cellular therapies.

References

1. Chan JY, Lim ST, Ong CK, et al. Treatment of mantle cell lymphoma in Asia: updated consensus from the Asian Lymphoma Study Group. Cancer Res Treat. Published online September 9, 2026. doi:10.4143/crt.2026.0738
2. Yoon DH, Cao J, Chen TY, et al. Treatment of mantle cell lymphoma in Asia: a consensus paper from the Asian Lymphoma Study Group. J Hematol Oncol. 2020;13(1):21. doi:10.1186/s13045-020-00855-9