I have a new diagnosis of Mantle Cell Lymphoma in a 78 year old, who has extensive disease burden in lymph node, skeleton. He is high risk per MIPI although LDH is normal. I dont know about p53 status [never checked] and or morphology of MCL. We have a clinical trial open, with Rituximab and Zanubrutinib. I worry with disease burden, it will be difficult to give rituximab with standard premeds of Tylenol and Benadryl. Would you agree to it? and how to circumvent this anticipated infusion reaction? Do you expect to know mantle cell is blastoid or not and TP53 status? I was thinking of giving prednisone 50 mg for 2-3 days before giving rituximab and giving rituximab test dose and then even slower drip rate.
I usually do ask pathology to stain for p53, they can easily do it by IHC and it can be helpful in deciding about chemo. However, I agree with you that ritux + zanu sounds better than chemo for this 78-year-old. We also participated in a trial of this regimen previously and had great results. Strategies for minimizing risk of reaction: I agree giving 3 days of prednisone 50mg can help a lot. Capping rate for first dose at ~200ml/hr is reasonable too if you have enough infusion time. I have occasionally had to admit for slow infusion, but I would try it outpatient first. Re: blastoid, I would assume they would have reported that from the morphology if that were the case.
