B-Cell Lymphomas, Version 4.2026, NCCN Clinical Practice Guidelines In Oncology
In brief
Pirtobrutinib and CAR-T effective after covalent BTK inhibitor failure in mantle cell lymphoma
NCCN guidelines now list the noncovalent BTK inhibitor pirtobrutinib and CAR-T products (brexucabtagene autoleucel or lisocabtagene maraleucel) as recommended options for patients whose mantle cell lymphoma progresses despite covalent BTK inhibitor therapy. These agents expand salvage choices, especially for high-risk disease such as TP53-mutated cases, but long-term outcomes and optimal sequencing remain to be defined.
- Journal
- Journal of the National Comprehensive Cancer Network : JNCCN (Q1)
- Published
- 1 September 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Andrew D Zelenetz, Leo I Gordon, Jeremy S Abramson, Ranjana H Advani, Alaa Altahan, Babis Andreadis, et al.
- PMID
- 42753811
- DOI
- 10.6004/jnccn.2026.0042
Why clinicians should know about it
- Picked for Hematology (top studies of the week, 20 September 2026): Provides NCCN guideline recommendations for B‑cell lymphoma management
Abstract
Mantle cell lymphoma (MCL) is a heterogenous subtype of B-cell non-Hodgkin lymphoma (NHL). The treatment landscape of newly diagnosed MCL has evolved in recent years with the incorporation of covalent BTK inhibitors, sensitive assays for the assessment of measurable residual disease (MRD), and predefined maintenance or continuous therapy. Covalent BTK inhibitor-based regimens are also appropriate options for patients with previously untreated classic MCL with TP53 mutations. Pirtobrutinib (a highly selective noncovalent BTK inhibitor) and CAR T-cell therapy (brexucabtagene autoleucel or lisocabtagene maraleucel) have emerged as effective treatment options for refractory or progressive disease after prior treatment with covalent BTK inhibitors. This selection from NCCN Guidelines for B-Cell Lymphomas focuses on the recommendations for the diagnosis and treatment of MCL.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.