Blastoid or pleomorphic histologic variant of mantle cell lymphoma — ~10-15% of MCL at di...
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
| ID | RF-MCL-BLASTOID-VARIANT |
|---|---|
| Type | Red flag |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | DIS-MCL |
| Sources | SRC-ESMO-MCL-2024 SRC-NCCN-BCELL-2025 SRC-ZUMA-2-WANG-2020 |
Red Flag Origin
| Definition | Blastoid or pleomorphic histologic variant of mantle cell lymphoma — ~10-15% of MCL at diagnosis, biology aggressive (Ki-67 typically >50%, often co-mutated TP53/CDKN2A), poor response to chemoimmunotherapy (BR, R-CHOP, R-DHAP) with median OS <2 years on cBTKi. ZUMA-2 (Wang NEJM 2020) established brexucabtagene autoleucel (KTE-X19) for R/R MCL post-cBTKi (ORR 91%, CR 68%, mPFS not reached at 24 mo). Routes blastoid/pleomorphic MCL to CAR-T prioritization at 2L (post-cBTKi or post-chemoimmuno failure) over alloHCT or further chemoimmuno. |
|---|---|
| Clinical direction | intensify |
| Category | high-risk-biology |
| Shifts algorithm | ALGO-MCL-2L |
Trigger Logic
{
"any_of": [
{
"finding": "mcl_histology_variant",
"value": "blastoid"
},
{
"finding": "mcl_histology_variant",
"value": "pleomorphic"
},
{
"finding": "blastoid_morphology",
"value": true
},
{
"finding": "pleomorphic_morphology",
"value": true
}
],
"type": "biomarker"
}
Notes
Distinguish from RF-MCL-BLASTOID-OR-TP53 — that flag is broader (any high-risk biology including TP53/del(17p)/Ki-67>30%) and routes 1L to BTKi-based; this flag is narrower (histology-defined blastoid/pleomorphic morphology) and routes 2L specifically to brexu-cel CAR-T. Both fire in parallel for blastoid + TP53-mut cases. Brexu-cel manufacture takes ~3 weeks — bridge with cBTKi (acalabrutinib) or pirtobrutinib if cBTKi-pretreated. Eligibility check via RF-CAR-T-ELIGIBLE composite. Lisocabtagene maraleucel (TRANSCEND-NHL-001 MCL cohort) is a second CAR-T option with similar efficacy and lower CRS/ICANS rates. Access UA: CAR-T not domestically available; international referral pathway only.
Used By
Algorithms
ALGO-MCL-2L- ALGO-MCL-2L
Indications
IND-MCL-3L-LISOCEL- IND-MCL-3L-LISOCEL