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Clinical Decision-Making in Relapsed/Refractory Mantle Cell Lymphoma: Test Your Skills

  • Authors: Nirav N. Shah, MD
  • CME / ABIM MOC Released: 6/27/2023
  • Valid for credit through: 6/27/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for hematologists/oncologists, pathologists, and other healthcare professionals on the oncology care team who manage patients with MCL.

The goal of this activity is for learners to be better able to improve their skills and confidence in managing patients with R/R MCL to optimize clinical outcomes.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Data informing treatment decisions for patients with R/R MCL
  • Have greater competence related to
    • Individualizing treatment for patients with R/R MCL
    • Managing treatment-related adverse event in patients with R/R MCL
  • Demonstrate greater confidence in their ability to
    • Select appropriate treatment strategy for patients with R/R MCL


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All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

Disclosures for additional planners can be found here.


  • Nirav N. Shah, MD

    Associate Professor
    Medical College of Wisconsin
    Brookfield, Wisconsin


    Nirav N. Shah, MD, has the following relevant financial relationships:
    Consultant or advisor for: Bristol Myers Squibb Company; Epizyme Inc.; Incyte Corporation; Kite Pharma, Inc.; Lilly Oncology; Miltenyi Biotec; Novartis; TG Therapeutics, Inc.
    Research funding from: Lilly Oncology; Miltenyi Biotec
    Owns stock (privately owned) in: Tundra Therapeutics


  • Sanneke Koekkoek

    Senior Director, Content Development, WebMD Global, LLC


    Sanneke Koekkoek has no relevant financial relationships.

  • Tristin Abair, PhD

    Senior Medical Writer, WebMD Global, LLC


    Tristin Abair, PhD, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements

Developed through a collaboration between The Leukemia & Lymphoma Society and Medscape Oncology.


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    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

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  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

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Clinical Decision-Making in Relapsed/Refractory Mantle Cell Lymphoma: Test Your Skills

Authors: Nirav N. Shah, MDFaculty and Disclosures

CME / ABIM MOC Released: 6/27/2023

Valid for credit through: 6/27/2024, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Kaye is a 72-year-old retired real estate agent who has been married for 40 years and has 3 adult children. She has a history of atrial fibrillation and chronic obstructive pulmonary disease (COPD). She initially presented to the emergency department 1 year ago with difficulty speaking, and her family was concerned that she was having a stroke. Evaluation and imaging ruled out a stroke but showed significant lymphadenopathy and swelling of her tonsils and sinus area. Her white blood cell (WBC) count was low, and lactate dehydrogenase (LDH) was elevated. Ultrasound-guided biopsy and a full hematologic workup led to a diagnosis of mantle cell lymphoma (MCL) -- TP53 wild type, non-blastoid histology.

Kaye began first-line bendamustine plus rituximab (BR) and completed 6 cycles in total, with the course complicated by hospitalization during cycle 1 due to a pulmonary embolism and worsening of her atrial fibrillation. A positron emission tomography (PET) scan following completion of BR showed residual disease in her tonsils, so she underwent tonsillectomy, which demonstrated small focus of MCL. A postprocedure PET was negative following surgery. She was placed on close observation with no signs of progressive disease. Twelve months after her tonsillectomy, her PET scan now shows increasing lymphadenopathy suggestive of relapse and biopsy confirms recurrent MCL. Her most recent workup is summarized in Table 1.

Table 1. Kaye’s Workup



Demographics/patient information

  • 72 years old, female
  • Height: 5 ft 4 in; weight: 160 lb
  • BMI: 27.5 kg/m2

Personal and family medical history

  • History of atrial fibrillation and COPD
  • No major surgeries
  • Current medications include amiodarone and inhaled corticosteroids
  • No family history of cancer

Physical examination

  • Increasing cervical lymphadenopathy
  • Moderate palpable splenomegaly
  • BP: 130/85 mm Hg; HR: 85 bpm
  • ECOG PS: 1


  • WBC count: 8.3 × 109/L
  • RBC count: 4.8 × 109/L
  • Hemoglobin: 14.2 g/dL
  • Hematocrit: 39%
  • Platelet count: 245 × 109/L
  • Lymphocytes: 28%
  • Neutrophils: 55%
  • Serum LDH: 215 U/L


  • Diffuse 18F-FDG update in lymph nodes in the neck and spleen

Biopsy analysis

  • Immunophenotype: CD5+, CD10+, CD20+, CD23+, CD43+, cyclin D1+
  • Ki-67 index: 55%
  • No TP53 mutations
BMI, body mass index; BP, blood pressure; CT, computed tomography; ECOG PS, Eastern Cooperative Oncology Group performance status; 18F-FDG, ¹⁸F-fluorodeoxyglucose; HR, heart rate; RBC, red blood cell.

You sit down with Kaye and her husband and discuss her treatment options now that her disease has progressed.

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