SOHO State of the Art Updates and Next Questions | Accessing BTK Inhibitors and Other Novel Therapies for Mantle Cell Lymphoma: Are We All Invited to the Party?

Mantle cell lymphoma (MCL) has undergone a profound therapeutic transformation over the past 2 decades. Historically characterized by frequent relapse and limited survival, MCL outcomes have improved with the incorporation of high-dose cytarabine-containing induction, maintenance rituximab, autologous stem cell transplantation (ASCT), and, more recently, targeted therapies. Contemporary trials have challenged long-standing paradigms: BTK inhibitor-based strategies in both transplant-eligible and transplant-ineligible patients have demonstrated unprecedented progression-free survival, while recent randomized data question the universal need for consolidative ASCT in the era of optimized induction and maintenance. In relapsed/refractory disease, covalent and non-covalent BTKi, followed by CAR T-cell therapies, have redefined expectations, offering meaningful durability even in high-risk populations. Yet, these advances have not translated uniformly across healthcare systems. Real-world evidence from Latin America and other low- and middle-income regions demonstrates substantial variability in access to rituximab, transplantation, BTKi, and cellular therapies, with corresponding survival disparities. As frontline therapy increasingly incorporates continuous oral agents and resource-intensive cellular platforms, access and reimbursement may become dominant determinants of outcome, rivaling disease biology itself. This update reviews the evolution of frontline and relapsed MCL management, critically examines the contemporary role of ASCT and BTKi sequencing, and highlights emerging cellular and antibody-based therapies. We further address the central equity question: how can health systems prioritize high-impact interventions to maximize population-level benefit? Ensuring consistent access to rituximab-based chemoimmunotherapy, expanding availability of at least one BTKi, and developing structured referral networks for advanced therapies represent pragmatic, high-yield strategies. In MCL, innovation must now be paired with implementation to achieve global progress.