Mantle cell lymphoma is a relatively rare B-cell lymphoma with a specific 
genetic lesion and a typical immunophenotypic profile. The median age is 65 
years. There is no curative treatment, except allogeneic stem cell 
transplantation for a selected group of patients. For the majority of patients, 
especially the elderly, the aim of therapy should therefore be a long 
progression-free survival. Age and comorbidity may hamper the use of the most 
active treatment regimen, such as high dose cytarabine and autologous stem cell 
transplantation. Therefore, it is a challenge to select the most appropriate 
therapy for an elderly patient. Studies specifically designed for elderly 
patients are rare. A recently performed large randomized study for elderly 
patients, however, has shown that R-CHOP (rituximab with cyclophosphamide, 
doxorubicin, vincristine, and prednisone) chemotherapy followed by maintenance 
rituximab can result in a long progression-free survival. For patients too frail 
for R-CHOP chemotherapy, a treatment should be offered that benefits the patient 
in reducing the symptoms of the disease without causing too many side effects. 
Progression or relapse will occur in all patients sooner or later. Second-line 
treatment should again be carefully selected. Several options are mentioned. New 
drugs are being developed, and new combinations are investigated. Further 
improvement in the outcome of patients with mantle cell lymphoma is expected. 
Participation in well-designed clinical trials, also by elderly patients, is 
important to find the real benefit that can be achieved, and to get information 
on the tolerability of these treatments in this age group.