Uncovering practice gaps in the management of mantle cell and diffuse large B-cell lymphomas amidst advances with Bruton's tyrosine kinase inhibitors

Abstract BACKGROUND: Mantle cell lymphoma (MCL) and diffuse large B-cell lymphoma (DLBCL) are two of the most diagnosed subtypes of B-cell non-Hodgkin lymphoma. Each presents unique diagnostic and therapeutic challenges, especially in community-based settings where access to novel agents and specialist expertise may be limited. In response to these needs, a series of four educational activities was developed as part of a six-phase initiative to support clinical decision-making, improve differential diagnosis, and raise awareness of emerging frontline targeted therapies for MCL and DLBCL. METHODS: Between 2023 and 2025, Medlive implemented four educational activities—two focused on MCL and two on DLBCL designed for expanded awareness for early recognition (broad audience) and for refined treatment strategies (specialty audience). To reach a broad audience, one MCL and one DLBCL activity was featured in the Medlive/National Organization for Rare Disorders (NORD) annual Rare Hematology Series. The other two activities were disseminated via nationwide networks to hematology/oncology specialists. For MCL, a 30-minute on-demand activity was made available from December 2023 to December 2024, followed by a 60-minute on-demand activity from June 2024 to June 2025. For DLBCL, a similar 30-minute activity ran from October 2024 to October 2025, with a 60-minute activity available January 2025 through January 2026. Learner outcomes were assessed through pre-/post-test questions to evaluate changes in knowledge and competence. Aggregate data on clinician-reported barriers to care and self-reported intent to change practice were analyzed. RESULTS: There were 2,731 participants across all four activities. In the MCL programs, 84% of participants were clinicians and 12% were nurses or advanced practice practitioners (APPs). For DLBCL, 81% were clinicians and 15% were nurses or APPs. Notably, 84% of all learners were hematologists/oncologists. Educational engagement revealed key barriers to optimal care. For MCL, the most cited obstacles included limited access to targeted therapies (21%) and unfamiliarity with novel treatment options (18%). For DLBCL, top barriers were unfamiliarity with novel therapies and access to targeted agents (33% each). Importantly, the education prompted approximately 40% of learners to report an intent to change their clinical practice. Across all four activities, the most common intended practice modifications include application of up-to-date treatment guidelines (50%) and revise therapeutic selection strategies (24%). When asked about systemic barriers to integrating new therapies, 44% of MCL and 48% of DLBCL treaters cited lack of knowledge of evidence-based approaches as the primary limitation. Secondary to those were disease-specific barriers: DLBCL clinicians frequently reported unfamiliarity with mechanisms of action (29%), while MCL clinicians pointed to limited experience with oral agents and continued reliance on traditional regimens (27% each). Furthermore, only 36% of hematologists/oncologists reported confidence in using BTK inhibitors for newly diagnosed MCL—despite the recent frontline approval of acalabrutinib-based combinations—highlighting a critical gap in knowledge and comfort with modern therapeutic options. Across all CME questions, knowledge improvements were observed, with an average increase of 15% in MCL programs and 26% in DLBCL programs based on paired pre-/post-assessment results. CONCLUSION: This multi-activity educational initiative successfully engaged clinicians who treat MCL and DLBCL, uncovering distinct challenges in clinical practice and highlighting persistent educational gaps. The findings affirm that while enthusiasm for integrating novel therapies exists, practical limitations such as lack of familiarity and barriers to access continue to hinder adoption. Given the evolving treatment landscape, particularly with the introduction of BTK inhibitors and other targeted agents in the frontline setting, continued clinician education is essential. These results emphasize the importance of ongoing, disease-specific, and multidisciplinary learning to improve confidence, address gaps, and ultimately enhance patient outcomes in MCL and DLBCL care. Support was provided by an independent educational grant from AstraZeneca Pharmaceuticals.