Before and after 3 months of acalabrutinib. A 54-year-old man was diagnosed with stage IVB MCL in 2014. He received chemoimmunotherapy including cytosine arabinoside and an adjuvant autologous SCT. (A) In 2018, he relapsed with left leg swelling due to bulky pelvic disease and a new deep vein thrombosis. (B) After biopsy proof of relapsed MCL, he received acalabrutinib 100 mg twice daily, rituximab, and apixaban; within 3 months, he achieved a marked response with no side effects of the combination. He has returned to full-time work and continues on therapy as of January 2019.