Mantle Cell Lymphoma Treatment

What Options are Given at Different Ages for Mantle Cell Lymphoma

What are the treatment options for mantle cell lymphoma?. Credit: Photo©PngMoji

How is mantle cell lymphoma treated?  How have these options changed in recent years, and what can I expect?

Mantle Cell Lymphoma

Mantle cell lymphoma is a rare form of Non-Hodgkin lymphoma. It is a fast growing tumor that spreads rapidly to different organs of the body. In this article, we will discuss the treatment options and outcomes. This cancer tends to affect men more than women and is most common in older adults.

Treatment Options

Most people with mantle cell lymphoma have advanced-stage disease at the time of diagnosis, with the disease having already spread to different parts of the body. Since the disease has spread, systemic treatments - that is, treatments that reach the whole body - are needed. Chemotherapy is the main form of treatment as the drugs that are injected into the veins can reach all parts of the body through the blood. Treatments like surgery or radiation therapy which can remove a tumor from only one part of the body are not ordinarily useful.

Slow-Growing (Indolent) Mantle Cell Lymphoma

Most mantle cell lymphomas are aggressive and rapidly growing, but sometimes they are instead slow growing - something oncologists refer to as "indolent."  When this is the case, a period of no treatment called "watchful waiting" may be an option.  Most of these cancers, however, need treatment right away.

Rituximab (Monoclonal Antibody Treatment)

Rituxan (rituximab) is used with several different chemotherapy regimens and is often used in older patients as a form of maintenance treatment after initial treatment with chemotherapy.  Rituxan is a monoclonal antibody designed to kill lymphoma cells.  To understand how these medications work it's helpful to think about how our bodies make antibodies fend off bacteria and viruses.

  Rituxan is essentially a "man-made" antibody, which instead of fighting off bacteria and viruses, fights off lymphoma cells.

Combination Chemotherapy

There are many combinations of chemotherapy drugs used in mantle cell lymphoma. The exact type used is based on individual circumstances and your oncologist's preferences.  Most individuals receive a combination of drugs along with Rituximab.  With younger patients a treatment such as HyperCVAD may be used, whereas older patients may be more likely to have a regimen such as R-CHOP recommended, though there are many variations on both of these.  Chemotherapy is administered in the form of injections or drips in the veins over a few hours to few days. Each such session or cycle of chemotherapy is repeated at intervals of one or more weeks. Occasionally chemotherapy may also be given in the form of tablets.

Young Healthy Patients - Chemotherapy Plus Stem Cell Transplant

With young healthy patients, intensive chemotherapy such as HyperCVAD, or numerous others may be followed by autologous stem cell transplant for those individuals who have a matched donor.

In this setting stem cell transplants have a high response rate and long survival rate, but also carry a high initial and long-term risk of toxicity.

Older Patients

With older patients, some of the chemotherapy regimens may be too toxic although we are learning that older patients tolerate these treatments better than we had thought in the past.  Unlike younger patients, stem cell transplants are not usually considered an option.  Other options which are being used - now first line, or right after diagnosis - include a combination of Rituxan and Velcade (bortezomib) or Treanda (bendamustine) or Imbruvica (ibrutinib.)  Or, a clinical trial may be recommended.  These treatments are usually followed by maintenance therapy with Rituxan.

Recurrent Mantle Cell Lymphoma

Mantle cell lymphoma treatment is often unsuccessful. After an initial response to chemotherapy, the disease may come back in many patients. In order to improve the treatment outcomes, more intensive chemotherapy combinations have been tried. Some of these combinations are based on the treatment of leukemias – cancers of blood cells. Some of these combinations have shown better outcomes. But these combinations are also very toxic and not all individuals can tolerate these regimens. Doctors will only advise these combinations if they feel that the patient will be able to bear the side effects.

Other drugs combinations may be used after a mantle cell lymphoma has relapsed, such as Velcade (bortezomib) or Revlimid (lenalidomide) or a clinical trial.  Velcade is a drug in a new class of biological drugs that acts on proteasomes, a special structure in cells. Proteasomes kill some old and harmful proteins in cells . Bortezomib inhibits or acts against these proteasomes in cancer cells and hasten the death of these cells.

Radiation therapy in Mantle Cell Lymphoma

Radiation is not commonly used in mantle cell lymphomas. In the few individuals in whom the disease is diagnosed in an early stage where only a small part of the body is affected, radiation to that area may be added after chemotherapy is completed. In the majority of individuals, however, the disease is more advanced and spread out. Radiation to large areas of the body is a problem. Nevertheless, low dose radiation can sometimes be used over large areas of the body with long-term benefit.

Treatment Outcomes

Mantle cell lymphoma is rarely curable. In most individuals, there is a good initial response to chemotherapy. However, in the majority, the disease again relapses after months or a few years. The main aim of treatment is to prolong this period of remission as much as possible. New treatment modalities and drugs are being tried in clinical trials, and doctors will encourage you to join clinical trials in which new treatments are being tested.

A Final Note About Clinical Trials

Many myths have been propagated about clinical trials, along with comments about people participating in these trials being guinea pigs.  It may be helpful to realize that any new drug or breakthrough in oncology is first tested as a form of clinical trial.  In recent years the treatments for cancer have made significant strides, and unlike some clinical trials of the past, those now in progress may well offer people an opportunity to use an experimental treatment which is better than those available otherwise.


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