Because science so recently became familiar with mantle cell lymphoma, it does not currently have a varied set of mantle cell lymphoma treatment options for patients. Mantle cell lymphoma is a B-cell subtype of non-Hodgkin's lymphoma that has only in the last twenty years been identified as a lymphoma subtype. It is a rare cancer in the US, affecting between 3,500 and 4,000 people annually (for every one woman diagnosed with mantle cell lymphoma, there are about 4 men) more of them over age 60 than under age 60.
The clinical features of mantle cell lymphoma include:
- Diagnosis in later stages
- B symptoms in three of every ten patients
- Extranodal involvement
- Involvement of the gastrointestinal (GI) tract
- Two elevated CBC levels (LDH elevated by 25%, and B2M, by 60%)
- A rather poor prognosis
The prognosis of mantle cell lymphoma is indeed poor—it has the poorest overall survival of any non-Hodgkin's lmyphoma, according to Dr. Brad S. Kahl of the University of Wisconon.
Mantle Cell Lymphoma Treatment
While there is no outright consensus on what is the best, or most effective mantle cell lymphoma treatment option for first-line mantle cell lymphoma therapy. However, the following have been cited as having some efficacy against this cancer.
- 6 to 8 cycles of R-CHOP combination chemotherapy (more appropriate for older patients, who can handle the toxicity of the regimen)
- 6 to 8 cycles of R-MTX/Arc combination chemotherapy (more appropriate for younger patients because it is a very toxic and aggressive mantle cell lymphoma treatment
- Either R-CHOP or R-MTX/AraC as salvage chemotherapy prior to an autologous stem cell transplant
- Bendamustine + rituximab as a less aggressive induction mantle cell lymphoma treatment
- Cladribine + rituximab
- Hyper-CVAD combination chemotherapy or a modified Hyper-CVAD regimen followed by maintenance with rituximab
In the US, only one drug has been given FDA approval as a mantle cell lymphoma treatment, and that drug is called bortezomib (Velcade). It is approved for mantle cell lymphoma treatment in patients who have undergone a prior treatment and that treatment has failed. Velcade is sometimes used alone, and other times used in conjunction with another anti-cancer agent. In short, Velcade is considered second-line therapy. Other second-line therapies include (but are not limited to) the following:
- Bendamustine as an individual agent
- FC+R (Fludarabine, cyclophosphamide and rituximab)
- FMR chemotherapy regimen (fludarabine, mitoxantrone, and ritiximab)
- Thalidomide + rituximab
It is not uncommon for radiotherapy to be included with chemotherapy in mantle cell lymphoma treatment.
Sources
National Cancer Institute, Information on Bortezomib (Velcade)
National Comprehensive Cancer Network, "Non-Hodgkin's Lymphomas" V.I.2010
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