What is Involved in the Treatment of Mantle Cell Lymphoma?

Mantle cell lymphoma (MCL) is a very rare and difficult to treat subtype of B-cell non-Hodgkin's lymphoma. In the United States about 4,000 diagnoses of MCL are made annually and they represent somewhere around five percent of all NHLs diagnosed.

The prognosis for mantle cell lymphoma patients at the moment is not terribly good, in large part because the disease has only recently been recognized as a distinct subtype, and solid data on effective treatments has yet to make its way to medical journals.

Furthermore, it is exceedingly uncommon for MCL to be found by doctors in the early stages. It is almost always found when in advanced stage, and this doesn't tend to bode well for any cancer, and mantle cell lymphoma is no different.

Nonetheless, there are treatment options available for mantle cell lymphoma of varying degrees of efficacy and they are highly dependent on factors such as overall health of the patient and the age of the patient, to name a few.

Aggressive Treatment

A patient with advanced mantle cell lymphoma (in either stage III or stage IV) will generally be treated with one of several induction therapies for aggressive disease, including but not limited to those listed below, according to the National Comprehensive Cancer Network:

  • -- HyperCVAD combination chemotherapy (cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high-dose methotrexate and cytarabine) plus rituximab
  • -- NORDIC combination chemotherapy (dose intensified immunotherapy: rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone, alternating with rituximab and high-dose cytarabine)
  • CALGB combination chemotherapy (Rituximab and methotrexate with augmented CHOP)

Less Aggressive Treatment

If a patient presents with MCL that doctors think can be treated with less aggressive therapies, or they are worried about the ability of the patient to withstand the therapies, they may go with something less aggressive, such as one of the regimens listed below.

  • Bendamustine and rituximab
  • R-CHOP combination chemotherapy
  • CVP combination chemotherapy (cyclophosphamide, vincristine, prednisone)
  • DA-EPOCH combination chemotherapy

Second Line Treatment

If first-line therapy has failed, doctors turn to second-line therapies. These are based on the needs and the health and wellness of the individual.

  • Bendamustine and rituximab
  • Bortezomib and rituximab
  • Cladribine and rituximab
  • Fludarabine, cyclophosphamide and rituximab
  • Fludarabine, cyclophosphamide, mitoxantrone and rituximab
  • Lenalidomide and rituximab

Oftentimes, doctors may recommend that mantle cell lymphoma patients undergo an autologuous stem cell transplantation, which involves high-dose chemotherapy, radiation, and of course a stem cell transplant. In especially difficult cases, they may simply recommend that the patient try a clinical trial.

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