Mantle cell lymphoma medical therapy: Difference between revisions

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:* Drug Regimen: Hyper-(CVAD) Course A:[[Cyclophosphamide]] {{and}} [[Vincristine]] {{and}} [[Doxorubicin]] {{and}} [[Dexamethasone]] ; Course B : [[Methotrexate]] {{and}} [[Cytarabine]]     
:* Drug Regimen: Hyper-(CVAD) Course A:[[Cyclophosphamide]] {{and}} [[Vincristine]] {{and}} [[Doxorubicin]] {{and}} [[Dexamethasone]] ; Course B : [[Methotrexate]] {{and}} [[Cytarabine]]     
===Immunotherapy===
===Immunotherapy===
[[Immunotherapy|Immune-based therapy]] is dominated now by the use of the effective [[rituximab]] monoclonal antibody. It can have good activity against mantle cell lymphoma alone but especially in combination with chemotherapies to prolong response duration. Rituximab essentially tags the cancer cells for destruction by the body. There are newer variations on monoclonal antibodies combined with radioactive molecules known as [[Radioimmunotherapy]] (RIT). These include Zevalin and [[Bexxar]].
*[[Rituximab]] is monoclonal antibody that is effective against mantle cell lymhpma. It may be used in combination with other chemotherapeutic regimens to prolong response duration. Rituximab tags the cancer cells for destruction by the body.
*Oariations on monoclonal antibodies combined with radioactive molecules include [[Radioimmunotherapy]] (RIT), such as Zevalin and [[Bexxar]].
 
===Targeted Therapy===
===Targeted Therapy===
Targeted agents include the proteasome inhibitor [[Velcade]] and mTor (mammalian target of rapamycin) inhibitors such as [[Torisel|temsirolimus]].
Targeted agents include the proteasome inhibitor [[Velcade]] and mTor (mammalian target of rapamycin) inhibitors such as [[Torisel|temsirolimus]].

Revision as of 16:30, 4 September 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Overview

The predominant therapy for mantle cell lymphoma is chemotherapy. Adjunctive immune based therapy, radioimmunotherapy, and new biologic agents may be required.

Medical Therapy

There are no proven standards of treatment for mantle cell lymphoma, and not even consensus among specialists on how to treat it optimally. Many regimens are available and often get good response rates, but patients almost always get disease progression after chemotherapy. Each relapse is typically more difficult to treat, and relapse is generally faster. Fortunately, regimens are available that will treat relapse, and new approaches are under test. Because of the aforementioned factors, many MCL patients enroll in clinical trials to get the latest treatments.

  • There are four classes of treatments currently in general use:
  • The phases of treatment are generally:
  • Frontline
  • Following diagnosis
  • Consolidation
  • After frontline response (to prolong remissions)
  • Relapse (Relapse is usually experienced multiple times.)

Chemotherapy

Chemotherapy is widely used as frontline treatment, and often is not repeated in relapse due to side effects. Alternate chemotherapy is sometimes used at first relapse.[1]

  • Frontline treatment
  • Elderly (over 65) patients, baseline beta-2 microglobulin blood test was normal

Immunotherapy

  • Rituximab is monoclonal antibody that is effective against mantle cell lymhpma. It may be used in combination with other chemotherapeutic regimens to prolong response duration. Rituximab tags the cancer cells for destruction by the body.
  • Oariations on monoclonal antibodies combined with radioactive molecules include Radioimmunotherapy (RIT), such as Zevalin and Bexxar.

Targeted Therapy

Targeted agents include the proteasome inhibitor Velcade and mTor (mammalian target of rapamycin) inhibitors such as temsirolimus.

References

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