Mantle cell lymphoma medical therapy

Mantle cell lymphoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Mantle cell lymphoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Mantle cell lymphoma medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Mantle cell lymphoma medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Mantle cell lymphoma medical therapy
on Mantle cell lymphoma medical therapy
Mantle cell lymphoma medical therapy in the news
Blogs on Mantle cell lymphoma medical therapy
Directions to Hospitals Treating Mantle cell lymphoma
Risk calculators and risk factors for Mantle cell lymphoma medical therapy

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:

• Chemotherapy
• Immune based therapy
• Radioimmunotherapy
• New biologic agents

• 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.

• Frontline treatment

• Drug Regimen: CHOP (IV) (Cyclophosphamide AND Doxorubicin AND Vincristine AND Prednisone) PLUS Rituximab
• Drug Regimen: Fludarabine
• Drug Regimen: Fludarabine ± (Cyclophosphamide AND Mitoxantrone AND Rituximab)

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

• Drug Regimen: Hyper-(CVAD) Course A:Cyclophosphamide AND Vincristine AND Doxorubicin AND Dexamethasone ; Course B : Methotrexate AND Cytarabine

Immunotherapy

• Rituximab is a 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.
• Other variations of 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.