Mantle cell lymphoma medical therapy
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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 mainstay of treatment for mantle cell lymphoma is chemotherapy. However, immunotherapy, radioimmunotherapy, targeted therapy using newer biological agents and stem cell transplantation are also used along with chemotherapy to treat the disease. Mantle cell lymphoma shows a heterogeneous clinical behavior, with some patients having indolent disease whereas a vast majority show aggressive presentation. Most of the patients eventually relapse and have disease progression after treatment. Hence, mantle cell lymphoma is still considered an incurable disease and there is no consensus among oncology specialists about its optimal treatment. It is therefore recommended that mantle cell lymphoma patients are seen by physicians having extensive experience in dealing with mantle cell lymphoma and they are also encouraged to participate in clinical trials to get the latest treatments.
Medical Therapy
Mantle cell lymphoma shows a heterogeneous clinical behavior, with some patients having indolent disease whereas a vast majority show aggressive presentation. Most of the patients eventually relapse and have disease progression after treatment. Hence, mantle cell lymphoma is still considered an incurable disease and there is no consensus among oncology specialists about its optimal treatment. It is therefore recommended that mantle cell lymphoma patients are seen by physicians having extensive experience in dealing with mantle cell lymphoma and they are also encouraged to participate in clinical trials to get the latest treatments.
- Different types of treatment currently being used to treat mantle cell lymphoma are as follows:
- Chemotherapy
- Immunotherapy
- Radioimmunotherapy
- Targeted therapy using newer biological agents
- Stem cell transplantation
Chemotherapy
Chemotherapy is predominantly used as frontline treatment, and is usually not repeated in relapse due to high risk of adverse effects. Alternate chemotherapeutic regimens, however, are sometimes used upon first relapse.[1]
- 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
- Drug Regimen:
- Hyper-(CVAD) Course A:Cyclophosphamide AND Vincristine AND Doxorubicin AND Dexamethasone
- Hyper-(VCAD) 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.