In a nutshell
This review explores the current treatments for patients with relapsed or difficult to treat mantle cell lymphoma.
Some background
Mantle cell lymphoma (MCL) is a type of non-Hodgkin lymphoma. Patients with relapsed MCL generally have poor outcomes. These patients with relapsed or difficult to treat (refractory) MCL have traditionally been treated with further chemotherapy.
More recently, other treatments have been used to treat relapsed or refractory MCL. These include stem cell transplantation and targeted biological treatments.
Methods & findings
This study reviewed the current treatment options for MCL.
Patients with relapsed, slow-growing (indolent) MCL may be treated with a watch and wait strategy. For patients with aggressive MCL, more intense treatments should be used.
Autologous stem cell transplantation (auto-SCT):
Auto-SCT (using stem cells from the patient’s own body) is used to treat many types of cancers. However, auto-SCT is not as successful for patients with relapsed or refractory MCL. Auto-SCT following high dose chemotherapy is more effective as a first line treatment. However, patients with a complete response (no detectable cancer) after first or second relapse benefitted from auto-SCT.
Allogeneic stem cell transplantation (allo-SCT):
Allo-SCT (using stem cells from a matched donor) is the only potential cure for relapsed or refractory MCL. However, there are significant transplant-related risks associated with allo-SCT. The 4-year treatment related mortality rate (death related to treatment) was nearly 40%. The 4-year overall survival rate (time from treatment to death from any cause) was between 40% and 50%. Survival rates are generally lower for patients treated with allo-SCT compared to those treated with auto-SCT.
There is no difference in overall survival between patients who received stem cells from unrelated compared to related donors.
New targeted treatments:
Bortezomib is a targeted biological treatment that has had good outcomes for patients with relapsed or refractory MCL. When combined with rituximab and dexamethasone¸ bortezomib had a complete response rate (no detectable cancer) of 44%.
Temsirolimus (Torisel) is another targeted biological treatment that specifically attacks MCL cancer cells. The overall response rate (complete response plus partial response rates) was 38%. When combined with rituximab, the overall response rate was 59%.
Lenalidomide (Revlimid) has shown an overall response rate of between 28% and 53% for patients with relapsed or refractory MCL. When combined with rituximab, the overall response rate was 56%.
Ibrutinib (Imbruvica) has also had good outcomes for patients with relapsed or refractory MCL. The overall response rate for patients with relapsed or refractory MCL was 68%. When combined with rituximab, the complete response rate was 44%.
The bottom line
This was a review of the current treatment strategies for patients with relapsed or difficult to treat mantle cell lymphoma.
Published By :
International journal of hematology
Date :
Mar 01, 2017
