Review of current treatments for mantle cell lymphoma

This is a review of the current standards of care for patients with mantle cell lymphoma. 

Mantle cell lymphoma (MCL) is a relatively rare type of non-Hodgkin lymphoma. It is considered an incurable disease. Treatment type depends on many clinical factors, such as patient age, disease stage, and disease aggressiveness. Most patients relapse after initial treatment. The goal of MCL treatment is to increase patient survival while decreasing disease- and treatment-related side effects. 

This review summarizes the current standard of care for patients with MCL.

Initial treatment:

Younger patients have fewer complications and can generally tolerate a more intense regimen. R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy has been a common treatment option. More recent studies are looking at better treatments.

One study looked at the R-DHAP chemotherapy regimen (rituximab plus dexamethasone, high-dose cytarabine, and cisplatin) followed by autologous stem cell transplantation (auto-SCT; using stem cells from the patient’s own body). All patients received R-CHOP followed by either R-CHOP or R-DHAP before auto-SCT. The average time to treatment failure (relapse or death) was 9.1 years for patients receiving R-DHAP and 4 years for patients only receiving R-CHOP.

Another treatment with good outcomes is bendamustine plus rituximab (BR). One study found the average progression free survival (time from treatment to disease progression) of patients receiving BR was 35.4 months compared to 22.1 months for the R-CHOP group. VR-CAP (rituximab plus cyclophosphamide, doxorubicin, bortezomib, and prednisone) is also a good treatment option.

Older patients have had good results when treated with BR plus intermediate- or low-dose cytarabine. Current and future clinical trials are looking at BR plus other treatments.

Consolidation and maintenance treatment:

Auto-SCT is the standard consolidation treatment for young and fit patients. Future trials are looking at cytarabine chemotherapy and ibrutinib therapies.

In younger and older patients, rituximab maintenance therapy (treatment to maintain remission) is the standard of care. Future studies are looking at adding new targeted treatments to rituximab maintenance.

Relapse/Previously treated:

Ibrutinib has had good outcomes. Studies suggest that ibrutinib should be given soon after initial treatment failure.  Bendamustine is the first choice for second-line chemotherapy. It is often given in combination with other therapies, including rituximab, cytarabine, lenalidomide, or ibrutinib.

Ongoing studies are looking at chimeric antigen receptor T-cells as a potential cure. These are cells that are genetically modified to fight against lymphoma cells.

This study reviewed the current standard of care for patients with mantle cell lymphoma.

Mantle cell lymphoma is highly individualized, and patients should talk to their doctor about what treatment will work best for them.