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Posted by on Jun 30, 2019 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This article reviewed the current treatment options for patients with mantle cell lymphoma (MCL).

Some background

MCL is a rare but aggressive type of non-Hodgkin’s lymphoma. Chemoimmunotherapy is the typical first-line treatment for MCL. 80 – 90% of patients respond to this treatment. However, many patients eventually have the cancer return (relapse) or stop responding to treatment (refractory). The goal of MCL therapy is to extend remission while minimizing side effects. Improving treatment strategies for patients with MCL remains challenging.

Methods & findings

Approximately 70% of patients diagnosed with MCL have symptoms and need treatment right away. On the other hand, patients who have a low tumor burden and no symptoms are managed with observation or watchful waiting. Watchful waiting is a way of monitoring cancer that is not causing symptoms. Anti-cancer therapy is then required when symptoms develop.

When anti-cancer therapy is needed, the choice of treatment is based on a patient’s age and fitness. Typical treatment for younger patients is high-dose chemotherapy followed by an autologous stem cell transplant. After the transplant, maintenance therapy is often given. This is a low-dose treatment given over a long period of time. The goal of this therapy is to delay relapse. Several different agents may be used for maintenance therapy. The most common one is rituximab (Rituxan).

Elderly patients may not be good candidates for intensive treatments due to side effects. For these patients, immunochemotherapy remains the standard of care. Most regimens include CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or bendamustine (Treanda). Rituximab is also commonly added to both. New combinations of agents are under investigation, such as lenalidomide (Revlimid) plus rituximab.

10 – 15% of patients with MCL who need treatment right away are frail. These patients may not be able to tolerate conventional chemotherapy. There is no standard treatment for these patients. However, lower doses of standard regimens or single-agent therapy may be used.

For patients who experience relapse, targeted therapy can be highly effective with fewer side effects compared to chemotherapy. Ibrutinib (Imbruvica) is a tyrosine kinase inhibitor. This agent blocks cancer cell survival. This leads to cancer cell death. Venetoclax (Venclexta) is another targeted therapy. Studies suggest that combinations of targeted therapies may be more effective than single agents alone.

The bottom line

This article reviewed current treatment options for patients with MCL. Treatments for younger versus older patients and patients who relapse were recommended.

What’s next?

Talk to your oncologist about which treatments may be right for you.

Published By :

Hematological Oncology

Date :

Jun 01, 2019

Original Title :

The modern approach to mantle cell lymphoma.

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