In recent years, researchers have gained a better understanding of the disease process that takes place in patients with mantle-cell lymphoma. This process is thought to be triggered by mutations inside the cells that make up the lymphatic system. These mutations trigger a chain of biologic events that sometimes lead to cancer. The resulting cancer may be slow-growing or aggressive.1
The interaction between healthy tissues and mutated cells is thought to play an important role in cancer growth and development.1 Researchers are working to understand the exact mechanisms by which these changes occur. This knowledge is important, because it helps researchers to find new biologic targets in the body to fight cancer. New drugs are then developed and tested to determine whether they are able to show clinical activity in these target areas. Although drug development remains a process of trial and error, the more we know about cancer biology, the better the chances are for developing effective treatments.
Until about 5 years ago, treatment options in mantle-cell lymphoma were limited to intensive chemotherapy regimens. Some of these regimens included rituximab (Rituxan), a monoclonal antibody. Stem-cell transplants were also used to treat the disease. Although these therapies are still frequently used, changes have been made in the way doctors categorize and treat mantle-cell lymphoma. More and more, patients are being prescribed chemotherapy-free “targeted” biologic therapies.1
Two newer drugs approved by the FDA for the treatment of relapsed or refractory mantle-cell lymphoma are ibrutinib (Imbruvica) and acalabrutinib (Calquence). Both of these drugs are given orally and are currently approved only for use in patients who have received other treatments and experienced a relapse.2,3 However, they are now being tested in newly diagnosed patients who have not yet received treatment.1
Researchers are also testing other types of new therapies to determine if they are effective for treating patients with mantle-cell lymphoma. One of these is CAR T-cell therapy, which has recently shown promising results and may offer a new treatment option in the future.1,4 Another targeted therapy, venetoclax (Venclexta), is FDA approved for other types of lymphoma and is being tested in mantle-cell lymphoma.1
Although many treatment advances have occurred, many questions remain to be answered. This is an exciting time, however, and we understand more about cancer biology and identification of new potential therapies than ever before. Research continues, with the goal of curing patients with mantle-cell lymphoma in the coming years.
- Jain P, Wang M. Mantle cell lymphoma: 2019 update on the diagnosis, pathogenesis, prognostication, and management. Am J Hematol. 2019;94:710-725.
- Imbruvica [prescribing information]. Sunnyvale, CA: Pharmacyclics LLC; January 2019.
- Calquence [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; November 2017.
- Goy A. The curative potential of CAR-T cell therapy in mantle cell lymphoma. July 26, 2018. www.curetoday.com/cure-tv/the-curative-potential-of-car-t-cell-therapy-in-mantle-cell-lymphoma. Accessed May 20, 2019.