Patients newly diagnosed with mantle-cell lymphoma (MCL) have many different treatment choices. Several factors may weigh into the treatment decision, including the disease stage and symptoms the patient is experiencing. In addition, the patient’s age, overall health, life circumstances, and other conditions they may have could affect the choice of treatment.1
For patients who are diagnosed early with a relatively small amount of slow-growing disease, active surveillance (also called “watchful waiting”) may be an acceptable option. This option typically only applies to patients who have not developed any symptoms. In active surveillance, patients’ overall health and their MCL are closely watched by scheduling regular checkup visits and laboratory or imaging tests. If patients begin to develop symptoms or show signs that the disease is progressing, then it is time to consider active treatment.1,2
For patients needing active treatment, chemotherapy is often recommended. Several different chemotherapy regimens are prescribed for MCL. For younger patients in otherwise good health, hematologists will often recommend one of the following combinations for a first treatment1-3:
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)
- Bendamustine in combination with rituximab
- Hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with high-dose methotrexate and cytarabine) plus rituximab.
Each of these chemotherapies usually requires several months of treatment. Each round of treatment is referred to as a cycle.1-3
For frail patients, hematologists may recommend less intensive chemotherapy followed by prolonged treatment with rituximab. When it is not possible to use aggressive treatments, a number of less intensive therapies are available, including1,2:
- Rituximab alone
- CVP (cyclophosphamide, vincristine, and prednisone)
- Chlorambucil, cladribine, or thalidomide, usually in combination with rituximab
The proteasome inhibitor bortezomib works differently than chemotherapy drugs and is approved by the FDA for the treatment of MCL. Recent studies have shown that bortezomib complements many conventional chemotherapy agents.2
Some patients with MCL may be eligible to receive a stem-cell transplant, in which patients receive their own stem cells or those of a donor. Patients receiving a stem-cell transplant are usually given high-dose chemotherapy first. The chemotherapy is intended to kill as many cancerous cells as possible, and the transplant gives the patient a chance to grow normal white blood cells in their place. This approach to treatment has been shown to give longer remissions in younger, medically fit patients.4
Although MCL is considered a difficult cancer to treat, tremendous progress has been made in the discovery of new treatments for the disease.2 Many new drugs and combinations of drugs are being studied in clinical trials, with promising results. A forthcoming article in this series will discuss new treatments being investigated by researchers.
- Leukemia & Lymphoma Society. Mantle cell lymphoma. www.lls.org/sites/default/files/file_assets/FS4_MCL_Facts_2018-final.pdf. Accessed March 1, 2019.
- Lymphoma Research Foundation. About lymphoma. www.lymphoma.org/aboutlymphoma/nhl/mcl/mcltreatment. 2019. Accessed March 2, 2019.
- Lymphoma News Today. Mantle cell lymphoma: what you need to know. https://lymphomanewstoday.com/mantle-cell-lymphoma. Accessed March 1, 2019.
- Lymphoma Research Foundation. Understanding the stem cell transplantation process. www.lymphoma.org/wp-content/uploads/2017/06/STEM_CELL_TRANSPLANTATION_BOOKLET-1.pdf. July 2016. Accessed March 11, 2019.