Mantle cell lymphoma is a rare form of Non-Hodgkin lymphoma. It is a fast growing tumor that spreads fast to different organs of the body. In this article we will discuss the treatment options and outcomes. To know more about who gets this lymphoma and how it affects the body, read the article on Mantle Cell Lymphoma.
Most people with mantle cell lymphoma have advanced stage disease at diagnosis. Their disease has spread to different parts of the body. Treatment of this lymphoma must be targeted at reaching all parts of the body. Chemotherapy is the main form of treatment as the drugs that are injected in the veins can reach all parts of the body through the blood. Treatments like surgery which can remove tumor from only one part of the body are not useful. Radiation therapy also has a limited role in treatment.
Chemotherapy in Mantle Cell Lymphoma:
Chemotherapy is administered in the form of injections or drips in the veins over a few hours to few days. Each such session or cycle of chemotherapy is repeated at intervals of one or more weeks. Occasionally chemotherapy may also be given in the form of tablets. There are many combinations of chemotherapy drugs used in mantle cell lymphoma. The exact type used is based on individual circumstances. Most individuals receive the CHOP regimen a combination of four drugs. CHOP is administered in a single day, and repeated every 3 weeks for 6 to 8 cycles.
Intensive Chemotherapy Regimens:
Mantle cell lymphoma treatment is often unsuccessful. After an initial response to chemotherapy, the disease may come back in many patients. In order to improve the treatment outcomes, more intensive chemotherapy combinations have been tried. Some of these combinations are based on the treatment of leukemias cancers of blood cells. Some of these combinations have shown better outcomes. But these combinations are also very toxic and not all individuals can tolerate these regimens. Doctors will only advise these combinations if they feel that the patient will be able to bear the side effects.
Adding Biological Therapy to Chemotherapy:
Biological therapy has been tried successfully in many forms of lymphoma. It involves injections of special molecules called monoclonal antibodies that target cancer cells based on special markers on their surface. (See the article on Monoclonal Antibodies in Lymphoma). Rituximab is a monoclonal antibody that is widely used in many types of Non-hodgkin lymphoma. Rituximab has also been used in mantle cell lymphoma in addition to different chemotherapy combinations. The results have been promising, though there have been no drastic improvements.
New Drugs for Mantle Cell Lymphoma:
Some new drugs are being tested in clinical trials that promise better outcomes in the future. One of them is Bortezomib, a new class of biological drugs that acts on proteasomes, a special structure in cells. Proteasomes kill some old and harmful proteins in cells . Bortezomib inhibits or acts against these proteasomes in cancer cells and hasten the death of these cells.
Bone Marrow Transplants:
A bone marrow or stem-cell transplant after chemotherapy may be an option for young individuals who have a matched donor. This modality is not widely practiced, as most people with mantle cell lymphoma are older and unfit for transplant. In some hospitals, the results of this procedure have been good with some patients having a long survival.
Radiation therapy in Mantle Cell Lymphoma:
Radiation is not commonly used in mantle cell lymphomas. In the few individuals in whom disease is diagnosed in an early stage where only a small part of the body is affected, radiation to that area may be added after chemotherapy is completed. In the majority of individuals however, disease is more advanced and spread out. Radiation to large areas of the body is a problem. Nevertheless, low dose radiation can sometimes be used over large areas of the body with long-term benefit.
Mantle cell lymphoma is rarely curable. In most individuals, there is a good initial response to chemotherapy. However, in the majority, the disease again relapses after months or a few years. The main aim of treatment is to prolong this period of remission as much as possible. New treatment modalities and drugs are being tried in clinical trials, and doctors will encourage you to join clinical trials in which new treatments are being tested.