Jia Ruan, MD gives a deep dive into Mantle Cell Lymphoma.
About Dr. Ruan: Jia Ruan, MD, Ph.D, Weill Cornell Medicine.
More About Mantle Cell Lymphoma:
Treatment Options
Initial treatment approaches for MCL in younger patients include the monoclonal antibody, rituximab (Rituxan), with a cytarabine (Cytosar)-containing combination chemotherapy regimen, and are often followed by consolidation with autologous stem cell transplantation (patient’s own cells are infused after high-dose chemotherapy). This treatment may be followed by an extended course of rituximab (Rituxan) alone, known as maintenance therapy, with the goal of prolonging remissions (disappearance of signs and symptoms). For older or less fit patients, less-intensive chemotherapy is often recommended and may also be followed by rituximab (Rituxan) maintenance. One such treatment is bendamustine (Treanda) in combination with rituximab (BR) as a frontline (initial) therapy.
Allogeneic stem cell transplantation (patients receive stem cells from a donor) can produce deep responses, including cure, but can also cause significant side effects. Typically, it is only used in selected younger patients whose disease has relapsed (returned after treatment).
Bortezomib (Velcade) is approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients with MCL. Studies with bortezomib (Velcade) show that the drug may be effectively combined with conventional chemotherapy.
Lenalidomide (Revlimid) is another treatment for MCL approved by the FDA for patients who have relapsed or progressed after two prior therapies, one of which included bortezomib (Velcade). In addition to directly targeting MCL cells, lenalidomide (Revlimid) affects the growth and survival of tumor cells by altering the body’s immune cells. It may be given in combination with rituximab (Rituxan).
Ibrutinib (Imbruvica), zanubrutinib (Brukinsa), and acalabrutinib (Calquence) are Bruton tyrosine kinase (BTK) inhibitors that stop signals in cancer cells responsible for growth and survival. All three are approved by the FDA for treatment of MCL in patients who have received at least one prior therapy.
Treatment options may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with their physician or with the Lymphoma Research Foundation (LRF) for any treatment updates that may have recently emerged.
Treatments Under Investigation
Many new approaches are being studied as initial therapy in clinical trials for MCL. These include attempts to determine who most benefits from stem cell transplantation and the use of new drugs to replace or shorten the course of chemotherapy.
New agents being investigated alone or as a part of combination therapy include Acalabrutinib (Calquence), Ibrutinib (Imbruvica), Lenalidomide (Revlimid), Obinutuzumab (Gazyva), Venetoclax (Venclexta), Ixazomib (Ninlaro), Axicabtagene Ciloleucel (Yescarta), JCAR017 that targets AntiCD19 CAR T Cells, JCAR018 that targets AntiCD22 CAR T Cells.
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The Lymphoma Research Foundation is the nation's largest non-profit organization devoted to funding innovative research and providing people with lymphoma and healthcare professionals with up-to-date information about this type of cancer.
