Mantle cell lymphoma medical therapy: Difference between revisions
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[[Chemotherapy]] is widely used as frontline treatment, and often is not repeated in relapse due to side effects. Alternate chemotherapy is sometimes used at first relapse. | [[Chemotherapy]] is widely used as frontline treatment, and often is not repeated in relapse due to side effects. Alternate chemotherapy is sometimes used at first relapse. | ||
====Frontline treatment==== | ====Frontline treatment==== | ||
* Drug Regimen: [[CHOP]] (IV) ([[Cyclophosphamide]], [[Doxorubicin]], [[Vincristine]], {{and}} [[Prednisone]]) {{ | * Drug Regimen: [[CHOP]] (IV) ([[Cyclophosphamide]], {{and}} [[Doxorubicin]], {{and}} [[Vincristine]], {{and}} [[Prednisone]]) {{plus}} [[Rituximab]] | ||
* Drug Regimen: [[Fludarabine]] | * Drug Regimen: [[Fludarabine]] | ||
* Drug Regimen: [[Fludarabine]] {{withorwithout}} ([[Cyclophosphamide]] {{and}} [[Mitoxantrone]] {{and}} [[Rituximab]]) | * Drug Regimen: [[Fludarabine]] {{withorwithout}} ([[Cyclophosphamide]] {{and}} [[Mitoxantrone]] {{and}} [[Rituximab]]) | ||
====Elderly(over 65) patients,baseline beta-2 microglobulin blood test was normal==== | ====Elderly(over 65) patients, baseline beta-2 microglobulin blood test was normal==== | ||
Hyper-CVAD chemotherapy consists of two combinations of drugs (courses A and B) given in an alternating fashion. The term 'hyper' refers to the hyperfractionated nature of the chemotherapy, which is given in smaller doses, more frequently, to minimize side effects. HyperCVAD is becoming popular and showing promising results, especially with rituximab. It is showing better complete remissions (CR) and progression free survival (PFS) than CHOP regimens | Hyper-CVAD chemotherapy consists of two combinations of drugs (courses A and B) given in an alternating fashion. The term 'hyper' refers to the hyperfractionated nature of the chemotherapy, which is given in smaller doses, more frequently, to minimize side effects. HyperCVAD is becoming popular and showing promising results, especially with rituximab. It is showing better complete remissions (CR) and progression free survival (PFS) than CHOP regimens | ||
* Drug Regimen: CVAD | * Drug Regimen: (CVAD) Course A:[[Cyclophosphamide]], {{and}} [[Vincristine]], {{and}} [[Doxorubicin]], {{and}} [[Dexamethasone]] ; Course B : [[Methotrexate]] {{and}} [[Cytarabine]] | ||
====Relapsed patients==== | ====Relapsed patients==== | ||
* Drug regimen: PEP-C (oral), [[Prednisone]], [[Etoposide]], [[Procarbazine]], {{and}} [[Cyclophosphamide]][http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=23&abstractID=104642]. | * Drug regimen: PEP-C (oral), [[Prednisone]], {{and}} [[Etoposide]], {{and}} [[Procarbazine]], {{and}} [[Cyclophosphamide]][http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=23&abstractID=104642]. | ||
* [[Chemotherapy]] {{ | * [[Chemotherapy]] {{withorwithout}} [[Total body irradiation]] (TBI) | ||
===Immunotherapy=== | ===Immunotherapy=== | ||
[[Immunotherapy|Immune-based therapy]] is dominated now by the oft used and effective [[rituximab]] monoclonal antibody. It can have good activity against mantle cell lymphoma alone but especially in combination with chemotherapies to prolong response duration. Rituximab essentially tags the cancer cells for destruction by the body. There are newer variations on monoclonal antibodies combined with radioactive molecules known as [[Radioimmunotherapy]] (RIT). These include Zevalin and [[Bexxar]]. | [[Immunotherapy|Immune-based therapy]] is dominated now by the oft used and effective [[rituximab]] monoclonal antibody. It can have good activity against mantle cell lymphoma alone but especially in combination with chemotherapies to prolong response duration. Rituximab essentially tags the cancer cells for destruction by the body. There are newer variations on monoclonal antibodies combined with radioactive molecules known as [[Radioimmunotherapy]] (RIT). These include Zevalin and [[Bexxar]]. | ||
Revision as of 14:51, 4 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]
Overview
The predominant therapy for mantle cell lymphoma is chemotherapy. Adjunctive immune based therapy, radioimmunotherapy, and new biologic agents may be required.
Medical Therapy
There are no proven standards of treatment for mantle cell lymphoma, and not even consensus among specialists on how to treat it optimally. Many regimens are available and often get good response rates, but patients almost always get disease progression after chemotherapy. Each relapse is typically more difficult to treat, and relapse is generally faster. Fortunately, regimens are available that will treat relapse, and new approaches are under test. Because of the aforementioned factors, many MCL patients enroll in clinical trials to get the latest treatments.
- There are four classes of treatments currently in general use:
- Chemotherapy
- Immune based therapy
- Radioimmunotherapy
- New biologic agents
- The phases of treatment are generally:
- Frontline
- Following diagnosis
- Consolidation
- After frontline response (to prolong remissions)
- Relapse (Relapse is usually experienced multiple times.)
Chemotherapy
Chemotherapy is widely used as frontline treatment, and often is not repeated in relapse due to side effects. Alternate chemotherapy is sometimes used at first relapse.
Frontline treatment
- Drug Regimen: CHOP (IV) (Cyclophosphamide, AND Doxorubicin, AND Vincristine, AND Prednisone) PLUS Rituximab
- Drug Regimen: Fludarabine
- Drug Regimen: Fludarabine ± (Cyclophosphamide AND Mitoxantrone AND Rituximab)
Elderly(over 65) patients, baseline beta-2 microglobulin blood test was normal
Hyper-CVAD chemotherapy consists of two combinations of drugs (courses A and B) given in an alternating fashion. The term 'hyper' refers to the hyperfractionated nature of the chemotherapy, which is given in smaller doses, more frequently, to minimize side effects. HyperCVAD is becoming popular and showing promising results, especially with rituximab. It is showing better complete remissions (CR) and progression free survival (PFS) than CHOP regimens
- Drug Regimen: (CVAD) Course A:Cyclophosphamide, AND Vincristine, AND Doxorubicin, AND Dexamethasone ; Course B : Methotrexate AND Cytarabine
Relapsed patients
- Drug regimen: PEP-C (oral), Prednisone, AND Etoposide, AND Procarbazine, AND Cyclophosphamide[3].
- Chemotherapy ± Total body irradiation (TBI)
Immunotherapy
Immune-based therapy is dominated now by the oft used and effective rituximab monoclonal antibody. It can have good activity against mantle cell lymphoma alone but especially in combination with chemotherapies to prolong response duration. Rituximab essentially tags the cancer cells for destruction by the body. There are newer variations on monoclonal antibodies combined with radioactive molecules known as Radioimmunotherapy (RIT). These include Zevalin and Bexxar.
Targeted Therapy
New targeted agents include the proteasome inhibitor Velcade and mTor (mammalian target of rapamycin) inhibitors such as temsirolimus.