Mantle cell lymphoma medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The predominant therapy for mantle cell lymphoma is [[chemotherapy]]. Adjunctive immune based therapy, [[radioimmunotherapy]], and new biologic agents may be required. | The predominant therapy for mantle cell lymphoma is [[chemotherapy]]. Adjunctive immune-based therapy, [[radioimmunotherapy]], and new biologic agents may be required. | ||
==Medical Therapy== | ==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 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. | ||
Revision as of 16:33, 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 predominantly used as frontline treatment, and is usually not repeated in relapse due to high risk of adverse effects. Alternate chemotherapeutic regimens, however, are sometimes used upon first relapse.[1]
- 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
- Drug Regimen:
- Hyper-(CVAD) Course A:Cyclophosphamide AND Vincristine AND Doxorubicin AND Dexamethasone
- Hyper-(VCAD) Course B: Methotrexate AND Cytarabine
Immunotherapy
- Rituximab is a monoclonal antibody that is effective against mantle cell lymhpma. It may be used in combination with other chemotherapeutic regimens to prolong response duration. Rituximab tags the cancer cells for destruction by the body.
- Other variations of monoclonal antibodies combined with radioactive molecules include Radioimmunotherapy (RIT), such as Zevalin and Bexxar.
Targeted Therapy
Targeted agents include the proteasome inhibitor Velcade and mTor (mammalian target of rapamycin) inhibitors such as temsirolimus.