After a Relapse
Treatment depends on several factors, including:
- The length of time since initial treatment
- The extent of the disease
- The treatments the patient has already received, and how effective they were
- The patient’s age and overall health
Mantle cell lymphoma is an uncommon type of non-Hodgkin lymphoma that affects the immune system’s B cells—white blood cells that come from the “mantle zone” on the outer edge of the lymph node. The disease is often diagnosed late, when it’s already present in many parts of the body, but it usually responds well to initial therapy, often chemotherapy, and patients are able to achieve remission.
Unfortunately, mantle cell lymphoma usually returns at some point after remission, and doctors must decide among many options for treating it again. Patients with mantle cell lymphoma are monitored frequently during their remission so signs of relapse may be detected early. Regular blood tests, CT scans, and PET scans will help doctors determine when treatment is necessary again.
Because relapse is so common, doctors sometimes opt to supplement the initial treatment and continue treating patients even after they’ve achieved remission, hoping to prevent or at least postpone a relapse. “One big question in mantle cell lymphoma is whether or not a remission upfront should be consolidated with a stem cell transplant,” says Dr. Elise Chong, a hematologist/oncologist at Penn Medicine.
Doctors don’t really know yet whether this “extra” treatment up front will help prevent relapse. “The answer to that is currently being studied in clinical trials,” explains Dr. Chong. “Researchers are investigating whether or not patients who are in remission are fine and can be followed after completing chemotherapy, or whether they’re best off consolidating that remission, meaning proceeding to an autologous stem cell transplant in that first remission.”
After a Relapse
When a patient does relapse after achieving a remission, what to do next depends on several factors, including:
- The length of time since their initial treatment
- The extent of the disease
- The treatments the patient has already received and how effective they were
- The patient’s age and overall health
There’s no consensus among doctors about which therapy is best, and there are many clinical trials underway to further study existing options, and to find new and effective treatments as well. In the meantime, there are many different options available to treat relapsed (returned after remission) or refractory (no longer responding to treatment) mantle cell lymphoma. These include:
“The major drugs include BTK inhibitors such as Imbruvica, as well as Revlimid, with or without Rituxan,” says Dr. Chong, who explains that if a patient hasn’t already received these drugs, they’re non-chemotherapy agents that “have a lot of activity in mantle cell lymphoma and are quite exciting.” BTK inhibitors work by blocking the protein — called Bruton’s tyrosine kinase, or BTK — that mantle cell lymphoma cells need to grow. Calquence and Brukinsa are also BTK inhibitors. These three BTK inhibitors come in pill forms that a patient takes once or twice a day.
Revlimid is a drug that spurs the immune system to kill more cancer cells, stop new cells from growing, and cut off the growth of blood vessels so cancer cells don’t have the blood supply they need to survive. It also comes in pill form.
These drugs may be combined with Rituxan, a monoclonal antibody that works with the immune system to destroy cancer cells.
Another promising option, according to Dr. Chong, is CAR T-cell therapy. “This is one of the newest approved therapies for mantle cell lymphoma, and it’s exciting. It was previously only approved for aggressive B-cell lymphomas.” CAR T cells are immune system T cells that have been genetically engineered to recognize and kill mantle cell lymphoma cells.
A stem cell transplant, if not done earlier as part of initial treatment, can also be very effective. The transplant may be autologous (using a patient’s own harvested stem cells) or allogenic (retrieved from a compatible donor). Because of the risk of rejection from donor cells, allogenic transplants are considered riskier but also potentially curable.
There are many clinical trials underway to determine which existing drugs provide the best outcome and whether specific combinations of drugs work better. There are also many clinical trials investigating a variety of new drugs for their effectiveness in treating mantle cell lymphoma, either initially or after a relapse. Patients with mantle cell lymphoma should ask their doctor about whether it would be beneficial for them to volunteer for one of these trials.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Elise Chong is a medical oncologist at Penn Medicine, and an assistant professor of medicine at the Hospital of the University of Pennsylvania. She is board certified in medical oncology and internal medicine. Read More
After a Relapse
Treatment depends on several factors, including:
- The length of time since initial treatment
- The extent of the disease
- The treatments the patient has already received, and how effective they were
- The patient’s age and overall health
is an uncommon type of non-Hodgkin lymphoma that affects the immune system’s B cells—white blood cells that come from the “mantle zone” on the outer edge of the lymph node. The disease is often diagnosed late, when it’s already present in many parts of the body, but it usually responds well to initial therapy, often chemotherapy, and patients are able to achieve remission.
Unfortunately, mantle cell lymphoma usually returns at some point after remission, and doctors must decide among many options for treating it again. Patients with mantle cell lymphoma are monitored frequently during their remission so signs of relapse may be detected early. Regular blood tests, CT scans, and PET scans will help doctors determine when treatment is necessary again.
Read More Because relapse is so common, doctors sometimes opt to supplement the initial treatment and continue treating patients even after they’ve achieved remission, hoping to prevent or at least postpone a relapse. “One big question in mantle cell lymphoma is whether or not a remission upfront should be consolidated with a stem cell transplant,” says
Dr. Elise Chong, a hematologist/oncologist at Penn Medicine.
Doctors don’t really know yet whether this “extra” treatment up front will help prevent relapse. “The answer to that is currently being studied in clinical trials,” explains Dr. Chong. “Researchers are investigating whether or not patients who are in remission are fine and can be followed after completing chemotherapy, or whether they’re best off consolidating that remission, meaning proceeding to an autologous stem cell transplant in that first remission.”
After a Relapse
When a patient does relapse after achieving a remission, what to do next depends on several factors, including:
- The length of time since their initial treatment
- The extent of the disease
- The treatments the patient has already received and how effective they were
- The patient’s age and overall health
There’s no consensus among doctors about which therapy is best, and there are many clinical trials underway to further study existing options, and to find new and effective treatments as well. In the meantime, there are many different options available to treat relapsed (returned after remission) or refractory (no longer responding to treatment) mantle cell lymphoma. These include:
“The major drugs include BTK inhibitors such as Imbruvica, as well as Revlimid, with or without Rituxan,” says Dr. Chong, who explains that if a patient hasn’t already received these drugs, they’re non-chemotherapy agents that “have a lot of activity in mantle cell lymphoma and are quite exciting.” BTK inhibitors work by blocking the protein — called Bruton’s tyrosine kinase, or BTK — that mantle cell lymphoma cells need to grow. Calquence and Brukinsa are also BTK inhibitors. These three BTK inhibitors come in pill forms that a patient takes once or twice a day.
Revlimid is a drug that spurs the immune system to kill more cancer cells, stop new cells from growing, and cut off the growth of blood vessels so cancer cells don’t have the blood supply they need to survive. It also comes in pill form.
These drugs may be combined with Rituxan, a monoclonal antibody that works with the immune system to destroy cancer cells.
Another promising option, according to Dr. Chong, is CAR T-cell therapy. “This is one of the newest approved therapies for mantle cell lymphoma, and it’s exciting. It was previously only approved for aggressive B-cell lymphomas.” CAR T cells are immune system T cells that have been genetically engineered to recognize and kill mantle cell lymphoma cells.
A stem cell transplant, if not done earlier as part of initial treatment, can also be very effective. The transplant may be autologous (using a patient’s own harvested stem cells) or allogenic (retrieved from a compatible donor). Because of the risk of rejection from donor cells, allogenic transplants are considered riskier but also potentially curable.
There are many clinical trials underway to determine which existing drugs provide the best outcome and whether specific combinations of drugs work better. There are also many clinical trials investigating a variety of new drugs for their effectiveness in treating mantle cell lymphoma, either initially or after a relapse. Patients with mantle cell lymphoma should ask their doctor about whether it would be beneficial for them to volunteer for one of these trials.
Learn more about SurvivorNet's rigorous medical review process.
Dr. Elise Chong is a medical oncologist at Penn Medicine, and an assistant professor of medicine at the Hospital of the University of Pennsylvania. She is board certified in medical oncology and internal medicine. Read More
