Choosing the Right Treatment
- Some mantle cell lymphomas grow slowly and don’t usually need to be treated right away, while others grow quickly and may need immediate treatment
- Treatment often pairs chemotherapy with a targeted therapy
- Many cancer centers treat mantle cell lymphoma with a stem cell transplant
- New targeted and immune-based drugs are also available
Non-Hodgkin lymphoma isn’t one disease — it’s a whole collection of them, each of which has very different characteristics. One group of lymphomas affects B cells — infection-fighting white blood cells of the immune system. Mantle cell lymphoma is one of the B-cell lymphomas. It grows from B cells on the outer edge of the lymph node, called the mantle zone.
“One feature that makes it somewhat unique is that it’s a very heterogeneous group of diseases,” Dr. Jakub Svoboda, medical oncologist at Penn Medicine, tells SurvivorNet. “Even though it’s just under one label, we have patients with mantle cell lymphoma who may have a very indolent or slow-growing disease, and then we have patients who may have quite aggressive disease. And so, it’s somewhat challenging for clinicians and patients to treat this disease because there’s perhaps different options for different situations.”
Coming Up With a Treatment Plan for Mantle Cell Lymphoma
Before your doctor can treat you, he or she needs to determine your stage — the extent of cancer in your body — and how aggressive your cancer is. People with slower-growing mantle cell lymphoma might not need any treatment to start. This strategy is known as “watchful waiting” or “active surveillance.” Doctors who opt for this approach will schedule visits every couple of months for tests to see if the cancer is progressing, which would mean that it needs treatment.
Those with more aggressive cancer will want to start on treatment right away. Therapy looks pretty much the same for many people with aggressive mantle cell lymphoma. “The treatment options continue to evolve, but when we want to talk in general terms, most patients with mantle cell lymphoma have the more aggressive subtype, and those patients are generally treated with conventional chemotherapy with rituximab,” explains Dr. Svoboda.
Most of the accepted chemotherapy regimens include a drug called cytarabine. It’s paired with rituximab (Rituxan), a monoclonal antibody that seeks out and targets a protein called CD20 on the surface of cancer cells.
Unlike with most other types of lymphoma, many cancer centers will treat mantle cell lymphoma with an autologous stem cell transplant when people are in their first remission, Dr. Svoboda says. “So most patients with mantle cell lymphoma tend to get quite aggressive treatment early on.” A stem cell transplant starts with very high doses of chemotherapy to get rid of as many cancer cells as possible. That’s followed by an infusion of your own stem cells — the young cells that grow into new blood cells — to replace the ones chemotherapy damaged.
New Treatments for Mantle Cell Lymphoma
“What’s been happening in the past several years is that we are finding that quite a few of what we refer to as novel agents, like acalabrutinib, ibrutinib, and lenalidomide, are quite active in this disease,” Dr. Svoboda tells SurvivorNet. “And so there are efforts to move these drugs upfront and/or at least to do clinical trials that will incorporate these novel agents.”
Acalabrutinib (Calquence) and ibrutinib (Imbruvica) are targeted drugs. They both work by blocking a protein called Bruton tyrosine kinase that helps cancer cells grow. Lenalidomide (Revlimid) is an immune modulating therapy. It stimulates the immune system to help it recognize and destroy cancer cells, and it cuts off the tumor’s blood supply to prevent it from growing and surviving.
In July 2020, the FDA approved a new CAR T-cell therapy for some people with mantle cell lymphoma. The new treatment, called brexucabtagene autoleucel (Tecartus), is approved for people whose cancer hasn’t responded to other treatments or has come back.
In one study, 87% of people who received this treatment responded to it, and 62% had a complete response, meaning there were no longer any signs of the cancer in their body.
“We now can utilize that, but that type of therapy is generally reserved for patients who would fail some of the more conventional treatments,” Dr. Svoboda says. “So we’ve now started using Tecartus in our patients with relapsed refractory [treatment-resistant] mantle cell lymphoma.”
Learn more about SurvivorNet's rigorous medical review process.
Dr. Jakub Svoboda is a medical oncologist at Penn Medicine, and associate professor of medicine at the Hospital of the University of Pennsylvania. Read More
Choosing the Right Treatment
- Some mantle cell lymphomas grow slowly and don’t usually need to be treated right away, while others grow quickly and may need immediate treatment
- Treatment often pairs chemotherapy with a targeted therapy
- Many cancer centers treat mantle cell lymphoma with a stem cell transplant
- New targeted and immune-based drugs are also available
Non-Hodgkin lymphoma isn’t one disease — it’s a whole collection of them, each of which has very different characteristics. One group of lymphomas affects
B cells — infection-fighting white blood cells of the immune system. Mantle cell lymphoma is one of the B-cell lymphomas. It grows from B cells on the outer edge of the lymph node, called the mantle zone.
“One feature that makes it somewhat unique is that it’s a very heterogeneous group of diseases,” Dr. Jakub Svoboda, medical oncologist at Penn Medicine, tells SurvivorNet. “Even though it’s just under one label, we have patients with mantle cell lymphoma who may have a very indolent or slow-growing disease, and then we have patients who may have quite aggressive disease. And so, it’s somewhat challenging for clinicians and patients to treat this disease because there’s perhaps different options for different situations.”
Coming Up With a Treatment Plan for Mantle Cell Lymphoma
Read More Before your doctor can treat you, he or she needs to determine your stage — the extent of cancer in your body — and how aggressive your cancer is. People with slower-growing mantle cell lymphoma might not need any treatment to start. This strategy is known as “watchful waiting” or “active surveillance.” Doctors who opt for this approach will schedule visits every couple of months for tests to see if the cancer is progressing, which would mean that it needs treatment.
Those with more aggressive cancer will want to start on treatment right away. Therapy looks pretty much the same for many people with aggressive mantle cell lymphoma. “The treatment options continue to evolve, but when we want to talk in general terms, most patients with mantle cell lymphoma have the more aggressive subtype, and those patients are generally treated with conventional chemotherapy with rituximab,” explains Dr. Svoboda.
Most of the accepted chemotherapy regimens include a drug called cytarabine. It’s paired with rituximab (Rituxan), a monoclonal antibody that seeks out and targets a protein called CD20 on the surface of cancer cells.
Unlike with most other types of lymphoma, many cancer centers will treat mantle cell lymphoma with an autologous stem cell transplant when people are in their first remission, Dr. Svoboda says. “So most patients with mantle cell lymphoma tend to get quite aggressive treatment early on.” A stem cell transplant starts with very high doses of chemotherapy to get rid of as many cancer cells as possible. That’s followed by an infusion of your own stem cells — the young cells that grow into new blood cells — to replace the ones chemotherapy damaged.
New Treatments for Mantle Cell Lymphoma
“What’s been happening in the past several years is that we are finding that quite a few of what we refer to as novel agents, like acalabrutinib, ibrutinib, and lenalidomide, are quite active in this disease,” Dr. Svoboda tells SurvivorNet. “And so there are efforts to move these drugs upfront and/or at least to do clinical trials that will incorporate these novel agents.”
Acalabrutinib (Calquence) and ibrutinib (Imbruvica) are targeted drugs. They both work by blocking a protein called Bruton tyrosine kinase that helps cancer cells grow. Lenalidomide (Revlimid) is an immune modulating therapy. It stimulates the immune system to help it recognize and destroy cancer cells, and it cuts off the tumor’s blood supply to prevent it from growing and surviving.
In July 2020, the FDA approved a new CAR T-cell therapy for some people with mantle cell lymphoma. The new treatment, called brexucabtagene autoleucel (Tecartus), is approved for people whose cancer hasn’t responded to other treatments or has come back.
In one study, 87% of people who received this treatment responded to it, and 62% had a complete response, meaning there were no longer any signs of the cancer in their body.
“We now can utilize that, but that type of therapy is generally reserved for patients who would fail some of the more conventional treatments,” Dr. Svoboda says. “So we’ve now started using Tecartus in our patients with relapsed refractory [treatment-resistant] mantle cell lymphoma.”
Learn more about SurvivorNet's rigorous medical review process.
Dr. Jakub Svoboda is a medical oncologist at Penn Medicine, and associate professor of medicine at the Hospital of the University of Pennsylvania. Read More
