Mantle Cell Lymphoma Health Article

Clinical staging, treatments, and prognosis

There is no formal staging system for mantle cell lymphoma and no standard treatment has yet been adopted for MCL patients. Patients have been treated with surgery, radiation, single drug or combination chemotherapy and stem cell transplants. CHOP is one of the most common chemotherapy regimens for treating MCL. It derives its name from the combination of drugs used: Cyclophosphamide (cytoxan, neosar), adriamycin (doxorubicin or Hydroxydoxorubicin), vincristine (Oncovin), and Prednisone.

There is no cure for mantle cell lymphoma. As with other slow-growing lymphomas, spontaneous remissions have been reported, but only partial, lasting a year at the most. All mantle cell lymphoma experts agree that the long-term prognosis of MCL patients receiving conventional treatment is poor, and that there is an urgent need for new, improved therapies.

Alternative and complementary therapies

Because MCL is a cancer of the lymphatic system, immunologic therapies are often used, or combined with the more conventional radiation and chemotherapy treatments. Immunological therapies take advantage of the body's immune system. The immune system is a network of specialized cells and organs that defends the body against foreign invaders (antigens) by producing special "defense" proteins, an example of which are the antibodies. These substances recognize and attach to the antigens, usually found on the surface of cells and destroy them. There are reports of immunological therapies being used for MCL using interferon, one such natural substance produced by the body in response to a virus. Numerous studies show that interferons can stimulate the immune system to fight the growth of cancer, but there has not yet been enough evidence produced to see it emerge as a strong candidate for MCL treatment.

Other immunological therapies based on monoclonal antibodies (MABs or MOABs) have recently emerged, such as Rituxan (rituximab). MABs work on cancer cells in the same way natural antibodies work, by identifying and binding to the target cells, alerting other cells in the immune system to the presence of the cancer cells. MABs are very specific for a particular antigen, meaning that one designed for a B-cell lymphoma will not work on T-cell lymphomas. MABs used alone may enhance a patient's immune response to the cancer but they are thought to be more efficient when combined to another form of therapy, such as a chemotherapeutic drug. This way, the cancer is attacked on two fronts: chemical attack from the chemotherapy and immune response attack stimulated by the MAB.

Coping with cancer treatment

It is important to have a caregiver system when receiving medical treatment for MCL, and it is just as important to have a network of support for coping with the non-medical aspects of the cancer. Friends, relatives, coworkers and health professionals all can provide help, as well as the national cancer associations, some specifically addressing the needs of lymphoma patients. Please refer to the Resources section at the end of this entry for contact information.

Clinical trials

Clinical trials addressing the needs of MCL patients are very recent because the mantle cell lymphoma subtype has only recently been defined. There are now several trials being carried out in the United States specifically for mantle cell. Some other trials designed for patients with lymphomas may also accept mantle cell patients. Ongoing trials in this area are cheifly concerned with investigating monoclonal antibodies. Information regarding clinical trials can be obtained through the Clinical Trials web site listed at the end of this entry.

The following clinical protocols are specifically designed for MCL patients:

• The MD Anderson Protocol (high-dose chemotherapy with or without stem cell transplant)
• Rituxan, by itself or with CHOP
• Bexxar
• Oncolym
• Flavopiridol
• Phenylacetate

Prevention

Because the cause of MCL is unknown, no prevention measures can be recommended.