Your FAQs Around Mantle Cell Lymphoma Treatment After Chemotherapy

If you have MCL that’s growing quickly or causing symptoms, a doctor typically prescribes chemotherapy and other medications to treat it. This may include:

• dose-intensified R-CHOP, or rituximab, cyclophosphamide, doxorubicin (or hydroxydaunorubicin), vincristine (Oncovin), and prednisolone, alternating with rituximab and cytarabine
• hyper-CVAD or cyclophosphamide, vincristine, doxorubicin (Adriamycin), and dexamethasone, alternating with high-dose methotrexate plus cytarabine
• RDHAP, or rituximab, dexamethasone, cytarabine, and cisplatin
• rituximab
• rituximab plus bendamustine

When possible, doctors typically recommend an intensive regimen to treat MCL. Some treatment regimens may require in-patient care during infusions.

A doctor may also recommend high dose chemotherapy and a stem cell transplant following an intensive treatment regimen. However, this treatment has risks. Doctors can only recommend it to people with good overall health.

You may experience side effects from treatment for MCL. These can include:

• nausea
• vomiting
• diarrhea or constipation
• hair loss
• mouth sores
• loss of appetite
• low white blood cell counts, which can increase your risk of infections that can lead to negative health effects and outcomes
• low platelet count, which can cause increased bleeding and bruising
• low red blood cell counts, or anemia, which can cause fatigue or shortness of breath

After your initial treatment regimen, a doctor may recommend additional treatments to help prolong remission.

Stem cell therapy

If you’re younger and relatively healthy, a doctor may recommend a stem cell transplant (SCT) after chemotherapy. This procedure replaces bone marrow destroyed by cancer, chemotherapy, or radiation therapy.

Your care team can help you understand SCT’s potential benefits and risks. The two main types of SCT include:

• Autologous SCT: In autologous SCT, the healthcare team removes and freezes some of your stem cells before chemotherapy. After you finish chemotherapy, they’ll thaw and transplant the stem cells back into your body.
• Allogeneic SCT: If you go through allogeneic SCT, the healthcare team gives you stem cells from another person. Usually, the best donor is a sibling or another close relative. But you might be able to find a suitable match through a national transplant registry.

SCT may help you stay in remission for longer after you’ve gone through successful chemotherapy. But it can also cause potentially serious side effects, such as:

• bleeding
• infection
• lung inflammation
• blocked veins in your liver
• graft failure, which happens when transplanted cells don’t multiply as they should
• graft-versus-host disease, which happens when your body rejects donor stem cells

Doctors prescribe medications to promote a successful transplant, but these can also cause side effects, including organ damage.

Due to the risk of side effects, SCT is rarely recommended for people over age 65 or with other illnesses. In these cases, doctors usually recommend less intensive treatment.

Maintenance therapy

After successful chemotherapy with or without SCT, a doctor may recommend maintenance therapy. This treatment may help you stay in remission longer.

Maintenance therapy typically involves injections of rituximab every 2–3 months for up to 2 years. For some diagnoses, they may recommend a shorter treatment period.

You can ask your doctor about the potential benefits and risks of maintenance therapy. They can help you learn how it might affect your health and well-being, including your risk of relapse.

Whatever treatment you receive after chemotherapy, you will likely need regular follow-up appointments.

During these appointments, your care team checks for signs of relapse and side effects from treatments. They may order regular tests, such as blood tests and CT scans, to help monitor your condition.

You can ask your doctor how often to schedule checkups and routine tests.

The costs of follow-up care and treatments can vary widely, depending on:

• how often you visit your doctor
• the types and number of tests and treatments you receive
• whether you have health insurance coverage

If you have health insurance coverage, you can contact your insurance provider to learn how much follow-up appointments, routine tests, and treatment will cost.

If you cannot afford your doctor’s recommended treatment plan, let them know. In some situations, they might make changes to your prescribed treatment. They might know about rebates, discounts, or subsidy programs that could help reduce the cost of treatment. Or they might discuss available opportunities to enroll in a clinical trial to receive experimental treatment for free.

In most cases, MCL relapses within a few years. If your doctor learns that the cancer has come back or started to grow again, they typically recommend additional treatments.

They might prescribe another round of chemotherapy. Or they may recommend targeted treatments, such as:

• lenalidomide (Revlimid)
• ibrutinib (Imbruvica)
• acalabrutinib (Calquence)

The doctor’s recommended treatment plan typically depends on:

• your age and overall health
• the treatments you’ve received in the past
• how the cancer is behaving

If your condition relapses, ask your doctor about your treatment options and clinical trials you may qualify for. Researchers are working to develop new treatments for MCL and other types of lymphoma.

After initial treatment with chemotherapy, MCL usually goes into remission but eventually comes back. That’s why it’s important to stay in touch with your doctor. They can help you learn how to stay in remission for longer and what to do if the cancer starts to grow again.