How is mantle cell lymphoma usually treated?

If you have mantle cell lymphoma (MCL) that’s growing quickly or causing symptoms, your doctor will likely prescribe chemotherapy medications to treat it. They might also prescribe other drugs, such as rituximab (Rituxan), bortezomib (Velcade), or a combination of chemotherapy with antibody treatment known as chemoimmunotherapy. In some cases, they might recommend radiation therapy, too.

After initial treatment with chemotherapy, MCL usually goes into remission. That happens when the cancer has shrunk and is no longer growing. Within a few years, the cancer usually starts growing again. This is known as relapse.

If you achieve remission after chemotherapy, your doctor might recommend a stem cell transplant, maintenance therapy, or both to help keep you in remission for longer. Their recommended plan will depend on your age and overall health, as well as the behavior of the cancer.

To learn about your recommended treatment plan following chemotherapy, here are a few questions that you can ask your doctor.

If you’re young and fit, your doctor might recommend a stem cell transplant (SCT) after chemotherapy. This procedure replaces bone marrow that’s been killed by the cancer, chemotherapy, or radiation therapy.

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. For example, possible complications include:

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

Medications prescribed to promote a successful transplant 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 those with other illnesses. In these cases, less-intensive treatment is usually recommended.

To learn if SCT might be a good choice for you, talk to your doctor. They can help you understand the potential benefits and risks of this procedure. They can also direct you in choosing between different types of SCT.

There are two main types of SCT: autologous and allogeneic.

If you undergo autologous SCT, your healthcare team will remove and freeze some of your stem cells before chemotherapy. After you finish chemotherapy, they’ll thaw and transplant the stem cells back into your body.

If you go through allogeneic SCT, your healthcare team will give you stem cells from another person. In most cases, the best donor is a sibling or other close relative. But you might be able to find a suitable match through a national transplant registry.

Each approach has potential benefits and risks. If you’re a good candidate for SCT, ask your doctor about the relative pros and cons of autologous and allogeneic transplants. If you decide to undergo one of these procedures, ask your doctor:

  • What should I expect during and after the procedure?
  • How can I prepare for the procedure?
  • How can I reduce my risk of complications?

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

Maintenance therapy typically involves injections of rituximab every two to three months. Your doctor may advise you to receive these injections for up to two years. In some cases, they may recommend a shorter treatment period.

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, your doctor will encourage regular follow-up appointments.

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

Ask your doctor how often you should schedule checkups and routine tests.

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’ll probably recommend additional treatments.

In some cases, they might prescribe another round of chemotherapy. Or they might recommend targeted treatments, such as:

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

Your doctor’s recommended treatment plan will depend 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.

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 or not you have health insurance coverage

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

If you can’t afford your doctor’s recommended treatment plan, let them know. In some cases, they might make changes to your prescribed treatment. They might know about rebate or subsidy programs that could help reduce the cost of treatment. Or they might encourage you to enroll in a clinical trial to receive experimental treatment for free.

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.