Combination Chemotherapy for Mantle Cell Lymphoma

Your treatment for mantle cell lymphoma depends on a variety of things, such as the stage of the disease, your age, and your overall health. Most people will get a combination of chemotherapy drugs, plus other medicines to destroy as much of the cancer as possible.

After Your Diagnosis

The first treatment that doctors often suggest for mantle cell lymphoma are a few different chemotherapy drugs, together with rituximab (Rituxan). Rituximab is a medicine called a monoclonal antibody that works with your immune system -- the body's defense against germs -- to kill cancer cells. You might hear your doctor call this treatment "combination chemo-immunotherapy."

A steroid drug like prednisone or dexamethasone might also be part of your treatment plan. Steroids can help chemotherapy work better and lessen the side effects.

Doctors use several chemotherapy combinations to treat mantle cell lymphoma. They're named for the first letter of each drug.

R-CHOP:

R = rituximab
C = cyclophosphamide
H = hydroxydaunomycin
O = vincristine sulfate (Oncovin)
P = prednisone

Hyper-CVAD:

C = cyclophosphamide
V = vincristine sulfate
A = doxorubicin (Adriamycin)
D = dexamethasone

Hyper stands for "hyperfractionated," which means that each daily dose is divided into smaller doses. Giving the drugs this way may help them work better. This chemotherapy plan also includes methotrexate and cytarbine. Because this treatment can have strong side effects, your doctor might not recommend it if you're older or you have other health problems.

VcR-CAP:

V = bortezomib (Velcade)
R = rituximab (Rituxan)
C = cyclophosphamide
A = doxorubicin (Adriamycin)
P = prednisone

VcR-CAP includes the targeted drug bortezomib (Velcade). Bortezomib is a type of medicine called a protease inhibitor. It prevents substances called proteasomes from breaking down the proteins inside cancer cells. When too many proteins build up, the cell dies.

Other chemotherapy options include drugs like cytarabine, cisplatin, and oxaliplatin in various combinations with rituximab and steroids. There is also a two-drug combination of rituximab plus a newer chemotherapy drug, bendamustine (Bendeka).

Some younger people with mantle cell lymphoma will get one or more high-dose chemotherapy drugs, followed by a treatment called autologous stem cell transplant. High doses of chemo kill lots of cancer cells, but they also damage healthy blood-forming cells in the bone marrow. A stem cell transplant puts these cells back in your body so your bone marrow can start to make healthy blood cells again.

If you're older or you have other health problems, these chemo combinations may be too strong for you to handle. Your doctor might instead suggest a single, gentler chemotherapy drug like chlorambucil (Leukeran).

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How You Get Chemo

Most of the chemotherapy drugs that treat mantle cell lymphoma come as a liquid that a doctor injects into your vein.  Other drugs are in pill form.

You get chemotherapy in cycles. You'll take the drugs for a few days, and then rest for a few days to give your body a chance to recover. Most cycles are 2 to 4 weeks long.

Side Effects

Chemotherapy kills cells that divide quickly, like cancer cells. But you also have healthy fast-growing cells in your hair follicles, mouth, intestines, and blood. The death of these healthy cells can cause side effects such as:

  • Temporary hair loss
  • Nausea and vomiting
  • Diarrhea
  • Tiredness
  • Mouth sores
  • Infections

Which problems you get depends on the types and doses of the drugs you take. Using more than one medicine at a time can raise your chances of side effects.

If Treatment Doesn't Work or Cancer Comes Back

The goal of treatment is to put mantle cell lymphoma into remission, which means you no longer have signs of cancer in your body. But it doesn't work for everyone. Mantle cell lymphoma that doesn't improve after your first round of treatment is called "refractory."

When your cancer returns after you go into remission, it's called a relapse.

If the first treatment doesn't work or your cancer comes back, your doctor can put you on another round of chemotherapy. Or you can try medicines called targeted drugs.

Acalabrutinib (Calquence) and ibrutinib (Imbruvica) are in a class of targeted drugs called BTK inhibitors. They block the Bruton's tyrosine kinase (BTK) protein, which B cells need to grow.

Researchers are studying new combinations of chemotherapy and other drugs for mantle cell lymphoma in clinical trials. If the treatments you've tried haven't controlled your cancer, ask your doctor if one of these trials might be a good fit for you.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on February 03, 2019

Sources

SOURCES:

Cancer Research UK: "Bortezomib (Velcade)."

Leukemia & Lymphoma Society: "Mantle Cell Lymphoma Facts."

Lymphoma Action: "Mantle Cell Lymphoma," "Steroids."

Lymphoma Research Foundation: "Mantle Cell Lymphoma: Treatment Options."

Mayo Clinic: "Rituximab (Intravenous route)."

Medscape: "Mantle Cell Lymphoma."

Memorial Sloan Kettering Cancer Center: "Autologous Transplantation."

National Cancer Institute: "Acalabrutinib receives FDA approval for mantle cell lymphoma," "Hyper-CVAD."

National Comprehensive Cancer Network: "Clinical Practice Guidelines in Oncology: B-Cell Lymphomas," "Guidelines for Patients: Mantle Cell Lymphoma."

National Organization for Rare Disorders: "Mantle Cell Lymphoma."

American Cancer Society: "Treating B-Cell Non-Hodgkin Lymphoma."

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