Mantle cell lymphoma (MCL) is a very rare form of cancer, and oncologists may only see a few cases of it through the course of their careers. Because of this rarity, there has not been much research on MCL in comparison to other cancers. Recently, there have been advancements in the research and treatment of this disease. In the past, chemotherapy was the main form of treatment for those with MCL, but doctors have been moving towards chemo-free therapies like ibrutinib and acalabrutinib. The newest form of treatment for this cancer is CAR-T cell therapy.
About Mantle Cell Lymphoma (MCL)
Mantle cell lymphoma is a cancer that belongs to a larger group of diseases called non-Hodgkin’s lymphomas. MCL develops in the mantle zone within the lymph nodes, and it develops from cancerous white blood cells, also called lymphocytes. These lymphocytes become cancerous due to an error in their production or an error in the transformation of the white blood cell into a malignant cell. Once malignant they can multiply without control, which can result in the enlargement of certain lymph node regions and the spread of cancer to other parts of the body. It is a B-cell lymphoma.
Healthcare professionals are uncertain of the exact cause of mantle cell lymphoma. They suspect that there is a gene mutation that triggers the release of the cyclin D1 protein, which is responsible for cell growth. An excess of this protein causes uncontrolled growth of B-cells.
The majority of those with MCL do not experience symptoms in the early stages of the disease. The first sign of this cancer is swelling of the lymph nodes, usually in the throat and neck area. Swelling is also common in the elbows, shoulders, and chest. Other symptoms include a lack of appetite, sense of fullness, nausea, vomiting, indigestion, bloating, heart burn, repeated fever, unexplained weight loss, pressure and pain in the lower back and down the legs, one or multiple swollen lymph nodes, and bowel issues. Symptoms can be different if MCL spreads to the brain or spinal cord. If this occurs, symptoms include dizziness, headaches, poor balance, confusion, irritability, and a change in personality.
The first step in a diagnosis of MCL is a thorough examination of the lymph nodes and of the patient’s family and medical history. Doctors may run tests to confirm their suspicions of MCL. These tests include blood tests, biopsies, CT scans, PET scans, and colonoscopies.
Treatment tends to begin right after diagnosis, but if a patient is asymptomatic and has a slow-growing form of the cancer, doctors may choose to postpone treatment until symptoms are present. Treatment options include chemotherapy, immunotherapy, targeted therapy, and stem cell transplants.
Changes in Treatment for MCL
Treatment for MCL has recently evolved past chemotherapy. Chemo-free therapies like acalabrutinib and ibrutinib have changed how patients receive treatment. With these drugs patients do not lose hair, do not need a central line, have a lower infection rate, and their blood counts do not drop as sharply. More research is being conducted into treatments for MCL and many other cancers, which is bettering the options for those with these diseases.
About CAR-T Cell Therapy
CAR-T Cell therapy is a chimeric antigen receptor T-cell therapy, and is used for those who have developed a resistance to chemotherapy. As MCL is a very aggressive form of cancer, it can progress through chemotherapy and even targeted therapies. CAR-T cell therapy offers another form of treatment, in that they remove the T-cells from the patient, conduct a gene transfer, and then put the cells back into the patient, where they bind to and kill the lymphoma cells.
Studies have shown that this treatment is effective. In a report at the 2019 American Society of Hematology, it was found that 80% of participants responded to the treatment. 53% of participants responded completely. As the people in this study had already exhausted other forms of treatment, these results were very promising.
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