NCCN Guidelines for Patients® | Mantle Cell Lymphoma

13 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2019 1  MCL basics Treatment types Treatment types This section briefly describes treatments for MCL. Not everyone receives the same treatment. Your doctor will tailor treatment to you based on tests described in this chapter and in Part 2 . Treatment options based on the extent of cancer and other factors are listed in Part 3 . Clinical trial One treatment choice may be a clinical trial. Joining a clinical trial is strongly supported by NCCN. NCCN believes that you will receive the best management if treated in a clinical trial. A clinical trial is a type of research that studies a promising test or treatment in people. It gives people access to health care that otherwise couldn’t usually be received. Ask your treatment team if there is an open clinical trial that you can join. Chemotherapy Chemotherapy works by damaging and killing cancer cells. It can also cause cells to destroy themselves. Chemotherapy is often used with rituximab to treat MCL. This combined treatment is called chemoimmunotherapy. There are many types of chemotherapy used to treat MCL. Vincristine belongs in a class of drugs called vinca alkaloids. Doxorubicin belongs in the class of drugs called anthracyclines. Bendamustine, carboplatin, cisplatin, cyclophosphamide, and oxaliplatin belong to a class of drugs called alkylating agents. Methotrexate and cytarabine belong to a class of drugs called antimetabolites. Corticosteroids Corticosteroids are a class of drugs that are often used to relieve inflammation. They also are toxic to MCL cells. Prednisone and dexamethasone are the two main corticosteroids used for treatment. They are part of some chemoimmunotherapy regimens. Antibody treatment Antibodies are proteins of the immune system. They help your body fight germs and other threats. Monoclonal antibodies can be made in a lab to treat certain types of cancer. Rituximab is an antibody treatment for MCL. It attaches to a surface protein on cells called CD20. It marks the cells so that your immune system can find and destroy them. It may directly kill cells, too. Targeted therapy Targeted therapy is a class of drugs. It impedes the growth process that is specific to cancer cells. It harms normal cells less than chemotherapy. Kinase inhibitors Within cells, kinases are part of many chemical pathways, some of which control cell growth. They change the action of proteins by attaching phosphates to them. Kinase inhibitors are drugs that stop kinases within cancer cells. Ibrutinib and acalabrutinib are drugs that stop a kinase called Bruton’s tyrosine kinase. This lowers the number of new MCL cells being made. BCL-2 inhibitors BCL-2 is a protein inside of B cells that helps prevent cell death. BCL-2 may build up in cancer cells and stop them from dying. Venetoclax is a BCL-2 inhibitor that allows the cancer cells to self-destruct. Immunomodulators Immunomodulators are drugs that modify some parts of the immune system. Lenalidomide is an immunomodulator that is used to treat MCL. Rituximab, ibrutinib, or both may be received with lenalidomide. Radiation therapy Radiation therapy uses high-energy x-rays to treat MCL. The x-rays damage DNA in cancer cells. This either kills the cancer cells or stops new cancer cells