NCCN Guidelines for Patients® | Mantle Cell Lymphoma
22 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2019 3 Treatment guide Overview This chapter presents the treatment options for MCL. It also reviews supportive care. Discuss with your doctor which options are right for you. Overview Treatment of MCL includes treatment of the cancer and support for you. At this time, MCL is not cured. Instead, the aim of treatment is to reduce symptoms, control the cancer, and extend life. Initial treatment Options for initial treatment depend on many factors. These factors include your age and level of fitness. Your doctor will also plan treatment based on the cancer. A very important factor is the cancer stage. Cancer stage The cancer stage describes the extent of cancer in the body. It is often based on blood tests, imaging, and biopsy results. The Lugano modification of the Ann Arbor Staging System is used for most lymphomas. In this system, there are five stages, which are: Stage I Stage II Stage II bulky Stage III Stage IV Rarely, MCL is stage I or II at diagnosis. The extent of these cancers is limited. They involve lymph nodes or an organ on one side of the diaphragm. Stage II bulky is stage II with a large tumor. Almost always, MCL is stage III or IV at diagnosis. The extent of these cancers is advanced. Stage III cancers involve 1) lymph nodes on both sides of the diaphragm or 2) lymph nodes above the diaphragm and the spleen. Stage IV cancers have widely spread outside of the lymph system. Treatment approach Your doctor will prescribe treatments that are safe and most likely to work. For MCL, chemoimmunotherapy is often used. This combined treatment uses both chemotherapy and rituximab. For chemoimmunotherapy, there are regimens that are intense and less intense. Good results are often achieved with either intense or less intense regimens. More research is needed to learn if one regimen is better than another. Intense regimens have more risk of harm, so they aren’t often given to older adults. A stem cell transplant is an intense treatment. So, it may not be part of your plan. If it is, get a referral from your doctor to the transplant center early on. Switching from chemoimmunotherapy to the transplant may go more smoothly. Treatment response Testing will be done to assess treatment outcomes. These tests include PET/CT. Contrast should be used with the CT scan. Tests done after treatment will be compared to those done before treatment. In the Lugano system, there are 4 types of treatment response. Complete response is the best result. Tests detect less cancer to the extent that suggests a good outlook (prognosis). Organs are of normal size. Bone marrow is normal. Partial response is a decrease in cancer but less so than a complete response.