Although MCL usually responds well to initial treatment, patients often relapse (disease returns after treatment) within a few years. For patients who relapse or become refractory (disease does not respond to treatment), secondary therapies may be successful in providing another remission.
Like other forms of non-Hodgkin lymphomas (NHL), there is no consensus on the best treatment for relapsed or refractory MCL; however, there are an increasing number of treatment options available for these patients. The type of treatment recommended for any individual patient depends on several factors, including the timing of the relapse, the patient's age, extent of disease, overall health, and prior therapies received.
Three agents have been approved by the FDA for treatment of relapsed or refractory MCL:
- Bortezomib (Velcade) with or without rituximab
- Ibrutinib (Imbruvica)
- Lenalidomide (Revlimid) with or without rituximab
Although not approved in combination, bortezomib and lenalidomide may be used with rituximab (Rituxan). Additional agents and regimens that are commonly used for the treatment of relapsed/refractory MCL include:
- Bendamustine (Treanda) +/- rituximab
- Combination chemotherapy +/- rituximab
Stem cell transplant (SCT) can be effective in patients with relapsed or refractory MCL. There are two types of SCTs: allogeneic (in which patients receive stem cells from another person) and autologous (in which patients receive their own stem cells). Autologous SCT is generally considered after initial therapy rather than in relapse, but may be an option for medically fit patients who have shown a good response to treatment of their relapsed MCL. In the case of younger, medically fit patients, intensive chemotherapy followed by allogeneic stem cell transplantation is a higher risk, but potentially a curative option.
Treatments Under Investigation
There are several clinical trials investigating the effectiveness of various new agents to be used in combination with current or new combination therapies, for relapsed or refractory MCL:
- Abemaciclib, ACP-196
- Carfilzomib (Kyprolis)
- Everolimus (Afinitor)
- Ibritumomab (Zevalin)
- Idelalisib (Zydelig)
- Obinutumzumab (Gazyva)
- Ofatumumab (Arzerra)
- Panobinostat (Farydak)
- Romidepsin (Istodax)
- Temsirolimus (Torisel)
- Tipifarnib (Zarestra)
- Vorinostat (Zolinza)
In addition, novel combinations of agents currently used in MCL are also being explored. Treatment options are changing as new therapeutics are becoming available and current treatments are improved.
For additional information on these therapies, as well as treatments for mantle cell lymphoma that are currently under investigation, view or order your free copy of the Lymphoma Research Foundation's Mantle Cell Lymphoma Fact Sheet or Relapsed/ Refractory Mantle Cell Lymphoma Fact Sheet.
Please note: Because today's scientific research is continuously evolving, it is important that patients check with their physician or with the Lymphoma Research Foundation (LRF) for any treatment updates that may have recently emerged.