Mantle cell lymphoma in patients non-eligible for high-dose chemotherapy

Abstract

Mantle cell lymphoma typically occurs at the age of 65 or more, is usually a generalized neoplasm of B-cell origin involving lymph nodes, bone marrow, blood, and gastrointestinal tract. Initially, it is reasonably well responsive to treatment but relapses uniformly follow with increasing resistance to subsequent treatments. A diagnosis requires histopathologic examination by experienced hemato-pathologist, immunohistochemistry, and in cases of atypical morphology or immunophenotype – FISH and flow cytomtery. A clinical course is heterogenous due to variable sites of involvement, rate of disease progression, and a burden of comorbidities in individual patient. The optimal treatment is a combination of anti-CD20 antibody and chemotherapy that needs to be tailored to the patient's particular health conditions. Rational choices include R-CHOP, bendamustine, and chlorambucil. If complete or partial remission is achieved, maintenance rituximab may prolong remission duration significantly. In rare cases of limited disease, involved field radiotherapy may result in long-term remissions. At relapse, treatment should be guided by symptoms or complications and aimed at the best possible quality of life. The optimal option would be a clinical trial of a new agent.