Mantle cell lymphoma
Mantle cell lymphoma is a rare type of B cell non-Hodgkin lymphoma (NHL).
NHL is a type of blood cancer that affects white blood cells called
Treatment usually includes
What is mantle cell lymphoma?
Mantle cell lymphoma is a rare type of B cell non-Hodgkin lymphoma (NHL).
Lymphoma develops when white blood cells called lymphocytes grow out of control. They move around your body in your blood and your lymphatic system.
The lymphatic system is an important part of our immune system. It has tubes that branch through all parts of the body.
These tubes are called lymph vessels or lymphatic vessels and they carry a straw coloured liquid called lymph. This liquid circulates around the body tissues. It contains a high number of white blood cells (lymphocytes) which fight infection.
There are two types of lymphocytes: T lymphocytes (T cells) and B lymphocytes (B cells).
Mantle cell lymphoma develops when the body makes abnormal B lymphocytes. So it is a type of B cell lymphoma. It develops in the part of the lymph node called the mantle zone.
The abnormal lymphocytes build up in the
Symptoms
The symptoms of mantle cell lymphoma are similar to those of most other types of NHL.
Painless swellings
The most common symptom of non-Hodgkin lymphoma (NHL) is one or more painless swellings in the:
-
neck
-
armpit
-
groin
These swellings are enlarged lymph nodes.
See your GP if you have a swollen lymph node that does not go away after 3 to 4 weeks.
General symptoms (B symptoms)
Other symptoms
Mantle cell lymphoma can develop outside the lymph nodes. The symptoms you have depend on where it grows. For example, it can grow in your:
- tummy (abdomen) or bowel - this might cause pain, diarrhoea or sickness
- bone marrow - this can cause
anaemia , bruising or bleeding problems - spleen - this can make you feel full very quickly when you eat, or cause discomfort behind your ribs
Stages and grades of mantle cell lymphoma
Grade
Grade describes how the cells look under a microscope. Your grade tells the doctor how quickly the lymphoma is likely to grow and spread. Doctors put NHL into 2 grades:
- low grade (slow growing)
- high grade (fast growing)
Mantle cell lymphoma looks like a low grade lymphoma under the microscope. But it often grows faster, more like a high grade lymphoma.
Stage
You have tests to find out the number of places in your body affected by lymphoma, and where these are. This is your stage. Doctors use your stage to plan your treatment.
There are 4 main stages of NHL (stage 1 to stage 4). Or your doctors might talk about early (limited) stage and advanced stage lymphoma.
Early stage usually means either stage 1 or stage 2 lymphoma. Advanced stage usually means either stage 3 or stage 4 lymphoma.
Mantle cell lymphoma can grow quickly. So unfortunately it's often widespread at diagnosis. This means you may have lymphoma cells in your lymph nodes, bone marrow and spleen.
Treatment
Treatment for mantle cell lymphoma can be similar to treatment for other types of NHL.
It grows quickly and is often diagnosed when it is in a later stage. Treatment can sometimes get rid of the lymphoma completely. But unfortunately it can come back fairly soon afterwards.
Chemotherapy and immunotherapy
You usually have some chemotherapy drugs in combination with immunotherapy and steroids. Chemotherapy aims to damage and kill cancer cells as they divide. Immunotherapy uses the immune system to fight cancer.
The most commonly used combinations are:
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and dexamethasone)
- R-DHAP (rituximab, cytarabine, cisplatin and dexamethasone)
- Nordic protocol (rituximab, cyclophosphamide, doxorubicin, vincristine, cytarabine, prednisolone)
- Bendamustine and rituximab
You might also have the drug lenalidomide.
Steroids
Steroids are substances made naturally in the body. They can also be made artificially and used as drugs.
For NHL, you take steroids along with your chemotherapy drugs. The treatment is more successful when you have steroids and chemotherapy together. Commonly used steroid drugs include prednisolone, dexamethasone and methylprednisolone.
Radiotherapy
Stem cell transplant
You might have a stem cell treatment if you are fit enough for high dose treatment and your lymphoma has responded to chemotherapy treatment. You may also have this treatment if your mantle cell lymphoma has come back after previous treatments.
There are different combinations of high dose treatment. The most common include:
- BEAM (carmustine, etoposide, cytarabine and melphalan)
- LEAM (lomustine, etoposide, cytarabine and melphalan)
After high dose treatment you have a transplant using your own stem cells.
You need to stay in hospital for a couple of weeks to have these treatments. It is hard going, but you get a lot of support from the staff during your stay in hospital and afterwards.
Less intensive treatment
If you are unable to have intensive treatment you might have:
-
bortezomib (a targeted cancer drug)
-
chlorambucil (a chemotherapy drug)
-
ibrutinib
Research
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to:
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make existing treatments better
-
develop new treatments
Treatments being tested for mantle cell lymphoma include:
-
olaparib
-
low intensity (mini) transplants
Coping with NHL
It can be difficult finding our you have NHL. Some people find it can be particularly worrying in the run up to check up appointments.
Advice and support is available to help you cope with NHL and its treatment.
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