Frontline therapy in mantle cell lymphoma: the role of high-dose therapy and integration of new agents.
Mantle cell lymphoma (MCL) is a unique lymphoma subtype comprising 6% to 8% of new lymphoma diagnoses. It is generally considered to be incurable with standard lymphoma therapies. The median overall survival (OS) is often reported to be 3 to 4 years, but more recent data suggest that the median OS may be longer than 5 years. There is considerable heterogeneity in MCL, with some patients succumbing to their disease in less than a year and others surviving for more than 10 years. The biology of MCL is reasonably well understood, and targeted therapies based on this knowledge are in development. Clinical trials incorporating new agents into standard therapies are under way. The optimal frontline treatment strategy is not defined and is a source of controversy. Intensive therapies administered to younger patients appear to produce better-quality remission than standard treatments, and one randomized clinical trial demonstrates improved OS with an intensive approach. Additional randomized clinical trials defining standard approaches are needed.
Kahl
Brad S
BS
University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, H4/534 CSC, Madison, WI, 53792, USA. bsk@medicine.wisc.edu
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003131:Combined Modality Therapy; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000628:therapy*; D009588:Nitrogen Mustard Compounds / Q000008:administration & dosage; D011719:Pyrazines / Q000008:administration & dosage; D016499:Radioimmunotherapy / Q000379:methods*; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D016019:Survival Analysis; D016896:Treatment Outcome
D001897:Boronic Acids; D009588:Nitrogen Mustard Compounds; D011719:Pyrazines; C401859:temsirolimus; D000069286:Bortezomib; D000069461:Bendamustine Hydrochloride; D020123:Sirolimus