Abby and John Friend Professor of Cancer Research, Professor in Medicine and Director of the Lymphoma Program at the Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Centre of Northwestern University
Would you briefly describe mantle cell lymphoma and discuss how common it is?
Mantle cell lymphoma (MCL) is a non-Hodgkin B-cell lymphoma, a relatively rare type of malignant lymphoma which, in the past, has been more resistant to treatment. MCL displays very characteristic features under the microscope, and it has molecular features as well. MCL makes up approximately five to 10 percent of all non-Hodgkin lymphoma’s.
How is MCL typically treated?
Treatment depends on the age and overall status of the patient, but the treatment for younger patients is an aggressive chemotherapy approach, sometimes followed by a stem cell transplant. In older patients, a less aggressive treatment regimen is often used, followed by rituximab (Rituxan) as a maintenance treatment. There are several very exciting new agents that are in development that have shown promising results MCL and are likely going to be approved soon.
What chemotherapy regimens do patients usually receive?
There are few different chemotherapy regimes for MCL. The first is rituximab hyper-CVAD (cyclophosphamide, vincristine, doxorubicin [Adriamycin], and dexamethasone alternating with methotrexate and cytarabine), which is an aggressive regimen but has very good response rates. Another is R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, prednisone); the duration of the responses isn’t as good, but it’s a little bit better tolerated. That regimen should probabkly be followed with stem cell transplant or for those patients who are not candidates for stem cell transplant , maintenance rituximab. The third is rituximab-bendamustine (Treanda), which is typically given to patients in their 60’s or 70’s.
In previously treated patients who have relapsed, lenalidomide (Revlimid) was recently approved for MCL, and bortezomib (Velcade) is approved in the US, and Temsirolimus (Torisel) is approved in Europe.
What are the current main areas of research for MCL?
There is a group of new drugs called B-cell receptor inhibitors. Among this group, ibrutinib (PCI-32765), which is a Bruton’s tyrosine kinase (BTK) inhibitor, appears quite promising and has been granted breakthrough approval status by the U.S. Food and Drug Administration. It is possible that this drug will be approved by the end of 2013 or the beginning of 2014. I do think that when ibrutinib is approved, the approach to this disease might change. It is something that is evolving right now, as new drugs are investigated in clinical trials and approved.
There is also extensive “basic” research going on in the laboratory to better understand the biology of the disease. This research is an important driver of the clinical research; the two are inter-related. We could not make the strides in this disease or in any disease without basic, laboratory based research.
Can you discuss the importance of clinical trials and are there specific trials that you want to discuss?
Clinical trials are important to develop new treatments and understand new drugs. For example, the clinical trial with ibrutinib shows a very high response rate and long duration of response. These data will likely lead to approval of the drug. Clinical trials are necessary for the advancement of new treatments.
What advice would you give to a newly diagnosed patient?
First, it is important for patients to see someone who specializes in lymphoma so they have access to some of the newer treatments and newer approaches to treatment, and so that the diagnosis can be established. Second, it is important that patients look at all the options suggested by their oncologist. Some people don’t need treatment right away; they can be observed for a period of time without being treated. Because this is an uncommon disease, I believe it is important for patients to be evaluated, or at least to get an opinion, from a physician who specializes in lymphoma.
How are you involved with the Lymphoma Research Foundation and why you would recommend a patient become involved with this organization?
Since 2007 I have served on the Scientific Advisory Board for the Lymphoma Research Foundation (LRF). The Scientific Advisory Board is responsible for reviewing all grant applications and for creating the agenda for the type of grants that are awarded. Members of the Scientific Advisory Board also give lectures to patients and plan regional seminars and forums, which are held in different areas of the country. Recently, we had a regional forum in Chicago and more than 500 patients attended. The Scientific Advisory Board planned the one-day forum which included lectures and breakout sessions on the different types of lymphoma. I have held the position of Chair of the Mantle Cell Consortium, which specifically focuses on research in MCL. Each year we sponsor a one-day workshop on MCL for physicians and scientists, and this meeting precedes LRF’s Scientific Advisory Board meeting. There are keynote lectures which discuss the basic and clinical research taking place. Starting in July, 2014, I’ll be the Chair of the Scientific Advisory Board for a period of two years.
Through the LRF Mantle Cell Consortium, we have established MCL cell lines that are available to anyone around the world who doing research in MCL. So, it’s a very good resource for scientists and physicians working in MCL.
I think that patients should be involved with the Lymphoma Research Foundation because they are so patient-focused, especially with coordinating the patient forums and lectures–that’s one of the main reasons patients should seek out information from LRF. There’s a lot more information geared to patients with this organization than there might be in some others.
Updated August 21, 2013