Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapy
Abstract The natural history of mantle cell lymphoma (MCL) is a continuous process with the vicious cycle of remission and recurrence. Because MCL cells are most vulnerable before their exposure to therapeutic agents, front-line therapy could eliminate MCL cells at the first strike, reduce the chanc...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | Journal of Experimental & Clinical Cancer Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13046-018-0800-9 |
| _version_ | 1819263540667613184 |
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| author | Haige Ye Aakash Desai Shengjian Huang Dayoung Jung Richard Champlin Dongfeng Zeng Fangfang Yan Krystle Nomie Jorge Romaguera Makhdum Ahmed Michael L. Wang |
| author_facet | Haige Ye Aakash Desai Shengjian Huang Dayoung Jung Richard Champlin Dongfeng Zeng Fangfang Yan Krystle Nomie Jorge Romaguera Makhdum Ahmed Michael L. Wang |
| author_sort | Haige Ye |
| collection | DOAJ |
| description | Abstract The natural history of mantle cell lymphoma (MCL) is a continuous process with the vicious cycle of remission and recurrence. Because MCL cells are most vulnerable before their exposure to therapeutic agents, front-line therapy could eliminate MCL cells at the first strike, reduce the chance for secondary resistance, and cause long-term remissions. If optimized, it could become an alternative to cure MCL. The key is the intensity of front-line therapy. Both the Nordic 2 and the MD Anderson Cancer Center HCVAD trials, with follow-up times greater than 10 years, achieved long-term survivals exceeding 10 years. But the Achilles heel in both trials were the severe toxicities, such as secondary malignancies including myelodysplastic syndromes /leukemia. Therefore, intensive therapies can act as a double-edged sword providing long term survival at the cost of severe toxicities. In our opinion, although intensive chemotherapy can cause detrimental side effects, it is indispensable given that we run the risk of sacrificing long-term survivals in these young and fit patients. We must seek for a powerful alternative at the front-line. Furthermore, minimal residual disease negativity should be the optimal therapeutic goal to achieve before and after autologous stem cell transplantation. Some novel therapeutic strategies have shown to improve outcomes, but it is not yet clear as to how these results translate in population. Of note, MCL patients need to be stratified at diagnosis and be provided with different intensities of front-line regimen. In this review, we discuss current strategies for the treatment of young patients with newly diagnosed MCL. |
| first_indexed | 2024-12-23T20:15:13Z |
| format | Article |
| id | doaj.art-0c516736ebdf409d8b21c9565be463d2 |
| institution | Directory Open Access Journal |
| issn | 1756-9966 |
| language | English |
| last_indexed | 2024-12-23T20:15:13Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Experimental & Clinical Cancer Research |
| spelling | doaj.art-0c516736ebdf409d8b21c9565be463d22022-12-21T17:32:42ZengBMCJournal of Experimental & Clinical Cancer Research1756-99662018-07-0137111210.1186/s13046-018-0800-9Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapyHaige Ye0Aakash Desai1Shengjian Huang2Dayoung Jung3Richard Champlin4Dongfeng Zeng5Fangfang Yan6Krystle Nomie7Jorge Romaguera8Makhdum Ahmed9Michael L. Wang10Department of Hematology, The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDivision of Cancer Medicine, Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterDepartment of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer CenterAbstract The natural history of mantle cell lymphoma (MCL) is a continuous process with the vicious cycle of remission and recurrence. Because MCL cells are most vulnerable before their exposure to therapeutic agents, front-line therapy could eliminate MCL cells at the first strike, reduce the chance for secondary resistance, and cause long-term remissions. If optimized, it could become an alternative to cure MCL. The key is the intensity of front-line therapy. Both the Nordic 2 and the MD Anderson Cancer Center HCVAD trials, with follow-up times greater than 10 years, achieved long-term survivals exceeding 10 years. But the Achilles heel in both trials were the severe toxicities, such as secondary malignancies including myelodysplastic syndromes /leukemia. Therefore, intensive therapies can act as a double-edged sword providing long term survival at the cost of severe toxicities. In our opinion, although intensive chemotherapy can cause detrimental side effects, it is indispensable given that we run the risk of sacrificing long-term survivals in these young and fit patients. We must seek for a powerful alternative at the front-line. Furthermore, minimal residual disease negativity should be the optimal therapeutic goal to achieve before and after autologous stem cell transplantation. Some novel therapeutic strategies have shown to improve outcomes, but it is not yet clear as to how these results translate in population. Of note, MCL patients need to be stratified at diagnosis and be provided with different intensities of front-line regimen. In this review, we discuss current strategies for the treatment of young patients with newly diagnosed MCL.http://link.springer.com/article/10.1186/s13046-018-0800-9Mantle cell lymphomaYoung fitIntensive therapyFront-line |
| spellingShingle | Haige Ye Aakash Desai Shengjian Huang Dayoung Jung Richard Champlin Dongfeng Zeng Fangfang Yan Krystle Nomie Jorge Romaguera Makhdum Ahmed Michael L. Wang Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapy Journal of Experimental & Clinical Cancer Research Mantle cell lymphoma Young fit Intensive therapy Front-line |
| title | Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapy |
| title_full | Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapy |
| title_fullStr | Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapy |
| title_full_unstemmed | Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapy |
| title_short | Paramount therapy for young and fit patients with mantle cell lymphoma: strategies for front-line therapy |
| title_sort | paramount therapy for young and fit patients with mantle cell lymphoma strategies for front line therapy |
| topic | Mantle cell lymphoma Young fit Intensive therapy Front-line |
| url | http://link.springer.com/article/10.1186/s13046-018-0800-9 |
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