Mantle cell lymphoma stage IV

Many people in the 28 counties and districts are familiar with this because everyone has more or less lymphatic tissue. This is a potential risk to people's bodies, where lymphatic tissue may mutate into lymphatic tumors or lymphatic cancer. Mantle cell lymphoma is a common type of lymphoma that occurs in people. I believe many people know that after suffering from a tumor, it will be divided into different stages according to the development of the tumor. So what is the status of stage 4 mantle cell lymphoma?

Mantle cell lymphoma is a special type of B-cell lymphoma that has been identified in recent years. In the past, this tumor was named intermediate lymphocytic lymphoma, centrocellular lymphoma (Kei) or classified as diffuse small cleaved cell lymphoma (WF). It is now known that the tumor originates from CD5, CD23 peripheral B cells in the inner layer of the follicular mantle that are not stimulated by antigens, so it is named mantle cell lymphoma.

How does mantle cell lymphoma differ from other small B-cell lymphomas?

Small B-cell lymphoma, immunocytic lymphoma/lymphoplasmacytic lymphoma, follicular lymphoma, mucosal and lymphoid tissue (MALT)-type marginal zone B-cell lymphoma (including monocytic-like B-cell lymphoma), and splenic marginal zone B-cell lymphoma and MCL are all small B-cell lymphomas. Mantle cell lymphoma is similar to most common small B-cell lymphomas. The tumor is more common in middle-aged and elderly people. It is often clinically stage III or IV and involves lymph nodes, bone marrow, liver, spleen and peripheral blood. However, mantle cell lymphoma is more common in elderly men; when it occurs extranodally, it is most often located in the gastrointestinal tract and oropharyngeal ring; the average survival time of patients is 3 to 5 years, and the prognosis is worse than other low-grade small B-cell lymphomas, and it is moderately malignant. Therefore, the treatment options and prognosis of mantle cell lymphoma are different from other small B-cell lymphomas.

How to judge the prognosis of mantle cell lymphoma

The prognosis of mantle cell lymphoma is often predicted based on the International Prognostic Index. MIPI (MCL International Prognostic Index) is a new MCL prognostic index proposed by Hoster et al. It divides patients into low-risk, intermediate-risk and high-risk groups according to four indicators: white blood cell count, Eastern Cooperative Oncology Group (ECOG) performance status (PS) score, lactate dehydrogenase (LDH) and age. There are significant differences in the survival of patients in each group.

How is mantle cell lymphoma treated?

Currently, the first-line treatment options for mantle cell lymphoma include R-CHOP and R-DHAP. At present, it seems that the complete remission rate of the R-DHAP regimen is higher, suggesting that cytarabine has a good effect on mantle cell lymphoma. In recent years, our hospital has achieved better therapeutic effects by using rituximab combined with bendamustine (RB), with an effective rate of 94% and good tolerance. The short-term efficacy of bortezomib combined with R-HyperCVAD is also good, but long-term follow-up is still needed to determine whether PFS and OS can be improved.

Treatment of relapsed patients: For relapsed or drug-resistant mantle cell lymphoma, the PEPC (prednisone + etoposide + procarbazine + cyclophosphamide) regimen has a certain effect on elderly patients with relapsed mantle cell lymphoma. The effective rate was 73%, the median PFS was 12 months, and the median OS was 22 months.