Mantle Cell Lymphoma

Mantle cell lymphoma is a type of cancer that develops in an area in the lymph nodes called the mantle zone. This results in a disruption in one type of white blood cell, namely B lymphocytes, which are able to produce antibodies to fight infection. This type of cancer is aggressive and often undiagnosed until the cancer cells spread to other organs. Mantle cell lymphoma is a type of non-Hodgkin's lymphoma and is very rare.

Causes of Mantle Cell Lymphoma

The cause of mantle cell lymphoma is not known with certainty, but gene mutations are thought to be the cause of the formation of abnormal B lymphocytes. Gene mutations cause the body to release too much cyclin D1 protein, which triggers abnormal reactions and growth of lymphocyte cells in the lymph nodes.

In addition, there are several factors that increase a person's risk of developing mantle cell lymphoma, namely:

•     Male gender
•     Age over 60 years
•     Weak immune system, which can be caused by HIV or consumption of immunosuppressive drugs
•     Viral or bacterial infections, such as Helicobacter pylori and Epstein Barr virus
•     Autoimmune diseases, such as rheumatoid arthritis, Sjogren's syndrome, and lupus
•     Exposure to pesticides.

Symptoms of Mantle Cell Lymphoma
Most sufferers do not realize that they have mantle cell lymphoma, so they are only diagnosed at an advanced stage, after the cancer cells have spread to other parts of the body. The main symptom of mantle cell lymphoma is swollen lymph nodes in the neck, armpits, or groin.

Mantle cell lymphoma can also cause other symptoms, including:

•     Nausea and vomiting
•     Fever without apparent cause
•     Excessive sweating at night
•     Decreased appetite
•     Gastric pains
•     Lower back pain
•     Discomfort due to enlarged tonsils, and liver or spleen.

Diagnosis of Mantle Cell Lymphoma

Doctors can suspect a patient suffering from mantle cell lymphoma if there are symptoms, which are strengthened by physical examination and investigations. Supporting examinations to be carried out include:

•     Blood test, to count white blood cell counts and detect antibodies that indicate mantle cell lymphoma.
•     Biopsy, which is an examination of swollen lymph node tissue samples that experience swelling to detect the presence of cancer cells. Biopsy can also be done on other organs, such as bone marrow.
•     CT scan, to detect the spread of lymphoma cells in other organs.
•     Colonoscopy, to detect whether lymphoma cells have spread to the large intestine.

After confirming the diagnosis, the doctor will determine the stage of the cancer suffered by the patient. Determination of the stage of cancer can help doctors to determine the method of treatment and estimate the possibility of cure. Just like other types of lymphoma, lymph cell mantle is also divided into 4 stages, namely:

•     Stage 1 - cancer cells attack lymph nodes in one area of ​​the body, such as the neck.
•     Stage 2 - cancer cells attack lymph nodes in two or more areas of the body, but all of these areas are still above the diaphragm or below the diaphragm.
•     Stage 3 - cancer cells have spread to lymph nodes in several areas of the body above and below the diaphragm.
•     Stage 4 - cancer cells have spread to organs outside the lymphatic system, such as bone marrow, liver, or lungs.

Mantle Cell Lymphoma Treatment

The doctor will determine the steps for treating mantle cell lymphoma based on several factors, namely:

•     Symptoms that appear
•     Overall age and condition of the patient
•     Lymphoma stage.

Patients with slow-growing mantle cell lymphoma (indolent lymphomas) will undergo the process of monitoring without treatment. The doctor will instruct the patient to conduct consultations every 2-3 months and undergo examination tests every 3-6 months to monitor lymphoma progression. If you experience enlargement, the doctor will take medication. Types of treatment that can be done, namely:

•     Chemotherapy. It is the main treatment step for treating mantle cell lymphoma. Chemotherapy uses a combination of drugs given intravenously to kill and prevent the development of lymphoma. Some combinations of drugs used in chemotherapy procedures are:
•         R-CHOP, a combination of the drugs rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.
•         VcR-CAP, a combination of bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone.
•         Maxi-R-CHOP, a combination of R-CHOP with cytarabine.
•         R-hyperCVAD, a combination of rituximab, cyclophosphamide, vincristine, doxorubicin, and dexamethasone, alternates with cytarabine and high-dose methotrexate.
•         R-DHAP, a combination of drugs rituximab, dexamethasone, cytarabine, and cisplatin.
•         R-CVP, a combination of drugs rituximab, cyclophosphamide, vincristine, and prednisone.
•         R-CBP, a combination of the drug rituximab, cyclophosphamide, bortezomib, and prednisone.
•     Radiotherapy, which is a treatment procedure with high-dose X-ray exposure to destroy cancer cells. Radiotherapy is performed on patients with stage 1 or 2 mantle cell lymphoma, and to relieve pain in certain parts of the body.
•     Bone marrow transplantation, which is a treatment procedure by inserting healthy blood stem cells into the body to restore the function of the bone marrow in producing healthy blood cells. A bone marrow transplant is performed if:

•         The patient's body is quite healthy and ready to undergo high dose treatment
•         Lymphomas respond well to chemotherapy treatment
•         Lymphoma reappears. 

 During treatment, patients will experience side effects from chemotherapy, radiotherapy, or bone marrow transplant procedures. Side effects that can arise are nausea, vomiting, body feels weak, itching or rashes on the skin, hair loss, and hands or feet feel burning and numbness. The support of family and loved ones is very important for patients, given the condition of patients who are vulnerable to emotional distress while undergoing treatment.
Complications of Mantle Cell Lymphoma

Mantle cell lymphoma can cause several complications, namely:

•     Leukocytosis or high number of white blood cells. This condition occurs when cancer cells have spread to arteries and veins.
•     Low blood cell count, occurs when lymphoma cells develop more and more and affect the bone marrow in producing normal blood cells, so the production of blood cells decreases. Low number of blood cells can cause anemia (low red blood cells), neutropenia (low white blood cells), and thrombocytopenia (low platelet count).
•     Disorders of the digestive tract. The growth of lymphoma cells can cause the formation of polyps along the digestive tract, so the intestines will narrow.

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