Mantle cell lymphoma
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Mantle cell lymphoma (MCL) is a rare type of non-Hodgkin lymphoma (NHL). MCL develops when B-cells become abnormal (cancerous). B-cells are white blood cells that normally help fight infection. They are sometimes called B-lymphocytes.
The abnormal B-cells (lymphoma cells) usually build up in lymph nodes, but they can affect other parts of the body.
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Painless swelling in the neck, armpit or groin
Some people do not have any symptoms, but a painless swelling in the neck, armpit or groin is the most common sign of MCL. It is caused by lymphoma cells building up in the lymph nodes, which makes them bigger.
Some people also have symptoms that doctors call B symptoms. These can include:
- drenching night sweats which require a change of nightwear and bed covers
- high temperatures (fevers) with no obvious cause
- unexplained weight loss.
Knowing if you have any B symptoms will help your doctor to stage the lymphoma and plan your treatment.
Sometimes MCL can affect other areas of the body. These can include the spleen, bowel and bone marrow.
Depending on where the lymphoma spreads to, this can cause symptoms such as:
- loss of appetite
- sickness (nausea)
- a full feeling in the tummy – this is caused by an enlarged spleen
- anaemia – this is caused by the low number of red blood cells in your blood.
The causes of mantle cell lymphoma (MCL) are mostly unknown. MCL is most common in people over the age of 70. It is more common in men than women.
Like other cancers, MCL is not infectious. It cannot be passed on to other people.
We have more information about causes and risk factors for non-Hodgkin lymphoma.
Sometimes MCL can be found with a routine blood test. But usually the most common test for diagnosing lymphoma is a biopsy. A doctor will take a sample of tissue from the affected area. The most common place to take a biopsy from is an enlarged lymph node. This is called a lymph node biopsy. You may have all or a part of the lymph node removed. The tissue will be sent to a laboratory for testing.
You may also have biopsies taken from other areas of your body, such as your bowel. This is done during a test called a colonoscopy.
You can read more about the tests you may have in our information about non-Hodgkin lymphoma.
Waiting for test results can be difficult. You may find it helpful to talk to your family, friends or specialist nurse.
Your test results will help your doctors find out how many areas of your body are affected by lymphoma and where these areas are. This is called staging.
Lymphomas are also grouped as either low-grade or high-grade. Low-grade lymphomas are usually slow growing. High-grade lymphomas usually grow more quickly. Mantle cell lymphoma (MCL) can be either high-grade or low-grade.
Knowing the stage and grade of the lymphoma helps your doctor plan the right treatment for you.
We have more information about the stages and grades of non-Hodgkin lymphoma.
A team of specialists will meet to discuss the best possible treatment for you. They are called a multidisciplinary team (MDT).
Your doctor, cancer specialist or nurse will explain the different treatments and their side effects to you. They will also talk to you about things to consider when making treatment decisions.
The aim of treatment is to get rid of as much of the lymphoma as possible.
Treatment for mantle cell lymphoma (MCL) may depend on:
- the stage of the lymphoma
- whether it has become active again after previous treatment
- whether you have symptoms that are causing problems.
The most common treatments for MCL include:
Immunotherapy and chemotherapy
MCL is often treated with a combination of the immunotherapy drug rituximab and chemotherapy. This is called chemoimmunotherapy. If the MCL responds well to rituximab and chemotherapy, you may continue to have regular treatments of rituximab on its own. The aim is to keep the lymphoma in remission. This is called rituximab maintenance. Your doctor can tell you how long maintenance treatment might continue.
People who are well enough to cope with the side effects of intensive treatments may be given a combination that includes high doses of the chemotherapy drug cytarabine. You may have the following treatments:
- R-DHAOx – rituximab, the steroid dexamethasone, high-dose cytarabine (ARA-C), oxaliplatin
- R-Maxi CHOP/H Ara-C – rituximab, cyclophosphamide, doxorubicin (or hydroxydaunorubicin, vincristine (oncovin), the steroid prednisolone, high dose cytarabine (Ara-C).
Steroids are drugs that are often given with chemotherapy to treat lymphomas. They can help make chemotherapy more effective.
Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to nearby healthy cells. It can be used to treat stage 1 or 2 MCL, or to relieve symptoms such as pain.
MCL usually comes back after treatment. Doctors are trying to find improved ways of treating it and controlling it for longer periods. We have more information about treating lymphoma that has come back.
You may have some treatments as part of a clinical research trial.
You will have regular follow-up appointments after your treatment. You can talk to your doctor or nurse about any concerns you may have at these appointments. Your doctor will want to know how you are feeling, and to check you are recovering from any side effects of treatment.
Sex life and fertility
Cancer and its treatment can sometimes affect your sex life. There ways to improve your sexual well-being and to manage any problems.
Treatment for lymphoma may affect your fertility. If you are worried about your fertility it is important to talk with your doctor before you start treatment. We have more information about:
Sometimes side effects may continue or develop months or years after treatment. These are called late effects. We have more information about long-term and late effects of treatment for lymphoma.
Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.
Macmillan is also here to support you. If you would like to talk, you can:
The organisations below also offer information and support:
Blood Cancer UK
Lymphoma Action gives emotional support, advice and information for people with Hodgkin lymphoma or non-Hodgkin lymphoma and those close to them. It has a national network of people with lymphoma, as well as local groups. Their website has a section called trialslink where you can see information about lymphoma clinical trials.
Below is a sample of the sources used in our mantle cell lymphoma (MCL) information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Dreyling M, Geisler C, et al on behalf of the ESMO Guidelines Working Group. Newly diagnosed and relapsed mantle cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2014. 25 (Supplement 3): iii83–iii92. Available from www.annalsofoncology.org/action/showPdf?pii=S0923-7534%2819%2934092-X
McKay P, Leach M, et al. British Committee for Standards in Haematology. Guidelines for the investigation and management of mantle cell lymphoma. British Journal of Haematology. 2012. 159 (4), 405–426.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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