The American Cancer Society reported in July 2009 that mantle cell lymphoma, a specific type of cancer that affects B lymphocytes, accounted for only 5 percent of all non-Hodgkin's lymphoma cases. B lymphocytes, white blood cells that produce antibodies for the immune system, primarily reside in the lymphatic system which includes the lymph nodes, the spleen, the thymus and bone marrow. Mantle cell lymphoma begins in the B lymphocytes found in the mantle zone, the outer edge of the lymph nodes. Although a slow growing form of lymphoma, mantle cell lymphoma remains difficult to treat, requiring aggressive medications.
CVAD
Chemotherapy uses anti-cancer medications to damage or destroy cancer cells. Most chemotherapy treatments involve the administration of a combination of medicines. Doctors learned that mantle cell lymphoma fails to respond to standard chemotherapy combinations used to treat other B cell lymphomas, according to CancerCare.org. As a result, a new combination of four medicines, including cyclophosphamide, vincristine, doxorubicin and the steroid dexamethasone was developed.
CVAD is similar to the commonly used CHOP, consisting of cyclophosphamide, doxorubicin, vincristine and prednisone, with dexamthasone replacing prednisone. Although classified as glucocorticosteroids with similar mechanisms of action, dexamethazone provides more potency with longer-lasting effects than prednisone, as described by Pharmacorama.com.
Although chemotherapy agents target rapidly growing cells, such as the cancer cells, they also affect normal health cells resulting in side effects. This aggressive combination of medicines produces side effects such as nausea, vomiting, diarrhea and frequent infections.
Cytarabine
Cytarabine is administered alternately with the CVAD medicines and methotrexate. Cytarabine, classified as an antimetabolite, masquerades as a substance necessary for cell growth and division. The medication incorporates itself into the cell and interferes with the ability of pyrimidine---a nucleotide necessary for DNA---to incorporate into the DNA. This halts normal cell division, resulting in cell death. The most common side effects of cytarabine include nausea, vomiting and mouth sores.
Methotrexate
Methotrexate, also classified as an antimetabolite, counteracts with the effects of folic acid, causing a folic acid deficiency in the cells. Without folic acid, cells die. Although effective in killing cancer cells, methotrexate also kills other cells in the body. This leads to potentially dangerous low blood cell counts, causing frequent infections, anemia and bleeding disorders. Methotrexate also causes hair loss, mouth sores, difficulty swallowing, diarrhea, liver damage, lung damage and kidney damage, according to Chemocare.com.
The procedure to administer the complete therapy of medicines to treat mantle cell lymphoma, known as hyperCVAD, tries to reduce the intensity of side effects. The "hyper" stands for hyperfractionated, meaning that the doses of medicines are given in small but frequent doses, as described by CancerCare.org.
Rituximab
Rituximab belongs to a group of medicines known as monoclonal antibodies. These medicines are proteins that mimic other proteins naturally produced by the immune system. Monoclonal antibodies target substances found on the cancer cells, thereby delivering the medicine directly to the affected B lymphocytes. Monoclonal antibodies also help trigger the body's immune system to fight the cells.
