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Aktuelle Therapiestrategien beim Mantelzelllymphom

Current therapeutic strategies for mantle cell lymphoma

  • Schwerpunkt: Maligne Lymphome
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Zusammenfassung

Das Mantelzelllymphom gehört zu den B‑Zell-Lymphomen und weist einen meist aggressiven Verlauf sowie eine schlechte Langzeitprognose auf. Die Wahl der Therapie hängt von Alter, Allgemeinzustand und Risikoprofil des Patienten ab. Randomisierte Studien haben in der Erstlinientherapie jüngerer Patienten mit gutem Allgemeinzustand die Überlegenheit einer dosisintensiven cytarabinhaltigen Induktionstherapie mit anschließender autologer Stammzelltransplantation belegt. Ältere Patienten profitieren von einer Erhaltungstherapie mit Rituximab nach Immunchemotherapie. Neue zielgerichtete Therapien des B‑Zell-Rezeptor-Signalpfads (Bruton-Tyrosinkinase-Inhibitor Ibrutinib, Mechanistic-Target-of-Rapamycin[mTOR]-Antagonist Temsirolimus) sowie Immunmodulatoren (Lenalidomid) zeigen vielversprechende Ergebnisse im Rezidiv. Der Proteasominhibitor Bortezomib ist für die Erstlinientherapie im Kombination mit einer konventionellen Chemotherapie zugelassen.

Abstract

Mantle cell lymphoma is a subtype of B‑cell lymphoma with a mostly aggressive behavior and poor long-term prognosis. The choice of therapy depends on the age, performance status and risk profile of the patient. Randomized trials have confirmed the superiority of a dose-intensified induction therapy containing cytarabine followed by autologous stem cell transplantation in the first-line treatment of younger patients with a good general condition. Elderly patients benefit from a rituximab maintenance therapy after immunochemotherapy. Novel targeted therapies of the B‑cell receptor pathway with the Bruton’s tyrosine kinase inhibitor ibrutinib and the mechanistic target of rapamycin (mTOR) antagonist temsirolimus as well as immunomodulatory drugs (lenalidomide) have shown promising results in relapsed disease. The proteasome inhibitor bortezomib has been approved for first-line treatment in combination with conventional chemotherapy.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Marchioninistr. 15, 81337, München, Deutschland

    M. Dreyling, A. Schnaiter, C. Schmidt & E. Hoster

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  1. M. Dreyling
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  2. A. Schnaiter
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  3. C. Schmidt
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  4. E. Hoster
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Correspondence to M. Dreyling.

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Interessenkonflikt

M. Dreyling: Redner- und Scientific Advisory-Honorare von Bayer, Celgene, Janssen, Mundipharma, Pfizer, Roche. Institutionelle Unterstützung akademischer Studien von: Celgene, Janssen, Mundipharma, Pfizer, Roche. A. Schnaiter, C. Schmidt und E. Hoster geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Redaktion

W. Hiddemann, München

Teile der Daten wurden ebenfalls diskutiert in Schnaiter A, Dreyling M (2015) Aktuelle Therapiestandards und neue therapeutische Strategien bei Mantelzelllymphom. Trillium Krebsmed 24:155–161.

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Dreyling, M., Schnaiter, A., Schmidt, C. et al. Aktuelle Therapiestrategien beim Mantelzelllymphom. Internist 57, 230–237 (2016). https://doi.org/10.1007/s00108-016-0017-y

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  • DOI: https://doi.org/10.1007/s00108-016-0017-y

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