An interview with Dr. Luhua (Michael) Wang, MD, Department of Lymphoma and Myeloma, Division of Cancer Medicine, MD Anderson Cancer Center
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When someone with mantle cell lymphoma faces a relapse, it can be hard to stay positive and can be confusing to know what comes next. Dr. Michael Wang, a professor in the Department of Lymphoma and Myeloma at MD Anderson Cancer Center, shares his thoughts about why there is more reason than ever before to be hopeful.
There are hundreds of lymph nodes throughout the body, including in the chest, neck, armpit, groin, pelvis, and along the gut. These lymph nodes carry lymphocytes that help our bodies operate and fight germs. The outer edge of the lymph node is called the “mantle zone” and when lymphoma, or blood cancer, starts to grow there, it’s called mantle cell lymphoma. Mantle cell lymphoma is usually aggressive, but it also can be slow growing.
You seem optimistic when we talk about Relapsed/Refractory (R/R) Mantle Cell Lymphoma (MCL). Tell us why.
“For patients with MCL who have progressed and need a second- or third-line treatment (also known as patients with relapsed or refractory disease), the science has progressed immensely over the past few years, and we’ve had many medical advancements,” says Wang.
He is referring to the string of FDA approvals for previously treated MCL that have happened within the last 15 years: the chemotherapy bortezomib in 2006, followed by targeted therapies ibrutinib in 2013, acalabrutinib in 2017, and zanubrutinib in 2019. In July 2020, in the middle of the COVID-19 pandemic, the FDA approved a CAR-T therapy for relapsed MCL, and many clinical trials now exist for patients.
“Outside of chemotherapy and immunotherapy, generally, we like to treat patients with targeted therapy, which can put them into remission for years, and we reserve the CAR-T therapy for patients who relapsed after trying chemoimmunotherapy and a BTK inhibitor. It’s terrific that we have many options now,” says Wang.
What is your strategy to support patients with MCL whose first-line treatment is no longer working for them?
There are many factors that go into the decision about how to treat patients with relapsed or refractory MCL, according to Wang.
“We typically want to conduct a very meticulous risk stratification to see what treatment might be right for them.” A risk stratification helps determine how fit someone is, and includes assessing factors such as age, smoking history, heart problems, and having other conditions such as diabetes or hypertension (often called co-morbidities).
But Dr. Wang doesn’t just assess the risk of his patients. He also looks at their tumor, to determine its size, how it responded to previous therapies, and any mutations it may have.
“If the tumor is indolent (ie, slow growing and causing little pain), I generally use a single oral medication such as acalabrutinibto try to put patients into remission for a long time. For example, in a clinical trial of patients with relapsed or refractory mantle cell lymphoma, 81% of patients (101 out of 124) saw their cancer reduce in size or not spread after approximately 38 months of follow-up. Individual results may vary.”
Tell us how your nursing team helps support the patients you treat.
“Here at our institution, nurses play a critical role when it comes to treating patients,” says Wang. “They educate patients around treatment options and potential side effects. Once a patient has started treatment for their disease, the nursing team stays in communication with them throughout their journey, booking follow-up scans and discussing ways to help stick to their new medication schedule.”
At MD Anderson Cancer Center, nurses can also be instrumental in finding clinical trials for patients. Navigating the clinical trial landscape can be challenging, and nurses can help guide patients to a trial that may be right for them.
“It’s very advantageous to have a strong nursing team,” says Wang, “They are literally taking care of our patients on a minute-to-minute basis.”
How can a patient’s family or friends (sometimes called “caregivers”) support patients with previously treated MCL?
When a patient is sick with life-threatening malignancy, according to Wang, it is spiritually, emotionally, and physically important for the well-being of the patient to have someone there to support them. “They can notice new symptoms or changes in behavior that a patient may not recognize on their own,” he says.
For Dr. Wang, ensuring protection against COVID-19 has not changed the need for caregiver support. Like many healthcare institutions, MD Anderson Cancer Center now requires patients to come alone to appointments to minimize the spread of infection.
“In the hospital setting in particular, we want to protect those entering the facility, but we need to find ways to keep caregivers informed and a part of the conversation. I like to encourage spouses, children, or whomever is supporting the patient to participate via phone or video chat, so that they can ask the questions they need answered.”
“I don’t feel I’ve completely helped a patient if I don’t involve their caregiver,” says Wang.
For more information about previously treated mantle cell lymphoma, visit https://yourcancer.org/resource/blood.
IMPORTANT SAFETY INFORMATION ABOUT CALQUENCE® (acalabrutinib) CAPSULES
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking CALQUENCE with certain other medications may affect how CALQUENCE works and can cause side effects. Especially tell your healthcare provider if you take a blood thinner medicine.
Serious infections can happen during treatment with CALQUENCE and may lead to death. Your healthcare provider may prescribe certain medicines if you have an increased risk of getting infections. Tell your healthcare provider right away if you have any signs or symptoms of an infection, including fever, chills, or flu-like symptoms.
The most common side effects of CALQUENCE include headache, diarrhea, muscle and joint pain, upper respiratory tract infection, and bruising.
These are not all the possible side effects of CALQUENCE. Call your doctor for medical advice about side effects.
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What is CALQUENCE?
CALQUENCE is a prescription medicine used to treat adults with mantle cell lymphoma (MCL) who have received at least one prior treatment for their cancer.
It is not known if CALQUENCE is safe and effective in children.