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Correctly Diagnosing Mantle Cell Lymphoma

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Published on August 4, 2020

MCL Expert Defines Mantle Cell Lymphoma Types

There is more than one type of mantle cell lymphoma. Dr. Peter Martin, Assistant Professor of Medicine in the Division of Hematology/Oncology at Weill Cornell Medical College and a member of the Center for Lymphoma and Myeloma and Patient Power co-founder Andrew Schorr explain that not all mantle cell lymphoma is exactly the same. The World Health Organization recognizes two types, one is a nodal mantle cell lymphoma and the other is non-nodal.


Transcript | Correctly Diagnosing Mantle Cell Lymphoma

Andrew Schorr:

Joining us now is Dr. Peter Martin who's really a world expert in lymphomas, and we're talking about mantle cell. He joins us from New York City and Weill Cornell. Dr. Martin, not all mantle cell is alike. So what testing do you do to understand with an individual patient, what subgroup they fit in? Not just on how old they are or how fit they are, but really looking maybe genomically at them to say, "Well, here's a plan related to this specific situation."

Dr. Martin:

Andrew you're absolutely right. That not all mantle cell lymphoma is exactly the same. Some of it has to do with the biological origins of the mantle cell lymphoma. In the most recent classifications of lymphoma by the World Health Organization recognizes this, splitting it into two entities. One is a nodal mantle cell lymphoma, one is a non-nodal mantle cell lymphoma that more commonly presents with enlarged spleen and often lymphoma cells floating around bloodstream. Frequently in the past, that was potentially even mistaken for chronic lymphocytic leukemia. So those two diseases really emerge by different pathways. Additionally, mantle cell lymphoma continues to evolve over time and oftentimes it starts to pick up speed. And sometimes that happens earlier on, sometimes that happens later. And one way we can identify that is by looking at the rate of proliferation of the cells.

This is most commonly done by looking at a marker called Ki-67. Effectively, what that measures is the fraction of cells that appear to be undergoing cell division and lymphomas that have a high fraction of cells that are dividing, are growing more quickly and can sometimes be a little bit harder to deal with. That can also be approximated by just looking at the cells under the microscope. There's something called blastoid morphology or pleomorphic morphology. Those cells look a little bit bigger and look a little bit less like the cells from which they originated, small lymphocytes, and those are also typically more rapidly proliferative and can be harder to deal with. And lastly, the one that I think is emerging is a factor that needs to be measured more commonly is a gene called TP53, which encodes a protein called p53. That protein helps the body's cells to deal with stress. For example, stress-induced by chemotherapy should cause a cell to essentially shut down and die.

Lymphoma cells that have mutations in TP53 or a dysfunctional p53 protein will often be more resistant to standard chemotherapy. So knowing all of those factors can help us to potentially pick a treatment that might be more appropriate under that circumstance.

Andrew Schorr:

Okay. So it's all about really understanding a patient's individual situation at the biological level as well as the physical level to make an informed decision. Thank you so much Dr. Martin for explaining that to patients.

Dr. Martin:

My pleasure. Thank you.

Andrew Schorr:

Okay. Andrew Schorr reminding our audience, knowledge and working with a specialist like Dr. Martin can be the best medicine of all

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.


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