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Mantle cell lymphoma

Conquest - Summer 2013

The treatment: Best ‘single agent tested’

Related story: A magnificent seven

By Sandi Stromberg

Michael Wang, M.D., has dedicated a good part of the past 12 years to researching treatments for mantle cell lymphoma. Based on the latest findings, the associate professor in MD Anderson’s departments of Lymphoma and Myeloma and Stem Cell Transplantation and Cellular Therapy believes he and his colleagues are “witnessing a breakthrough for treatment of the disease.”

Disease: Mantle cell lymphoma (MCL) is a rare, aggressive B-cell subtype of non-Hodgkin lymphoma that accounts for 6% of cases; relapse after treatment is common.

Oral medication: Ibrutinib is given at 560 mg daily in continuous 28-day cycles until disease progression.

Clinical trial: In an interim report on a Phase II, international study for patients with relapsed or resistant MCL, ibrutinib continues to show unprecedented and durable results with few side effects.

Patients: Of 115 people enrolled in the study, 110 patients with three prior treatment regimens were evaluated for the drug’s efficacy. Patients’ median age is 68; the time since diagnosis, 42 months.

Results: Overall response rate at median follow-up period of 9.2 months is 68%; complete remission rate is 22%.

“What impressed me the most is the high complete remission rate, which continues to improve with time, and yet it is the safest drug we have for this disease,” Wang says.

The patient: A remarkable zest for life

When chemotherapy treatments put Marvin Kimmel in a wheelchair, no one thought he would walk again. Or imagine he would play tennis five times a week in 2013 — except Marvin Kimmel.

Marvin Kimmel (right) flies himself to Houston every 28 days
to meet with his doctor, Michael Wang, M.D., and refill his
prescription for ibrutinib.
Photo: Barry Smith

During the 12 years he’s battled mantle cell lymphoma, Kimmel has been treated with a string of drugs from the cocktail of hyper CVAD (cyclophosphamide, vincristine, doxorubicin and dexamethasone) to valcade, revlemid and thalidomide. The first one put him in remission for a few years, but they all had debilitating side effects. He’s dealt wih blood and platelet transfusions, visits to the emergency room, overwhelming fatigue and neuropathy that required six weeks of physical therapy for him to learn to walk again.

But the latest therapy, ibrutinib, has this octogenarian bouncing through life like Tigger.

“I can only imagine how enthused the drug company has been to have a candidate approaching his mid-80s with very low platelets and a history of being in and out of remission,” he laughs. “After the first week of taking ibrutinib, I called Dr. Wang and told him that miraculously all of the cancerous nodes had disappeared.”

Kimmel is grateful for the 29 monhs he has now been on the therapy. “I’m still in remission with few or no side effects. I understand I’m the oldest person in the program and also one of those in it the longest.”

But what makes him the happiest is that, after being given 90 days to live in 2001, he’s had a full 12 years as husband, father and grandfather — and been around to welcome five great-grandchildren into the world.

— Sandi Stromberg

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