What You Should Know About Mantle Cell Lymphoma

Mantle Cell Lymphoma
Gabriel Caponetti/Wikimedia Commons/CC By 3.0

Lymphoma is the general name for many related kinds of cancer that arise from lymphocytes. Two major categories of lymphoma are Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL).

Mantle cell lymphoma (MCL) is one of the many different subtypes of NHL. More specifically, it is a non-Hodgkin lymphoma that arises from the B-lymphocytes.

MCL Statistics

  • It’s relatively rare — in the U.S., about six percent of non-Hodgkin lymphomas are MCL.
  • It tends to affect men more than women.
  • It tends to affect those over age 50, with the average age at diagnosis in the mid-60s.


  • Symptoms are similar to those of many other types of NHL, in that the most common symptom is one or more painless swollen lymph nodes.
  • General symptoms such as night sweats, fevers, and unintentional weight loss are also possible.
  • MCL can spread to the bowel, and if this happens, it can cause symptoms such as diarrhea and abdominal pain.

Staging and Evaluation

MCL looks like a low-grade lymphoma under the microscope, according to CancerResearchUK, and low-grade lymphomas have cells which look much more like normal cells; however, MCL may behave more like a high-grade lymphoma, growing quickly. Lymphoma cells may be widespread at the time of diagnosis — in the lymph nodes, the bone marrow and spleen.

Treatment and Outcomes

Chemotherapy in combination with other agents is used to treat MCL. A number of chemotherapy plus rituximab (Rituxan) combinations are used. Bortezomib (Velcade) may be used to treat patients who have relapsed disease and has been approved for untreated patients in a combination therapy. Ibrutinib (Imbruvica) is approved for patients with relapsed MCL.

Cure is uncommon unless diagnosed early. The aim of treatment is to keep the disease in control for as long as possible. However, MCL is the subject of many ongoing clinical trials to study potential improvements in treatment.

Why Is It Called Mantle Cell Lymphoma?

When you hear the word mantle, perhaps you think of that ledge above the fireplace where family photos and tchotchkes tend to be kept. The 'mantle’ in mantle cell lymphoma draws on a different definition — one referring to a cloak or shawl; it can also be a verb, to cloak or envelope — as in “heavy mists mantled the forested slopes.”

The 'mantle' in mantle cell lymphoma originally referred to the location of cells once thought to be primarily involved in the malignancy. Mantle cell lymphomas were associated with the mantle zone of lymph node follicles — cells that surround and envelop something called a germinal center, and all of this is explained in more detail in the next section.

The term mantle cell lymphoma was coined in the 1990s to refer to a specific set of lymphomas with a genetic rearrangement, and today it's thought that only a subset of mantle cell lymphomas has a broad, expansive cancerous 'mantle.' MCL can actually have a variety of different appearances under the microscope, but involvement of the mantle zone of follicles explains the origin of the name.

The Follicle and the Mantle

The image shown at the top of this is article is a cross section, or a single slice through an entire lymph node, as seen using a light microscope at low-power magnification. This slice has been stained and put on a glass slide so that you can see different types of cells and how they are organized within the node.

The dark circles or ovals that you see studying the lymph node — especially toward the periphery of the node — are called follicles. Follicles form in lymph nodes, and they can also form in lymphoid tissue in other parts of the body. Each of the many follicles in the above image is packed with B-cells, or B-lymphocytes, which are a type of white blood cell. Depending on where these B-cells are located within in the follicle, they may have slightly different jobs.

If you look closely at the follicles, you might be able to see that some of them are pale in the center and darker purple on the outside. The lighter center is known as the germinal center of the follicle while the darker outside is known as the mantle.

B-cells can mature to make antibodies that bind to ‘tags,’ or antigens, on invaders such as bacteria. While the pale germinal center has B-cells that are actively growing to make antibodies that will target antigens on invaders, the darker mantle zone is composed of B-cells that are resting and those that have a ‘memory’ of antigens encountered on past invaders.

MCL results when a B-lymphocyte in the outer edge of a lymph node follicle — the mantle zone — becomes transformed, or malignant. The transformed B-lymphocyte grows in an uncontrolled way, resulting in the accumulation of lymphoma cells, which causes enlargement of lymph nodes.

Non-Hodgkin Lymphomas, edited by James O. Armitage, Bertrand Coiffier. Lippincott Williams & Wilkins, Nov 1, 2009.

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