Nutritional And Supportive Care For Mantle Cell Lymphoma Patients

  • Polly Gitz Bsc Nutrition Student, University of Leeds
  • Richa Lal MBBS, PG Anaesthesia, University of Mumbai, India

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Overview

Mantle Cell Lymphoma is a rare type of aggressive B-cell non-Hodgkin's lymphoma.1 Symptoms of the disease include lymphadenopathy, fever, night sweats, and weight loss. A multidisciplinary approach, including nutritional and supportive care, is required to treat symptoms and manage mantle cell lymphoma, enhancing patient outcomes, reducing treatment side effects, and improving quality of life.

Mantle cell lymphoma

Mantle cell lymphoma is a rare form of lymphoma. Lymphomas are effectively cancer of the white blood cells. The standard medical treatment includes 

  • Chemotherapy
  • Targeted therapy
  • Immunotherapy
  • Stem cell transplantation

These treatments can lead to side effects which require nutritional and supportive care.

Symptoms of mantle cell lymphoma

Incidence of mantle cell lymphoma 

Mantle cell lymphoma is a rare type of B-cell non-Hodgkin lymphoma that occurs in around one person per 200,000 people. It is more common in men, and the primary age for diagnosis ranges from 60 to 70 years.2

Diagnosis of mantle cell lymphoma

Diagnosis of mantle cell lymphoma is generally made by excisional biopsy of a lymph node site. Blood tests are also recommended. Cerebrospinal fluid analysis can also be carried out to rule out central nervous system involvement.2 

Treatment of mantle cell lymphoma

Treatment options range from chemoimmunotherapy and stem cell transplantation to targeted therapies, cellular therapy and bispecific antibodies.1

Nutritional care in mantle cell lymphoma

The primary goal of nutritional care in mantle cell lymphoma is to support immune function, optimise nutritional status, minimise treatment side effects and improve quality of life.3

Nutrition helps to maintain body weight, muscle mass, and overall health, which is crucial for patients undergoing intensive treatments. A dietitian or nutrition nurse will be involved. 

Nutritional assessment

A thorough nutritional assessment by a dietitian is essential at the beginning of treatment and with ongoing review. This assessment will include many factors, including

  • Assessing the patient’s dietary intake 
  • Weight history 
  • Laboratory values
  • Physical examination 
  • Tools such as the Malnutrition Universal Screening Tool (MUST) can help identify patients at risk of malnutrition 

Nutritional recommendations

Nutritional recommendations will be tailored to the specific needs of the individual with mantle cell lymphoma. 

Macronutrients

Macronutrients are the main components of the diet and include protein, carbohydrates and fat. 

Protein

Protein is vital for maintaining muscle mass and supporting immune function. Dietary recommendations include early and continued optimisation of nutritional status, including elevated protein requirements.4 

People with mantle cell lymphoma often experience muscle wasting due to the disease and treatments. Protein needs may be higher than average, and sources should include 

  • Lean meats5
  • Fish
  • Dairy products
  • Legumes
  • Nuts

Carbohydrates

Carbohydrates are the body's primary energy source. Patients should focus on consuming complex carbohydrates such as whole grains along with fruits and vegetables, which provide energy, fibre and essential nutrients.

Fats

A certain amount of fat in the diet is important for energy, supporting cell function and enabling digestion of fat-soluble vitamins and minerals. Fats from plant and fish-based sources are healthier than those from animal sources, and a diet higher in these types of food has many health benefits.6 These healthier fats can come from foods such as

  • Avocados
  • Nuts
  • Seeds
  • Olive oil 
  • Fatty fish

Micronutrients

Vitamins and minerals are essential for immune function and other biochemical functions. A diet rich in fruits, vegetables and whole grains provides adequate micronutrients. Some patients with mantle cell lymphoma may require nutritional supplements if they have specific deficiencies or barriers to consuming an adequate balanced diet. 

Supplementation should only be done under medical or dietetic supervision to ensure that there are no interactions with other drugs.

Hydration

Adequate fluid intake is crucial to prevent dehydration, particularly for patients experiencing vomiting or diarrhoea. Mantle Cell Lymphoma patients, like most people, should aim to drink at least 6-8 cups of fluids per day with increased needs during hot weather, exercise, or illness.

Dietary modifications for treatment side effects

Managing nausea and vomiting

Chemotherapy and other treatments can cause nausea and vomiting. These side effects can reduce quality of life and nutritional intake. Strategies to manage these symptoms include 

  • Eating small, frequent meals 
  • Eating bland and easy-to-digest foods like crackers, toast, and rice 
  • Avoiding strong-smelling or spicy foods

Managing taste changes

Treatments for mantle cell lymphoma can alter the sense of taste and make foods taste metallic or bitter. This, in turn, may decrease nutritional intake. Advice that can be given to manage this can include

  • Adding herbs and spices
  • Using plastic utensils instead of metal ones
  • Trying different textures and temperatures of food

Managing gastrointestinal issues

Diarrhoea and constipation are common side effects of cancer treatments, and alterations to the diet can help in managing these uncomfortable symptoms. 

Diarrhoea

Where diarrhoea is a problem, patients should be advised to consume low-fibre foods. Antidiarrhoeal medication such as loperamide may also be required.

Constipation

In constipation, patients should be advised to increase their fibre intake with fruits, vegetables, and whole grains and ensure adequate hydration. Laxatives may also be required.

Food safety

Patients undergoing chemotherapy or stem cell transplantation are immunocompromised and, therefore, at higher risk of infections. Patients should, therefore, avoid raw or undercooked meats and unpasteurised dairy products. Food hygiene measures should be taken in handling and cooking of food.

Dietary management of other conditions

Patients with pre-existing conditions like diabetes or hypertension may require further specific dietary advice. 

People with diabetes need to manage their carbohydrate intake to ensure that blood insulin levels remain stable.

Patients with hypertension should avoid a high salt intake.7

Supportive care for mantle cell lymphoma

Pain management

Pain is a common symptom in patients with mantle cell lymphoma, either due to the disease or as a side effect of treatment. Adequate pain management is essential to optimise quality of life, improve physical comfort, and minimise stress. Pain can be managed with medication, physiotherapy, or pain management programmes

Exercise and activity

Regular physical activity can help maintain strength, improve mobility and boost mood.8 Exercise programmes tailored to the patient’s fitness level and treatment can include activities like walking, stretching, and light resistance training. Physiotherapists can provide customised plans to address specific needs and limitations.

Psychological support

The psychological impact of mantle cell lymphoma can be significant, leading to anxiety, depression and emotional distress. Access to counselling and psychotherapy, such as cognitive-behavioural therapy (CBT), can help patients cope with their diagnosis and treatment.

Stress management techniques, including meditation and mindfulness, are being increasingly used in various aspects of cancer management. Most of the evidence of mindfulness's benefit in cancer is that it reduces toxicity and stress.9 These practices can be integrated into daily routines and tailored to individual preferences. Other activities like yoga, tai chi, and pilates may benefit individuals positively.

Acupuncture

Acupuncture may help with pain management and alleviating symptoms like nausea and fatigue in cancer.10 

Herbal supplements

Some patients may take herbal supplements as part of their treatment regimen. It is essential to consult with healthcare providers to avoid any potential interactions with ongoing treatments.

Social support

Role of family and friends

Encouraging communication and involving loved ones in the care process can enhance the patient’s support network and support treatment aims, as family and friends can help with emotional support and daily activities. 

Support groups 

Support groups such as Lymphoma Action provide a platform for patients to connect with others facing similar challenges. 

Palliative care

Palliative care aims to improve the quality of life for patients with serious illnesses such as mantle cell lymphoma by treating symptoms and providing support. It can be used at any stage of the disease and is not limited to end-of-life care.

Symptom management

Palliative care focuses on managing symptoms like pain, nausea, fatigue, and breathlessness. A multidisciplinary team, including doctors, nurses, physiotherapists, social workers, and chaplains, works together to create a comprehensive care plan that improves the patient's comfort and well-being.

Summary

Mantle cell lymphoma is a rare form of non-Hodgkin's lymphoma. It can be treated by various drug therapies, which can cause side effects and other symptoms. Nutritional and supportive care are key components of managing mantle cell lymphoma. 

A multidisciplinary approach that includes medicine, tailored nutritional plans, and physical and psychological support can enhance patient outcomes and quality of life. 

References

  1. Jain P, Wang ML. Mantle cell lymphoma in 2022—A comprehensive update on molecular pathogenesis, risk stratification, clinical approach, and current and novel treatments. American J Hematol [Internet]. 2022 [cited 2024 Sep 9]; 97(5):638–56. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ajh.26523.
  2. Lynch DT, Koya S, Dogga S, Kumar A. Mantle Cell Lymphoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Sep 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK536985/.
  3. Cancemi G, Cicero N, Allegra A, Gangemi S. Effect of Diet and Oxidative Stress in the Pathogenesis of Lymphoproliferative Disorders. Antioxidants (Basel) [Internet]. 2023 [cited 2024 Sep 9]; 12(9):1674. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10525385/.
  4. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition [Internet]. 2017 [cited 2024 Sep 9]; 36(1):11–48. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261561416301819.
  5. Ford KL, Arends J, Atherton PJ, Engelen MPKJ, Gonçalves TJM, Laviano A, et al. The importance of protein sources to support muscle anabolism in cancer: An expert group opinion. Clinical Nutrition [Internet]. 2022 [cited 2024 Sep 9]; 41(1):192–201. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261561421005422.
  6. Tosti V, Bertozzi B, Fontana L. Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms. The Journals of Gerontology: Series A [Internet]. 2018 [cited 2024 Sep 9]; 73(3):318–26. Available from: https://academic.oup.com/biomedgerontology/article/73/3/318/4736301.
  7. Cappuccio FP, Campbell NRC, He FJ, Jacobson MF, MacGregor GA, Antman E, et al. Sodium and Health: Old Myths and a Controversy Based on Denial. Curr Nutr Rep [Internet]. 2022 [cited 2024 Sep 9]; 11(2):172–84. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9174123/.
  8. Brown JC, Winters-Stone K, Lee A, Schmitz KH. Cancer, Physical Activity, and Exercise. Compr Physiol [Internet]. 2012 [cited 2024 Sep 9]; 2(4):2775–809. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122430/.
  9. Mehta R, Sharma K, Potters L, Wernicke AG, Parashar B. Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques. Cureus [Internet]. [cited 2024 Sep 9]; 11(5):e4629. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6623989/.
  10. Yang J, Wahner-Roedler DL, Zhou X, Johnson LA, Do A, Pachman DR, et al. Acupuncture for palliative cancer pain management: systematic review. BMJ Support Palliat Care [Internet]. 2021 [cited 2024 Sep 9]; 11(3):264–70. Available from: https://spcare.bmj.com/lookup/doi/10.1136/bmjspcare-2020-002638.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Aisling Armstrong

PhD, MSc, BSc (Hons) dietetics, PGCE education

I am a dietitian registered with the Health Care Professionals Council (HCPC), having obtained my BSc (Hons) in dietetics in 1990 from Leeds Metropolitan University. Whilst working as a dietitian in 1994, I achieved an MSc in biomedical science/nutrition from Ulster University.

I completed my PhD in food intolerance and nutrition at Birmingham University in 1998. I currently work in the medical legal field alongside other allied health professionals and do a lot of report writing and editing. I enjoy medical and scientific writing and creating content that is interesting, informative and readable to all.

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