Treament of Lymphoma

After you have received a diagnosis of lymphoma, your physician will discuss treatment options available to you. Based on the type and stage of your lymphoma along with your age and general health, the best course of treatment will be determined.
There are four main types of treatment for lymphomas:

  • Chemotherapy
  • Radiation Therapy
  • Biological or Antibody therapy
  • Stem Cell Transplant

Hodgkin lymphoma

Hodgkin lymphoma is usually treated with chemotherapy and radiation therapy. Nearly all patients receive chemotherapy, and radiation may be used in early stage disease usually after chemotherapy or sometimes as the only treatment.
 

Chemotherapy for Hodgkin Lymphoma:
Chemotherapy is one of the main treatment options for Hodgkin disease. A combination of three or more drugs is usually used. All or most of the drugs are administered either as injections or slow infusions into your veins. Some drugs may be taken as pills. There are a number of effective drug combinations. The most common is called ABVD. Your doctor will determine the schedule of your chemotherapy treatments. Chemotherapy is typically administered every two to three weeks for a number of  'cycles.'
 

Radiation Therapy for Hodgkin Lymphoma:
Radiation therapy is also very effective in Hodgkin disease. Radiation can be used as the only treatment, or added after chemotherapy. Having radiation treatment is much like getting an X-ray taken. Radiation treatments are usually given five days a week for three to five weeks. Hodgkin lymphoma responds well to radiation and very high doses are not required.


High-dose chemotherapy and stem cell transplant for Hodgkin disease
Chemotherapy drugs can cause serious side effects to cells that divide fast, such as those in the bone marrow. Although higher doses of these drugs might work better to treat Hodgkin disease, they are not given because they would cause severe damage to bone marrow cells, lethal shortages of blood cells, and other vital organs could possibly be damaged.

If Hodgkin disease does not respond well to standard treatment, or the disease comes back after treatment, a stem cell transplant (SCT) may be recommended. This allows doctors to use very high doses of chemotherapy. After chemotherapy treatment the patient gets a transplant of blood-forming stem cells to restore the bone marrow.


Types of transplants
 

Autologous stem cell transplant: This is the most common type of transplant for Hodgkin disease. It uses blood-forming stem cells from the patient's own blood or from the bone marrow. The stem cells are removed, frozen, and stored weeks before treatment. Very high doses of chemotherapy (with or without radiation therapy) are given in order to kill the cancer. These high doses destroy bone marrow, too and the body is no longer able to make new blood cells. After the treatment the stored stem cells are thawed and put back into the patient's bloodstream through a vein. Over time the stem cells return to the bone, replacing the marrow and making new blood cells.

If this type of transplant fails, an allogenic stem cell transplant may be done. This type of transplant is when a matched donor supplies the stem cells.

Allogenic stem cell transplant: To prevent the risk of major problems every effort is made to find a donor whose tissue type matches the patient's as closely as possible. Usually the donor is a brother or sister with the same tissue type as the patient. If there are no siblings with a good tissue match, the cells may come from an unrelated donor whose tissue type closely matches the patients. Sometimes umbilical cord blood stem cells are used. These cells come from blood drained from the umbilical cord and placenta after a baby is born and the umbilical cord is cut.

If a patient is not able to have a regular transplant using high doses of chemo because of the likely side effects, they may be able to have what is called a "mini-transplant". This type of transplant utilizes lower doses of chemo and radiation so it does not destroy all the stem cells in the bone marrow. Donor stem cells are then given where they enter the body and form a new immune system. This new system sees the cancer cells as foreign and attacks them (called a "graft-versus-lymphoma" effect). This procedure is currently being studied to determine how well it will work for patients with Hodgkin disease.

 

Chemotherapy for non-Hodgkin Lymphoma
Depending on the type and the stage of the lymphoma, chemotherapy may be used alone or combined with radiation therapy.

Chemotherapy is given in cycles, in which a period of treatment is followed by a rest period that allows the body time to recover. Each chemo cycle generally lasts for several weeks. Most chemo treatments are given on an outpatient basis (in the doctor's office or clinic or hospital outpatient department) but some may require a hospital stay.

Many chemo drugs are useful in treating lymphoma patients. Often, several drugs are combined. The number of drugs, their doses, and the length of treatment depend on the type and stage of the lymphoma. Your medical oncologist will determine the best course of chemotherapy treatment for your disease.

 

Radiation Therapy for non-Hodgkin Lymphoma
When radiation is used to treat non-Hodgkin lymphoma, it is most often done with a carefully focused beam of radiation, delivered from a linear accelerator. The treatment is much like getting an x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.

Radiation might be used as the main treatment for some types of early stage lymphoma because these tumors respond very well to radiation. For more advanced lymphomas or more aggressive lymphomas, radiation is sometimes used along with chemotherapy.

People who are getting a stem cell transplant may get radiation to the whole body along with high-dose chemotherapy, to try to kill lymphoma cells throughout the body.
Radiation therapy can also be used to ease symptoms caused by lymphoma that has spread to internal organs, such as the brain or spinal cord, or when a tumor is causing pain because it is pressing on nerves.


Immunotherapy for non-Hodgkin Lymphoma
Immunotherapy is treatment that either boosts the patient's own immune system or uses man-made versions of the normal parts of the immune system. These treatments may kill lymphoma cells or slow their growth.

Monoclonal Antibodies

Antibodies are proteins made by the body's immune system to help fight infections. Man-made versions, called monoclonal antibodies, can be designed to attack a specific target, such as a substance on the surface of lymphocytes (the cells in which lymphomas start).

Several monoclonal antibodies are now being used to treat lymphoma.

Rituximab (Rituxan®): This is an antibody that attaches to a substance called CD20 found on some types of lymphoma cells, it seems to cause the lymphoma cell to die. Treatments are given as intravenous infusions in the doctor's office or clinic or hospital outpatient setting.

Ibritumomab (Zevalin®) and tositumomab (Bexxar®): These drugs are monoclonal antibodies aimed at CD20 (like rituximab) that have radioactive molecules attached to them. The antibodies bring radiation directly to the lymphoma cells, which may help them work better. These drugs are given as intravenous infusions.
These drugs are not used as often as Rituximab because they are somewhat harder to give (due to the radiation dosing involved). They cannot be used with chemotherapy because they lower blood counts, which can raise the risk of infections, bleeding, or other problems. At this time these drugs are most often used if chemotherapy and/or rituximab are no longer working.

Alemtuzumab (Campath®): This antibody is directed at the CD52 antigen. It is useful in some cases of chronic lymphocytic leukemia (CLL) and also some types of peripheral T-cell lymphomas. It is given by infusion into a vein.

Ofatumumab (Arzerra®): Ofatumumab is another antibody that also targets the CD20 antigen. It is approved to treat chronic lymphocytic leukemia (CLL), mainly when other treatments such as chemotherapy, rituximab, and alemtuzumab are no longer working. It is currently being studied for treatment of other lymphomas.

Brentuximab vedotin (Adcetris™): This drug is an anti-CD30 antibody attached to a chemotherapy drug. The CD30 molecule is found on the surface of some lymphoma cells. The antibody acts like a homing signal, bringing the chemo drug to the lymphoma cells, where it enters the cells and causes them to die when they try to divide into new cells.

Brentuximab can be used to treat anaplastic large cell lymphoma (ALCL) that has returned after other treatments. It is given as an infusion into a vein.


Interferon

Interferon is a hormone-like protein made by white blood cells to help the immune system fight infections. There are some studies that suggest giving a man-made interferon can make some types of lymphomas shrink or stop growing.

Because of side effects, interferon is not used very often. It may be given to some patients in addition to chemotherapy.

 

Immunomodulating agents
It is not clear how these drugs work but it is thought they work against certain cancers by affecting parts of the immune system. They are sometimes used to help treat certain types of lymphoma, usually after other treatments have been tried.

Thalidomide (Thalomid®): The main use of this drug is to treat another cancer of the lymphocytes known as multiple myeloma, but it may also be used to treat some types of lymphoma.

Lenalidomide (Revlimid®): This is a newer drug that is similar to thalidomide. It may be used to treat some types of lymphoma.

 

High-dose chemotherapy and stem cell transplant for non-Hodgkin lymphoma
Stem cell transplants are sometimes used to treat lymphoma patients who are in remission or who have a relapse during or after treatment. Although only a small number of patients with lymphoma are treated with this therapy, this number is growing.

Stem cell transplants allow doctors to use higher doses of chemotherapy (and sometimes radiation) than would normally be tolerated. High-dose chemotherapy destroys the bone marrow, which prevents new blood cells from being formed. This could lead to life-threatening infections, bleeding, and other problems due to low blood cell counts.

Doctors try to get around this problem by giving an infusion of blood-forming stem cells after the high-dose treatment. Stem cells are very primitive cells that can create new blood cells.

Chemotherapy drugs can cause serious side effects to cells that divide fast, such as those in the bone marrow. Although higher doses of these drugs might work better to treat Hodgkin disease, they are not given because they would cause severe damage to bone marrow cells, lethal shortages of blood cells, and other vital organs could possibly be damaged.

If Hodgkin disease does not respond well to standard treatment, or the disease comes back after treatment, a stem cell transplant (SCT) may be recommended. This allows doctors to use very high doses of chemotherapy. After chemotherapy treatment the patient gets a transplant of blood-forming stem cells to restore the bone marrow.

Blood-forming stem cells used for a stem cell transplant can come from:

  • The blood (for a peripheral blood stem cell transplant, or PBSCT)
  • The bone marrow (for a bone marrow transplant, or BMT)
  • Umbilical cord blood (for a cord blood transplant)

Most stem cell transplants are now PBSCTs.


Types of transplants

Autologous stem cell transplant: This is the most common type of transplant used for lymphoma. However it is not an option if the lymphoma has spread to the bone marrow or blood. When that occurs, it may be hard to get a stem cell sample that is free of lymphoma cells. Even after purging (treating the stem cells in the lab to kill or remove lymphoma cells), it's possible to return some lymphoma cells with the stem cell transplant.
It uses blood-forming stem cells from the patient's own blood or from the bone marrow. The stem cells are removed, frozen, and stored weeks before treatment. Very high doses of chemotherapy (with or without radiation therapy) are given in order to kill the cancer. These high doses destroy bone marrow, too and the body is no longer able to make new blood cells. After the treatment the stored stem cells are thawed and put back into the patient's bloodstream through a vein. Over time the stem cells return to the bone, replacing the marrow and making new blood cells.

If this type of transplant fails, an allogenic stem cell transplant may be done. This type of transplant is when a matched donor supplies the stem cells.

Allogenic stem cell transplant: To prevent the risk of major problems every effort is made to find a donor whose tissue type closely matches the patient's. Usually the donor is a brother or sister with the same tissue type as the patient. If there are no siblings with a good tissue match, the cells may come from an unrelated donor whose tissue type closely matches the patients. Sometimes umbilical cord blood stem cells are used. These cells come from blood drained from the umbilical cord and placenta after a baby is born and the umbilical cord is cut.

If a patient is not able to have a regular transplant using high doses of chemo because of the likely side effects, they may be able to have what is called a "mini-transplant". This type of transplant utilizes lower doses of chemo and radiation so it does not destroy all the stem cells in the bone marrow. Donor stem cells are then given where they enter the body and form a new immune system. This new system sees the cancer cells as foreign and attacks them (called a "graft-versus-lymphoma" effect).

 


 

You and your physician will discuss the treatment options available to you based on the type and stage of your disease. It is important that you ask any questions during this discussion. You should have a clear understanding of the risks and benefits of your treatment.

At the Foshay Cancer Center you will find a dedicated team of experienced physicians and healthcare professionals, state-of-the-art technology and comprehensive support services. For more information about treatment at the Foshay Cancer Center, call (561) 263-4400.

If you need a physician, call our physician referral department at (561) 263-5737.