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Frankly Speaking About Lymphoma

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Treatment of Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) depends on the stage of the cancer, its location in the body, symptoms of the disease, and the general health and age of the patient. With advances in treatment, some lymphoma patients can be cured. The less curable types of the disease, such as indolent NHL, can be effectively treated so that some patients can live for 20 years or more. The following information gives a general overview of the various types of treatment for lymphoma.

Treatment For Lymphoma:
Overview of Lymphoma Treatment

Treatment of Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) depends on the stage of the cancer (how widespread it is), its aggressiveness (how fast it is growing), its location in the body (critical sites needing immediate treatment), symptoms of the disease, and the general health and age of the patient. With advances in treatment, some lymphoma patients can be cured. The less curable types of the disease, such as indolent (slow growing) NHL, may still be effectively treated so that some patients can live for 20 years or more. The following information gives a general overview of the various types of treatment for lymphoma.

Standard Therapies

The following are the standard, commonly accepted approaches used to treat many lymphomas (depending on the type and the patient's specific situation).

"Watch and Wait"

For some types of slowly growing (indolent) lymphoma, doctors may recommend a policy of "Watch and Wait." This means you are not given any immediate treatment. You may continue on with your daily life while having regular follow-up visits with an oncologist. These visits often include laboratory tests or x-rays (diagnostic imaging). If you begin to show progression of your disease, your doctor may decide to give you some form of chemotherapy, radiation, and/or other type of cancer treatment.

Chemotherapy

Chemotherapy is a treatment that uses either a single drug or a combination of drugs to destroy or damage cancer cells so they die. Most chemotherapy drugs are given intravenously, but some are given orally. People with lymphoma receive treatment at regular intervals, as inpatients or outpatients, usually over several months. Chemotherapy is often given in different drug combinations and continues to work for days or weeks after the drugs are taken. Combinations of chemotherapy drugs may significantly increase the amount of cancer cells that are destroyed. The drugs are given in cycles so that after each dose, a period of rest and recovery follows. Chemotherapy, in addition to destroying cancer cells, also affects some normal cells. This may lead to side effects such as nausea, diarrhea, hair loss, mouth sores, low blood counts, and risk of infection.

Radiation

Radiotherapy (also known as radiation therapy) is another common treatment option for some types of lymphoma. With radiation therapy, high-energy x-rays from an external source are given to shrink tumors, relieve pain and pressure, decrease symptoms, and improve quality of life. Radiation can be effective treatment when used alone or in combination with surgery, chemotherapy, stem cell transplant, or immunotherapy. Radiation treatments are given to a specific area of the body called a radiation field during a series of outpatient hospital visits. Side effects of radiation depend on where the radiation field is located. They may include fatigue, loss of appetite, skin irritation, and nausea and vomiting.

Bone Marrow/Blood Stem Cell Transplantation

Bone marrow or blood stem-cell transplant is used primarily in patients whose cancers have returned. In these difficult-to-treat cancers, very high doses of chemotherapy or radiation may kill lymphoma cells that resisted the effects of lower dose (standard) chemotherapy. However, high doses of chemotherapy and radiation will also destroy bone marrow production of white blood cells, red blood cells, and platelets. Therefore, stem cells (immature cells that the body can use to form whatever type of cell it needs) must be infused back into the patient to "rescue" the bone marrow and allow for recovery of bone marrow function.

This form of therapy requires several weeks or months of care, and often means you must stay in or near the hospital for several days or weeks. Transplanted cells are either autologous (from your own body) or allogeneic (from a donor). Over the past few years, transplantation has changed from a "last resort" to a preferred therapy. In the year 2000, NHL was the most common reason for autologous stem cell transplants in the United States.

Newer Therapies for Lymphoma: Monoclonal Antibodies

One of the newest treatments for lymphoma is the use of monoclonal antibodies. A monoclonal antibody is a biologic protein produced in a laboratory that binds with a specific protein antigen found on the surface of cancer cells to help the body's general immune response. Rituximab (Rituxan®) was the first monoclonal antibody approved by the Food and Drug Administration (FDA) for treatment of lymphoma. Rituximab is approved for the treatment of indolent B-cell non Hodgkin's lymphoma as well as relapsed or refractory low grade or follicular NHL. Like all monoclonal antibodies, it is genetically engineered in the laboratory. It is used against an antigen called CD-20 that is found on both healthy and malignant B-cells. Rituximab is a kind of "smart bomb" that destroys specific lymphocytes in a way that saves other cells from damage. It reacts with cancer cells in a way that triggers the body to fight the cancer more effectively.

Radioimmunotherapy

Radioimmunotherapy (RIT) is another new therapy for NHL. This therapy combines two types of treatment: radiation therapy (radio) and immune therapy (immuno) with monoclonal antibodies. The term radiolabeled monoclonal antibodies describes radioimmunotherapy. With this dual-action therapy, cancer cells are destroyed by both high-energy radiation and the cell-killing action of the monoclonal antibody. When used in NHL, radiolabeled monoclonal antibodies target specific cells and destroy cancer cells while minimizing damage to normal cells. Radioimmunotherapy is usually given as a single, short course of treatment over one to two weeks versus several months of treatment with chemotherapy or radiation. It is generally given by intravenous infusion in an outpatient treatment center. Patients who are treated with radioimmunotherapy do not experience many of the more common side effects of chemotherapy, such as hair loss and vomiting. However, common side effects may include fever or chills during the infusion, nausea, flu-like symptoms, fatigue, and a decrease in blood count. For more information, see Novel Therapy for Non-Hodgkin's Lymphoma at the end of this section.

Experimental and Clinical Trial Therapies

Lymphoma researchers are actively investigating other forms of therapy to develop the best way to fight the disease. These experimental therapies may be used when conventional therapies fail or when newer therapies appear more promising. In many cases, these therapies are used as part of a clinical trial, which is a study that tests new treatments. (See Clinical Trials & Lymphoma.)

Vaccines

While still highly investigational, vaccines for lymphoma are being custom made from a tumor sample obtained from a patient's lymph nodes. Early studies show that lymphoma vaccines might have an anti-tumor effect in patients who are vaccinated, particularly those who have minimal disease or who are in remission. As a result, these vaccines are now being investigated with standard chemotherapy in large clinical trials with patients who have been newly diagnosed with low-grade, non-Hodgkin's follicular lymphoma.

Antisense Drugs

Antisense drugs are being used to attempt to stop the production of cancer specific proteins by interfering with the genes that create these proteins and "decode" any malfunctioning gene. Research is trying to design antisense drugs for specific lymphomas. Antisense drugs may have fewer side effects than other medications because they appear to spare healthy cells. Antisense
therapies are currently in clinical trials for further research.

The Wellness Community provides this information as a service. Publication of this information is not intended to take the place of medical care or the advice of your doctor. The Wellness Community strongly suggests consulting your doctor or other health care professional about the information presented.

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