Treatment of lymphoma depends on the type and stage of its progression (how far advanced the disease is in the body). Traditionally, lymphoma has been treated with chemotherapy, radiation treatment, or both. “Involved field” radiation therapy, a combined treatment approach of radiation and chemotherapy targets and kills cells in Hodgkin lymphoma patients. In recent years, several promising new treatments have emerged. Clinical trials, in which patients can receive otherwise unavailable forms of treatment, offer patients and doctors a way to explore new treatments. However, these trials are research studies and not necessarily safe for all patients. While they may provide enormous benefits, clinical trials can also pose harmful side effects and should be carefully considered beforehand.
New treatments currently being studied in clinical trials include vaccine therapy, and high-dose chemotherapy with stem cell transplant.
Vaccine therapy (also known as biotherapy or immunotherapy) uses proteins called antibodies to fight the cancer by targeting the cancer cells with substances produced by the body or in a laboratory. These vaccines are aimed at reducing the existing cancer from spreading rather than at prevention.
High-dose chemotherapy with stem cell transplant
This involves administering high doses of chemotherapy, and the removal of stem cells from the patient’s body (which are stored) to be replaced in the body following chemotherapy treatment.
Lymphoma is rarely treated with surgery, unless it is discovered in an organ such as the thyroid gland and it has not yet spread.
Radiation is first-line therapy for non-Hodgkin lymphomas that are caught early (stage I or II). Radiation treatment uses an external source of high-energy radiation to destroy tumors. Beams of radiation energy are carefully focused on target areas to kill cancer cells, while minimizing damage to surrounding healthy tissues. Such external beam radiation differs from radiation treatments in which radioactive material is implanted into a target organ (such as the prostate) to slowly deliver killing radiation.
External beam radiation treatment is painless and fairly rapid (requiring about five minutes of actual radiation exposure), but preparation for the procedure may take considerably longer. Ordinarily, patients receive such treatments for about five days a week, for several weeks. More advanced or more aggressive lymphomas may require additional treatment, usually consisting of chemotherapy. Radiation treatment may slightly increase a patient’s risk of developing other cancers later, such as lung or breast cancer. Other possible side effects often depend on the site of the tumor(s) being treated. For example, radiation aimed at the abdomen may cause nausea, vomiting, and diarrhea, but these side effects tend to be temporary.
Chemotherapy, commonly called chemo, involves the use of anti-cancer drugs injected directly into the bloodstream. This is especially helpful when tumors may have spread throughout the body, rendering radiation treatment impractical. When tumors occur in the brain or spinal cord, chemotherapy drugs may be injected directly into the cerebrospinal fluid, a clear colorless liquid that circulates within and around the brain and spinal cord. Such therapy is called intrathecal chemo.
Chemotherapy is usually given in rounds—periods (usually a week or more) of drug administration followed by rest periods followed by more chemo. These cycles give the patient’s body time to recover from the taxing effects of intensive drug therapy. Chemo may consist of a single drug or, more commonly, a mixture of two or more chemotherapy drugs. If a patient does not appear to be responding to a particular drug cocktail, his or her doctor may try another combination of drugs during subsequent rounds of chemo.
Chemo drugs target and destroy cells that are dividing unusually quickly, a defining characteristic of all cancers. However, other types of healthy cells also divide rapidly. These include hair follicle cells, bone marrow cells, and cells lining the mouth and digestive tract. As a result, these tissues are also affected by chemo drugs, which accounts for some of the worst side effects of chemo, such as hair loss, nausea and vomiting, mouth sores, fatigue, and increased susceptibility to infections (due to decreased blood cell production within the bone marrow).
Immunotherapy includes several new technologies that harness the body’s own immune system to identify and destroy cancerous cells.
Manmade proteins called monoclonal antibodies can be tailored to find and attach to the surface of lymphoma cells to destroy them. Examples include rituximab, ibritumomab, and alemtuzumab. Some make use of attached radioactive molecules to boost their lethality.
Interferons (IFNs) are proteins that are used to slow the growth of cancer cells in the body. There are three major types of interferons (-alpha, -beta, -gamma) which are produced by white blood cells to help fight infection. Interferon alpha is the most commonly-used for the treatment of cancer. While interferon alpha has been approved by the FDA for the treatment of several cancers, including leukemia and melanoma among others, interferon therapy is still being studied in cases of non-Hodgkin lymphoma.
Manmade interferon can shrink or halt the growth of some lymphomas, and it may be given in addition to chemo. Side effects of interferon may include:
- weight loss
- flu-like symptoms
- general weakness
- dry mouth
These drugs, which include thalidomide and lenalidomide, weaken or “modulate” certain aspects of the immune system. They are occasionally used to treat lymphoma, but side effects, including potentially serious blood clots, limit their appeal. These drugs also cause birth defects and must never be given to pregnant women.
Bone Marrow or Blood Stem Cell Transplants
Stem cell transplants are infrequently used to treat lymphoma, but the use of this technique is gradually increasing. This type of transplant may be appropriate when a patient is in remission (the disease is no longer active) or if there is a relapse of the disease during treatment. The two main types of stem cell transplants include allogenic stem cell transplant and autologous stem cell transplant.
Allogenic therapies make use of stem cells derived from donors’ bone marrow, peripheral (circulating) blood, or umbilical cord blood (from newborn babies). This type of stem cell transplant is of limited value, due to severe side effects stemming from compatibility issues.
Autologous stem cell transplants make use of a patient’s own cells, taken from his or her own bone marrow or peripheral blood. This approach avoids side effects related to compatibility but is only feasible if the patient’s disease has not spread to his or her bone marrow or blood. Even though the patient’s banked blood may be treated in the laboratory to remove any lymphoma cells, there is a possibility of reintroducing cancerous lymphoma cells.