How is lymphoma treated?

Individual treatment plans for lymphoma depend on the type of lymphoma, how far the cancer has spread, whether it’s aggressive or indolent, and the age and overall health of the patient. Thanks to traditional chemotherapy and newer treatment methods, lymphomas have a relatively high cure rate.

Hodgkin’s disease: For Hodgkin’s disease, chemotherapy and radiation therapy are the main treatment methods.With either one or both of these therapies, about 90 percent of patients with early-stage Hodgkin’s disease are cured. Patients with advanced-stage disease are treated with various combinations of chemotherapy drugs. About two-thirds of these patients are cured.

For patients who stop responding to standard therapy, bone marrow stem-cell transplantation is an option. This complex therapy provides doctors with a way to use very high doses of chemotherapy for more effective treatment. It involves harvesting stem cells (primitive blood cells) from the patient’s bone marrow or the blood stream through a process called apheresis. After the stem cells have been removed and stored, the patient is given extremely high doses of chemotherapy that destroy the bone marrow. The stored stem cells are then returned the patient as a blood transfusion. If successful, it takes several weeks after the stem cells are reinfused for the cells to mature and start making new blood cells.

Non-Hodgkin’s lymphoma: The success of treatment for non-Hodgkin’s lymphoma depends on whether the disease is aggressive or indolent. Aggressive lymphomas have the fastest-growing cancer cells, which means the cells are most vulnerable to the cancer-killing effects of chemotherapy and radiation. While indolent lymphomas do usually respond to chemotherapy and radiation, they are less likely to be completely cured by these treatments, and recurrences are common.

Because aggressive lymphomas grow very rapidly, some types can be life-threatening within months if left untreated. However, if an aggressive lymphoma is diagnosed at Stage I, the chance for a cure is about 80 to 90 percent, and even some of the most advanced cases have a 30 percent chance of a cure.

Usually a combination of several chemotherapy drugs combined with radiation therapy is used for Stage I. Chemotherapy alone is used for all other stages. If the cancer recurs, different chemotherapy drugs are used. Bone marrow transplantation is another option.

Indolent lymphomas may take as long as seven to 10 years before causing any problems. As a result, treatment is not always started immediately. Instead, the doctor may take a “watchful waiting” approach, and chemotherapy and/or radiation therapy are started once symptoms appear.

In some cases, indolent lymphomas are treated from the outset with radiation or chemotherapy, whether or not symptoms are present. The lymphoma often goes into remission, but it may recur many years later as an indolent form or as one of the aggressive kinds. In either case, chemotherapy is used again to treat the cancer. (Occasionally, radiation therapy is also used again, but not to treat the same area of the body.)

In addition to chemotherapy and radiation for treating non-Hodgkin’s lymphoma, a biological therapy called rituximab (Rituxan) is now available. Rituxan, a drug approved by the Food and Drug Administration in 1997 for the treatment of certain indolent lymphomas, is a monoclonal antibody. Monoclonal antibodies, which are genetically engineered in a laboratory, are designed to attach to certain substances on the surface of cancer cells. (Rituxan attaches to a substance called CD20, which is found on some types of indolent non-Hodgkin’s lymphoma cells.) The patient’s body recognizes the monoclonal antibody as an invader, and the immune system kills the cells to which it is attached.

Presently, chemotherapy and radiation therapy are the first treatments given for non-Hodgkin’s lymphoma, and Rituxan is used if these fail or cancer comes back after a remission. However, in the future, Rituxan may become the first line of therapy, depending on the results of research currently under way.

Another biological therapy is interferon. Interferon is a protein naturally produced by white blood cells to help the immune system fight infections. Some research has suggested that interferon can help shrink the tumors of certain types of non-Hodgkin’s lymphoma. It is still not clear, however, which patients are appropriate candidates for interferon therapy and whether it should be given to these patients in addition to chemotherapy.

Although indolent lymphomas are less responsive to treatment than aggressive varieties, this does not mean that the prognosis for indolent cancers is necessarily poor. In fact, indolent lymphomas can progress so slowly that treatment, although it may not cure the disease, can often prolong life to the point where an older adult lives a normal lifespan and dies from another cause.

Is there a lymphoma vaccine under development?

Yes. But, unlike conventional vaccines, the lymphoma vaccine is not intended to prevent lymphoma in healthy people. Rather, it is given to patients in remission from an indolent lymphoma to strengthen the body’s natural defenses to prevent a relapse. The vaccine contains a tiny amount of protein taken from the patient’s own tumor. This allows the body to detect the tumor protein and produce defenses against it, priming the immune system to be ready to destroy any cells it encounters that contain the tumor protein. In a study of 20 patients who were vaccinated, 18 remained in complete remission four years after the therapy began. A larger trial is now under way; however, it could take eight years to produce results.

The lymphoma vaccine will be an exciting addition to the therapeutic arsenal for fighting lymphomas.