Lymphomas

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is a group of many cancers of the lymphatic system. In NHL, B cells, T cells or natural killer (NK) cells in the lymphatic system change and grow uncontrollably, sometimes forming a tumor. The most common type of NHL is B-cell lymphoma. T-cell lymphoma is less common, and NK-cell lymphoma is relatively rare.

NHL can start almost an¬ywhere and can spread to almost any organ. It most often begins in the lymph nodes, liver, spleen or bone marrow, but it can also involve the stomach, intestines, skin, thyroid gland, brain or any other part of the body where lymphatic tissue is found.

Staging NHL

Staging your NHL helps your doctors describe how advanced it is. Knowing the stage of your NHL allows them to choose the best treatment option for you. The Ann Arbor staging system is often used to describe the extent of NHL and assigns a numbered stage from Stage I to Stage IV. For more about staging NHL, see Diagnosing and Staging.

Treating NHL

Your doctor will recommend the best option for you depending on the type and stage of NHL, along with your age, treatment history and overall health. Ask your doctor about the side effects that can accompany each option, as they can affect your quality of life.

Many side effects can be prevented or managed, and knowing what to expect will help you make a more informed treatment decision.

Chemotherapy

Chemotherapy is a systemic treatment that travels throughout the body to damage and destroy cancer cells. Many combinations may be used, and chemotherapy may be followed by radiation therapy or immunotherapy or both. The most common treatments include the following:

  • CHOP: cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone
  • R-CHOP: CHOP + rituximab (Rituxan); rituximab is a type of immunotherapy drug known as a monoclonal antibody
  • BR (bendamustine [Treanda] and rituximab), R-CVP (rituximab, cyclophosphamide, vincristine, prednisone), and fludarabine-based combinations

Radiation therapy

Radiation therapy is the use of high energy X-rays or other particles like electrons or protons to destroy cancer cells and shrink cancerous tumors. Radiation treatment for NHL is usually external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time.

Radiation therapy is usually given after or in addition to chemotherapy, depending on the NHL subtype. It is most often given to patients who have lymphoma in only one area of the body or who have a lymph node that is particularly large, usually more than 10 centimeters (about 4 inches) across. It may also be given for the treatment of pain in very low doses in patients with advanced disease who have localized symptoms.

Immunotherapy

Immunotherapy is a type of treatment that uses a person’s own immune system to recognize and destroy cancer cells. Monoclonal antibodies are directed against a specific protein and do not affect cells that do not have the protein. A laboratory-made monoclonal antibody called rituximab (Rituxan) is used to treat many different types of B-cell lymphoma. Although it works well by itself, research shows that it works better when added to chemotherapy for people with most types of B-cell NHL.

Brentuximab vedotin (Adcetris) is another monoclonal antibody called an antibody-drug conjugate. Antibody-drug conjugates attach to targets on cancer cells and then release a small amount of chemotherapy or other toxins directly into the tumor.

Radiolabeled antibodies are monoclonal antibodies with radioactive particles attached. They focus the radiation directly to the lymphoma cells. In general, radioactive antibodies are thought to be stronger than regular monoclonal antibodies but more damaging to the bone marrow. This type of therapy is also called radioimmunotherapy.

Cancer sometimes relapses (returns) or becomes resistant to treatment (known as refractory disease). In these cases, other treatment options, often called secondary therapies, are available. Rituximab is also given after remission for indolent (slow-growing) lymphomas to make remission last longer. A few monoclonal antibodies are approved for use in certain lymphomas that have returned after initial treatment, including obinutuzumab (Gazyva) and ofatumumab (Arzerra). And an immunomodulating (IMiD) drug is available; lenalidomide (Revlimid). IMiDs are thought to work against cancer by boosting parts of a person’s immune system.

Targeted therapy drugs

Targeted therapy drugs focus on the changes in cells that cause cancer. Bortezomib (Velcade) is a proteasome inhibitor, a drug that blocks proteasomes from breaking down proteins, used to treat lymphomas. Romidepsin (Istodax) and belinostat (Beleodaq) interact with a protein in chromosomes called histone to stop the growth of lymphoma cells. Two kinase inhibitors, ibrutinib (Imbruvica) and idelalisib (Zydelig), block proteins that transmit signals to some lymphoma cells that help them grow and survive.

Stem cell transplantation

Stem cell transplantation is considered an aggressive treatment and is generally used only for patients with NHL who have progressive or recurrent disease.

Clinical trials

Clinical trials are always underway to explore new treatment strategies and combinations for NHL. Ask your doctor and search online to learn about clinical trials for which you may be eligible.

Additional Resources

 

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