Therapy is based on the type of lymphoma and other factors such as the patient's age, gene classification of the disease and prognosis. It's critical to know the stage of disease. Staging for blood and lymph cancers varies and generally ranges from early-stage disease to stage IV, which means the cancer cells have already spread to distant sites in the body. The stage of disease affects lymphoma survival rates.
Hodgkin lymphoma and non-Hodgkin lymphoma use the Lugano staging system to classify the extent of disease. Generally, the practice is to treatment patients based on either limited disease (stages I or II) or advanced disease (stages III or IV). For Hodgkin lymphoma, sometimes the letters A or B are added to the stage number to reflect other symptoms among HL patients.
Some lymphoma patients’ cases are discussed at Wimot’s multidisciplinary board — a conference attended by many doctors with different specialties that might be required for your care.
Many types of treatment are used for lymphoma, including chemotherapy, radiation therapy, targeted therapies, immunotherapy, stem cell transplant (with bone marrow or peripheral blood), apheresis and surveillance. Surgery is rare, although there are some cases when it’s needed.
Chemotherapy uses drugs or a combination of drugs—given intravenously or as pills—to destroy cancer cells. Chemotherapy has traditionally been one of the most common treatments for both Hodgkin lymphoma and non-Hodgkin lymphoma.
Radiation therapy uses energy from radiation beams, radio isotopes or charged particles to target tumors and eradicate cancer cells. It is sometimes used to treat lymphomas and multiple myeloma. It’s most effective when the cancer is isolated to one area of the body.
These are newer drugs designed to target specific gene changes that result in some types of lymphoma. They single out cancer cells and usually have less severe side effects compared to chemotherapy.
Non-Hodgkin lymphoma: Different targeted therapies work for different types of lymphoma. Targeted therapy for non-Hodgkin lymphoma includes a drug called Bortezomib, which can be used if other treatments have failed. The drugs Ibrutinib and lenalidomide can be used to treat mantel cell lymphoma while Idelalisib may help to treat follicular lymphoma and small lymphocytic lymphoma. The drug rituximab can be used to treat all B-cell lymphomas.
Hodgkin disease: The drug brentuximab can be used to target a specific molecule on Hodgkin disease cells.
PTCL and CTCL: Approved targeted therapies for these diseases include romidepsin and belinostat.
Stem cell transplant
This involves using high doses of chemotherapy to wipe out cancer cells and decrease the amount of bone marrow in the body. Then, a stem cell transplant takes place to restore the healthy bone marrow. Despite the word “transplant,” this type of therapy does not require surgery.
Wilmot’s Blood and Marrow Transplant Program, which is the only such program in the Finger Lakes region, has been recognized for its high level of care and detailed quality management process.
Typically an autologous stem cell transplant is used for Hodgkin or non-Hodgkin lymphoma. The patient’s own blood or marrow is removed, stored safely, and later put back into the body. If this is not successful, an allogenic stem cell transplant can be done, which involves infusing the blood and bone marrow from a matched donor (usually a close relative).
This is a newer type of treatment that attacks cancer by boosting the patient’s own immune system. A new type of immunotherapy treatment— known as chimeric antigen receptors (CAR) T-cell therapy—is currently being studied in clinical trials. Wilmot is part of a select group in the northeast with access to clinical trials for CAR T-cell therapy for lymphoma.
Sometimes the blood of those with blood or lymph cancer becomes thickened with antibodies, which disrupts circulation. With apheresis, patients are connected to two IVs — one taking blood out and one putting it back in. Blood goes through the IVs and in the process, cancer cells or antibodies are removed and then blood is put back into the body in a less thickened state.
For slower growing blood cancers, watchful waiting may be the best route. This involves oncologists carefully monitoring patients with frequent visits to ensure the cancer hasn’t become more threatening. Surveillance is sometimes used for non-Hodgkin lymphomas and multiple myeloma.
Although it is rarely used as a lymphoma treatment, tissue or organs that are causing problems for the patient (such as the spleen), may be removed.
This type of therapy does not treat the cancer but can ease symptoms caused by cancer. Sometimes oncologists prescribe antibiotics, anti-viral drugs, or other medications to prevent infections or boost low blood counts.
Many cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences side effects in the same way.
Wilmot's Cancer Control & Survivorship program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects.
The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.