But that also puts a heavy burden on both you and your doctor. What exactly are the options? Which are best for you? And how do you and your doctor decide? Non-Hodgkin lymphoma can be treated with chemotherapy, immunotherapy, radiation, stem-cell transplants, and even, in rare cases, surgery.
Next Steps After the Diagnosis
When you learn that you have non-Hodgkin lymphoma, these are seven questions you should ask your doctor, according to the American Cancer Society: (1) Your doctors should also be willing to discuss their own experience treating non-Hodgkin lymphoma. Choose a doctor who has a lot of experience with this illness. Your doctor might also suggest you get a second opinion. Ask your doctor for help finding a physician who can provide one. RELATED: CAR T Cell Therapy Enhances the Human Immune Response to Cancer
Priority Number One: Determining What Kind of Lymphoma You Have
One of the first things your doctors will do is determine what kind of non-Hodgkin lymphoma you have. There are many kinds of lymphomas, and each has its own set of treatments. (1) Lymphomas are classified according to the type of lymphocyte (a white blood cell) they begin in; how the lymphocyte looks under the microscope; the chromosomes in the lymphoma cells; and the presence of certain proteins on the surface of the cell. Most cases of NHL in the United States are B-cell lymphomas. And the most common of those is diffuse large B-cell lymphoma, or DLBCL. It generally occurs in older people; the average age of diagnosis is the mid-sixties. It most often begins as a quickly growing mass in a lymph node in the chest or abdomen, or in the neck or armpit. (2) It’s an aggressive, fast-growing type of lymphoma, but it often responds well to treatment. Three out of four people will have no signs of disease after they finish their therapy. Follicular lymphoma is another common type, responsible for about 1 in 5 cases of lymphoma in the United States. It’s a slow-growing tumor that often responds to treatment but is not curable past stage 1 disease. Sometimes doctors will advise waiting for treatment until the cancer starts causing problems. Other less common forms of lymphoma include small lymphocytic lymphoma (SLL), and mantle cell lymphoma, which make up about 5 percent of lymphomas. There are others, but they are rare. Recently, a study published in April 2018 in the New England Journal of Medicine, identified a range of genetic subtypes of diffuse large B-cell (DBLC) lymphoma. The information may help explain why treatment works in some patients and fails in others, and moves the field closer to a system of classifying cancers by their unique molecular signatures rather than the generic type of cancer or the organs in which tumors arise. (3) RELATED: New Study Sheds Light on Genetic Differences in Types of Lymphoma
Most Doctors Start Treatment With Chemotherapy
When it’s time for treatment, it’s likely that your doctors will try chemotherapy. It’s the main treatment for most people with non-Hodgkin lymphoma. There are many chemotherapy agents available for treatment of lymphoma. They include steroids, platinum drugs, such as Platinol (cisplatin), and other chemotherapy drugs, such as Oncovin or Vincasar (vincristine), Adriamycin (doxorubicin), and methotrexate. The side effects can include hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and an increased chance of infection. Other types of therapy you may receive include:
Immunotherapy
Immunotherapy is another common treatment for non-Hodgkin lymphoma. Chemotherapies are often combined with a drug called Rituxan (rituximab), which is a type of immunotherapy. The idea of immunotherapy is to empower a patient’s immune system to attack and destroy the disease. Along with Rituxan, there are new therapies called chimeric antigen receptor T cells (or CAR-T cells), in which a patient’s immune cells are removed from them, modified in the lab so that they are better able to identify and target their cancer, and infused back into the patient. Recently, the FDA approved a type of CAR T-cell therapy known as Yescarta (axicabtagene ciloleucel) for people with diffuse large B-cell lymphoma, primary mediastinal larbe B-cell lymphoma, high grade B-cell lymphoma, and diffuse large B-cell lymphoma that started as follicular lymphoma and has failed other kinds of therapy. (4)
Targeted Therapy
Drugs in this category of therapies block some of the normal processes involved in tumor growth. These include drugs known as proteasome inhibitors, such as Velcade (bortezomib), and kinase inhibitors, such as Imbruvica (Ibrutinib) and Calquence (acalabrutinib), which recently gained FDA approval for the treatment of mantle cell lymphoma. There are others as well.
Radiation
Radiation is sometimes used as the main treatment for non-Hodgkin lymphoma if the disease is diagnosed as stage 1. In later stages, it may be used in combination with chemotherapy. Many non-Hodgkin lymphomas respond well to radiation. Radiation is usually given by a beam delivered from outside the body. It’s like an X-ray, but the radiation is stronger. A course of treatment can be five days a week for several weeks. The side effects include redness and blistering of the skin, fatigue, nausea, and diarrhea.
Stem Cell Transplants
Stem-cell transplants, sometimes called bone-marrow transplants, involve cells in the marrow where new blood cells are made. A high dose of chemotherapy can damage those cells, and transplants are used to replace them. Stem cells are also used to treat lymphoma patients in remission or who have a relapse. In one version, called autologous stem-cell transplants, the patient’s own cells are collected before treatment and then given back to the patient intravenously after treatment.
Supportive Care
Not all of the treatment of non-Hodgkin lymphoma is concerned with attacking cancer cells. Other care is sometimes needed to deal with the consequences of treatment. Some patients getting chemotherapy face a high risk of infection. They might be given antiviral drugs or antibiotics to prevent infection. Steps can also be taken to restore low blood counts, a possible side effect of chemotherapy drugs that attack the bone marrow, where blood cells are made.
