How is Lymphoma Treated?

An Introduction to Lymphoma Treatment

Lymphoma treatments vary, depending on the lymphoma type and patient factors.
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To someone newly diagnosed with lymphoma, treatment options may be difficult to understand. There are nearly 30 types of lymphoma, and often there are multiple treatment options for a single disease. In addition, new therapies emerge continually, and what was true about options and outcomes even 10 years ago for any given lymphoma may not still be true today. Here is a brief guide to understanding lymphoma treatment.

Before Treatment

After the diagnosis of lymphoma and determining the exact type of Hodgkin's or non-Hodgkin's lymphoma, a number of tests are still needed to find out the extent of disease -- the stage of lymphoma -- and to examine other factors that determine the prognosis. When all these tests and evaluations are complete, the oncologist counsels the patient regarding the best treatment options available.

Understanding Types of Treatment

There are four main types of treatment for lymphomas:

  • Chemotherapy – Drugs that are administered as infusions in your veins or as pills. Common chemotherapy schedules include ABVD, R-CHOP and CHOP.
  • Radiotherapy – High-energy rays that are directed at the tumor. Radiotherapy can be delivered over small areas (involved field radiation ) or large areas (extended field radiation).
  • Targeted therapy, including antibody therapy – also called biologic therapy – using drugs like rituximab that target special molecules on the surface of cancer cells. With the advance of molecular medicine, more and more therapies that target new mechanisms are being explored in clinical trials, and new agents continue to be approved by the US FDA. The immune checkpoint inhibitors are one such group of agents being developed, with possible applications in lymphoma therapy.
  • Bone marrow or stem cell transplant – Using high doses of chemotherapy or radiation to kill all cancer cells while saving the bone marrow with transplantation of marrow or stem cells.

Treatment of Hodgkin’s Lymphoma

Hodgkin’s lymphoma is usually treated with chemotherapy and radiotherapy. Treatment options are based on the stage of lymphoma and some prognostic factors.

Nearly all patients receive chemotherapy, and radiation may be used in early stage disease usually after chemotherapy or occasionally as the only treatment.

Treatment of non-Hodgkin’s lymphomas (NHL)

There are nearly 25 different types of non-Hodgkin’s lymphoma. Some of them behave very differently from others. The treatment of all NHL is not the same but depends on the lymphoma type, subtype, and behavior of the particular subtype. Chemotherapy is usually the main treatment. Radiation or monoclonal antibody therapy may be added to chemotherapy in some situations for added benefit.

Because the non-Hodgkin’s lymphomas are such a diverse group, what is true for one subtype may not be true for another. For example, some individuals with follicular lymphoma, a slow-growing or indolent lymphoma, may not require treatment early on, while aggressive lymphomas such as diffuse large B-cell lymphoma, or DLBCL, typically are treated more aggressively and often respond very well to chemotherapy.

Investigational Treatments

With respect to cancer therapy and lymphoma treatments, in particular, signing up for clinical trials can offer many patients the advantages of more options and newer agents. Perhaps this is especially true for individuals who have what is referred to as relapsed or refractory disease. Some lymphomas respond just as well to the same treatment again as they did the first time, while others demonstrate the need for newer options and different combinations.

The right match between patients and clinical trials may involve newer chemotherapy approaches, pathway-directed therapies, immune strategies or tumor-directed therapies.

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