Chemotherapy

Chemotherapy is the primary treatment for all stages of lymphoma. Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Doctors usually give a combination of different chemotherapy drugs to treat lymphomas. For some patients who don’t respond well to these regimens, doctors may recommend high-dose chemotherapy with stem cell transplantation or chimeric antigen receptor T cells therapies.

Radiation Therapy

Radiation therapy uses high-energy rays or particles produced in a precise way from a machine to destroy lymphoma cells that are found in nodes or tumor masses. The doctor may recommend radiation after completion of chemotherapy to kill any lymphoma that may be left over after the chemotherapy. Doctors also sometimes give radiation alone to treat some cases of early-stage non-Hodgkin lymphoma. A doctor who gives these kinds of treatments is called a radiation therapist, or radiation oncologist. These doctors commonly use a radiation technique called involved-field radiotherapy to treat lymphomas. This technique allows them to target only the area of the body where the lymphoma is located.

Intensity-modulated radiotherapy (IMRT)

Intensity modulated radiotherapy (IMRT) uses even more X-ray beams and beam angles to permit variations in the dose pattern so that the tumor will receive a higher total dose than the normal tissues.

Monoclonal Antibody Therapy

This treatment consists of drugs, called antibodies, that act like part of the immune system and are used to attack cancerous cells. These antibodies are medicines that are similar to normal antibodies that are produced by the body’s own normal B cells to fight infections, targeting bacteria and other common infectious agents. However, these medicines target instead parts of the lymphoma cell and cause it to die. Antibody therapy may play an important role in Burkitt lymphoma, as well as diffuse large B-cell and anaplastic large cell lymphoma and Hodgkin lymphoma.

Radioimmunotherapy

Radioimmunotherapy is treatment with monoclonal antibodies that have radioactive molecules attached to them. The monoclonal antibodies carry the radiation straight to the cancer cells. Radioimmunotherapy is often more effective than non-radioactive antibodies, and is approved in the United States for therapy of patients with slow-growing lymphomas.

Stem Cell Transplantation

This procedure allows patients to receive large doses of chemotherapy. High doses destroy lymphoma cells in the patient's body, but also cause significant damage to normal cells in the bone marrow. After chemotherapy, the patient receives blood-forming stem cells that help the body form new, healthy blood cells in the bone marrow. In an autologous stem cell transplant, the stem cells are taken from the patient prior to the administration of high dose therapy. In an allogeneic transplant, the stem cells are collected from a healthy donor.

Protein Inhibitors

Protein inhibitors disrupt tumor growth by blocking proteins necessary for cell growth and the formation of new blood vessels. These are very new therapies that have great potential to benefit patients with lymphomas, and are under intense research.

Immunomodulators

Immunomodulators stimulate the patient’s immune system to help it fight off lymphoma cells, but also have other ways to control the growth of cancer cells. These new medicines also appear very promising for therapy of lymphomas.

CAR-T-cell Immunotherapy

One approach to immunotherapy currently being studied in clinical trials involves engineering a patient’s own immune cells to recognize and attack tumor cells.  T-cells are a type of immune cell collected from the patient’s own blood.  After collection, the T-cells are genetically engineered to produce special receptors on their surface called chimeric antigen receptors (CARs).  These genetically engineered cells are then re-infused into the patient’s bloodstream.  After re-infusion, the T-cells multiply in the patient’s body and with guidance from their engineered receptor, are able to recognize and kill cancer cells. Click here to see introduction of CAR T-cells.

Clinical Trials

Clinical trials are studies of new cancer treatments that show promise in treatment of the disease. Phase 1 clinical trials introduce a new treatment to a small group of patients to determine if it is safe. Phase 2 clinical trials test if a specific type of cancer responds well to a new treatment. Phase 3 clinical trials usually compare a new disease treatment to a standard treatment. Such trials, particularly phase 2 and 3 trials, are designed to offer the best chance of remission using standard or non-standard medications. These trials also answer important questions about how well these medicines work for the particular lymphoma being treated, and whether or not they are a good choice of treatment for patients with lymphoma. Such trials may also be the best treatment option for patients with lymphomas that have not responded well to traditional treatments. Proton therapy is also being used in clinical trials.

What is Proton Therapy?

Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.