Lymphoma Non Hodgkins Treatment

Treatment strategies for NHL depend on several factors, including the type, stage, grade and extent of the lymphoma, as well as individual prognosis. Patients under the age of sixty usually respond better than those who are over sixty. The improved prognosis in younger patients may be due to their ability to tolerate higher doses of drugs and to withstand the invasive side effects of the various therapies.

Most non-Hodgkin’s lymphoma patients receive some form of chemotherapy, radiation therapy, biologic therapy, bone marrow or stem cell transplantation, or a combination of therapies. Very rarely, surgery is also required.

Apart from conventional treatments using chemotherapy and radiation therapy, several clinical trials are testing new approaches for the many types of non-Hodgkin’s lymphoma. Results to date are impressive, with a number of advances, such as monoclonal antibody therapy, currently proving particularly effective among patients with aggressive forms of NHL.

The Importance of Clinical Trials

Some patients may have the opportunity to take part in clinical trials to evaluate promising new treatments for NHL. Clinical trial participation is vital in the fight against non-Hodgkin’s lymphoma.

Treatment Strategies for Non-Hodgkin’s Lymphoma

If the patient is asymptomatic or has swellings that are not causing discomfort, doctors often prefer to “watch and wait” rather than instigate aggressive forms of treatment. The disease, however, is carefully monitored; in this situation, waiting does not adversely affect the outcome of any future treatment.

Radiation Therapy

Radiation is often used in the early stages of non-Hodgkin’s lymphoma or when the tumor is localized. In these situations, the five-year relative survival rate is as high as 95 to 100 percent. Radiation therapy may be used on its own or in combination with chemotherapy. Radiation therapy is sometimes used to ease symptoms that may occur when other internal organs are affected.

Chemotherapy

Chemotherapy is still one of the most widely used forms of treatment for NHL. Chemotherapy is administered either as a single high dose drug or as a combination of drugs and is often used in conjunction with radiation therapy.

The standard treatment for aggressive, diffuse large-B-cell lymphoma is cyclophosphamide, doxorubicin, vincristine and prednisone, commonly referred to as CHOP.

Single Agent Chemotherapy

Single agent therapy is generally used for less aggressive lymphomas, where the patient has a bulky mass tumor or is suffering excessively from other NHL symptoms. The most commonly used single alkylating agents are chlorambucil (Leukeran®) and cyclophosphamide (Cytoxan®). Chlorambucil is taken daily in pill form, whereas cyclophosphamide is given by injection every three to four weeks.

G-CSF

A number of recent clinical trials have shown that the use of filgrastim, a growth factor known as granulocyte-colony factor (G-CSF), may help increase the number of immune cells found in the bone marrow or peripheral blood cells of patients following chemotherapy. G-CSF, according to researchers, can significantly boost a person’s immune system and aid recovery from the bone marrow suppression associated with high dose chemotherapy.

Steroids

Steroid drugs are sometimes used along with chemotherapy drugs to treat NHL.

Surgery

Generally, surgery is recommended only if the NHL tumor affects other internal organs.

Autologous Transplants

An autologous transplant is a promising new treatment that involves the infusion of autologous (a patient’s own) peripheral blood progenitor cells, following high-dose therapy (HDT). The aim is to allow for high doses of chemotherapy by subsequently replacing the patient’s healthy cells. HDT is recognized for causing heavy bone marrow suppression, severe complications and infections. With this new form of treatment, however, the patient’s own blood cells are saved prior to treatment and injected afterwards to build up the bone marrow.

Although stem cell and bone marrow transplants are a relatively new concept, findings from several clinical trials indicate that autologous transplants are particularly effective for the treatment of large B-cell, follicular and mantle cell lymphomas. Indeed, autologous transplants could prove to be a breakthrough for the treatment of advanced and unresponsive cases of NHL.

Other new developments involve the possible use of cell transplants from other healthy persons (allogeneic transplant). Further research is required to determine the efficacy of this approach.

Monoclonal Antibodies

In recent clinical trials rituximab (MabThera™, Rituxan® or anti-CD20), a monoclonal antibody targeted against the CD20 B-cell antigen, has been shown to have a therapeutic effect in the treatment of diffuse large-B-cell lymphomas.

Manufactured monoclonal antibodies including the unmodified antibody rituximab, Campath 1H (anti-CD52) and epratuzumab (anti-CD22) are currently being used to treat lymphoma. Results, to date, are encouraging.

In addition, randomized trials are being carried out with elderly patients with diffuse large-B-cell lymphoma to compare CHOP chemotherapy with rituximab against CHOP alone.

Zevalin Rituxan

The FDA approval of Zevalinâ„¢ (February 2002) used in combination with Rituxan has proven to be a breakthrough in the treatment of B-cell non-Hodgkin’s lymphoma. Zevalin is approved for those patients who have failed to respond to standard chemotherapy using single dose Rituxan.

Radioimmunotherapy

Radioimmunotherapy can be used alone or in combination with conventional chemotherapy and involves the use of newer “hybrid” radioactive antibodies to target cancerous cells with radiation or toxins, such as radioactive iodine (I-131) and yttrium (Y-90). This involves attaching radioisotopes to the antibody to kill the cancerous cells more effectively while minimizing damage to the patients’ healthy cell tissue.

Radioactive antibodies currently being investigated include:

  • Lym-1 (anti-HLA-D)
  • 1311-tositumomab (Bexxar®, anti-CD20)
  • ibritumomabtiuxetan (Zevalinâ„¢, anti-CD20)
  • epratuzumab (anti-CD22)
  • denileukin diftitox (Ontak®), an antibody directed against the interleukin-2 receptor (IL-2R) and coupled to the diphtheria toxin.

Child-Specific Treatments For NHL

Treatments for the three major types of childhood non-Hodgkin’s lymphoma depend on the stage of the child’s disease and histology (what the cancerous cells look like under a microscope). The child’s age and general health are also important factors.

Much attention is currently being focused on clinical trials to find specific treatments for childhood lymphomas that do minimal damage to the healthy cell tissue of the developing child. A number of trials, for example, are testing new treatments for advanced stages of childhood non-Hodgkin’s lymphoma.

Useful NHL Treatment Terminology

primary therapy: This term refers to the first therapy used to treat the disease.

partial remission: Following treatment, the tumor is reduced to less than half its original size.

improvement: Following treatment, the tumor shrinks, but is still more than half its original size.

complete remission: All signs of the disease disappear after treatment; however, this does not mean that the disease has been completely eradicated.

durable remission: Complete remission following primary therapy is maintained for a long period (usually five years).

cure: This term is used with great caution by the medical profession to refer to situations where no signs of the disease recur for five years or more following treatment.

refractory disease: This designates a tumor that is resistant to treatment.

Resources

Beers, M. H.,