Treatment for Non-Hodgkin's Lymphoma
Treatment for non-Hodgkin's lymphoma (NHL) depends on the type, location, grade, and stage of disease, as well as the patient's age and overall health.
In patients who have slow-growing, localized, early-stage NHL (Stage 1 or 2), radiation therapy is the main form of treatment. In patients who have slow-growing nonlocalized, late-stage NHL (Stage 3 or 4), the treatment plan is not so well defined. Because of the unhurried growth of such tumors, chemotherapy and radiotherapywhich selectively destroy rapidly-dividing cellscannot eliminate all of the cancer cells. Therefore, these tumors usually are not "curable" and treatment options may include single agent chemotherapy, combination chemotherapy, or chemotherapy plus radiation therapy.
In some cases (e.g., elderly patients, patients who have additional health problems), physicians and patients choose to delay treatment until symptoms appear; however, recent studies suggest that the patient's survival is improved when treatment is begun as soon as possible after diagnosis.
In patients who are diagnosed with slow-growing NHL associated with Waldenstrom's macroglobulinemia (condition in which too much of the antibody immunoglobulin M [IgM] is produced), the physician may recommend plasmapheresis prior to chemotherapy. Plasmapheresis involves separating the plasma and its components, including IgM, from the blood, and eventually re-transfusing the blood back into the patient.
Patients who have intermediate-grade, aggressive, early-stage NHL (Stage 1 or 2) usually are treated with combination chemotherapy or radiation therapy plus chemotherapy. If the patient has health problems that do not permit the use of chemotherapy, radiation therapy may be used alone.
Patients who have intermediate-grade, aggressive, late-stage NHL (Stage 3 or 4) may be treated with combination chemotherapy (plus radiation therapy for individuals with bulky tumors), or high-dose chemotherapy with stem cell transplantation.
These patients may be given growth factors to aid the recovery of bone marrow cells and prevent infections after chemotherapy treatment. In December 2008, the U.S. Food and Drug Administration (FDA) approved plerixafor injection (Mozobil) to be used in combination with growth factors to increase the number of blood stem cells for bone marrow transplantation. This drug is approved for use in adults with non-Hodgkin's lymphoma or multiple myeloma (cancer of the plasma cells). Side effects include diarrhea, nausea and vomiting, fatigue, headache, joint pain, dizziness, and injection site reactions.
High-grade, highly-aggressive NHL (e.g., Burkitt's lymphoma, Burkitt's-like lymphoma, lymphoblastic lymphoma) are treated with intrathecal chemotherapychemotherapy injected directly into the spinal fluidto prevent the spread of cancer to the brain and central nervous system (CNS).
Unfortunately, some of these patients have certain conditions or characteristics that make them less responsive to this treatment. In these cases, the oncologist may recommend high-dose chemotherapy with stem cell transplantation or biological therapies.
Patients with acute T-cell leukemia/lymphoma generally have a poor prognosis. New antiviral drugs for HIV/AIDS have shown some promise against this type of lymphoma. This is because HIV (human immunodeficiency virus) infection is related to HTLV-1 (human T-cell leukemia/lymphoma virus)the virus that is associated with human T-cell lymphoma.
Non-Hodgkin's Lymphoma Clinical Trials
Many advances are being made in the treatment of NHL. However, continued advances in the field often depend on patient participation in clinical trials. Through the use of clinical trials, improved treatment outcomes and the development of additional risk appropriate strategies can be secured. NHL patients should discuss clinical trial options with their physicians.