Lymphomas: Treatment for Non-Hodgkin Lymphoma

Lymphoma Service Chief Anas Younes Lymphoma Service Chief Anas Younes confers with nurse Devin Callan (left) and Physician Assistant Sharyn Kurtz.

There are more treatment options than ever before for people with non-Hodgkin lymphoma, from traditional chemotherapy medicines to new drugs that are available only through clinical trials.

We’ll find the treatment strategy that works best for you based on which type of non-Hodgkin lymphoma you have and whether it’s affecting one lymph node area or several places in your body. We also classify non-Hodgkin lymphoma as either aggressive (fast growing) or indolent (slow growing and often referred to as “low grade”).

Pictured: Steven Horwitz
Video

Medical oncologist Steven Horwitz discusses advances in the diagnosis and treatment of lymphoma, with an emphasis on non-Hodgkin lymphoma.

(37:00)

Advances in the diagnosis, staging, and treatment of non-Hodgkin lymphoma have been made, explains medical oncologist Steven Horwitz. A good biopsy is important for making an accurate diagnosis. Today, pathologists can also use genetic information from a biopsy to inform a prognosis and help oncologists select the most effective treatments. The right combination of chemotherapy, radiation, and immunotherapy can lead to cure and remission in many people, and a number of new drugs are being studied in clinical trials at MSK and elsewhere. 

Various diagnostic tests help us to customize your treatment. And if your disease has returned after being treated in the past, we can often offer a variety of treatment options.

Active Surveillance and Treatment for Low-Grade (Indolent) Lymphoma

If you have a slow-growing lymphoma and aren’t experiencing any discomfort or other symptoms, we may recommend an approach called active surveillance, which is just what it sounds like: We’ll watch for any signs of change with regular physical exams, blood tests, and CT scans. If the disease becomes more active and needs to be treated, we’ll come up with a new treatment plan together.

Many of the patients in our active surveillance program don’t require any type of treatment and remain in the program for many years.

Radiation Therapy

Many types of lymphoma are highly sensitive to radiation and can be cured with much lower doses and smaller radiation fields (areas that are affected by radiation) than in the past.

If your lymphoma appears in only one lymph node or organ, we may recommend radiation therapy. Sometimes we combine it with chemotherapy to reduce the risk that the lymphoma will come back (recur), or to treat a disease that hasn’t respond to chemotherapy.

Thanks to advances in a sophisticated method called intensity-modulated radiation therapy, we’re able to deliver radiation to tumors with pinpoint precision and avoid damaging healthy tissue nearby.

Chemotherapy for Advanced or Aggressive Non-Hodgkin Lymphoma

Chemotherapy has long been a reliable and effective approach for treating people with non-Hodgkin lymphoma that is advanced or aggressive. With chemotherapy, we give you medicine by IV (intravenously) or in pill form to kill the rapidly dividing lymphoma cells throughout the body.

For people with aggressive B cell non-Hodgkin lymphoma, we commonly recommend a chemotherapy called R-CHOP, which is named after the medicines included in the mixture. Another particularly effective and commonly used chemotherapy for B cell non-Hodgkin lymphoma combines prednisone, a corticosteroid, with a drug called rituximab. Rituximab helps your immune system destroy the cancer cells and makes the chemotherapy more powerful.

We’re also developing new treatment strategies based on our understanding of why and how lymphoma develops, and the recognition that you may do best with a regimen customized for your specific case and the makeup of your particular tumor. Since chemotherapy can cause side effects, we also want to help you find ways to manage these and preserve your quality of life.

New Non-Chemotherapy Agents

Today, we have better drug options for patients than ever before. Often these newer drugs, sometimes called targeted agents, have a variety of benefits.

  • They’re formulated to be more powerful.
  • They’re designed to zero in on cancer cells, which results in fewer side effects and less damage to healthy cells.
  • They use the immune system to treat the cancer (a field known as immunotherapy).
  • They can be taken by mouth instead of by IV.
  • They can be taken alone or combined with chemotherapy.

Many of these non-chemotherapy drugs are available to MSK patients as a standard treatment option. We also have many clinical trials under way exploring new approaches to treating the disease.

Treatment for Diffuse Large B Cell Lymphoma (DLBCL)

New treatment strategies for diffuse large B cell lymphoma promise to dramatically change how we treat this common type of the disease.

Our approach to treatment will depend on the nature of your lymphoma. Some people receive R-CHOP, a chemotherapy named after the medicines included in the mixture, while others who are at high risk for recurrence get additional therapy to prevent the cancer from coming back.  

We’re also studying how new targeted therapies can boost the effectiveness of chemotherapy treatment.

Recurrent Non-Hodgkin Lymphoma: Stem Cell Transplantation and Other Approaches

In many people, non-Hodgkin lymphoma returns months or years after their first treatment with chemotherapy or radiation. In these situations, we may recommend additional chemotherapy, treatments that boost the power of the immune system or use it to keep the cancer away, or other approaches we’re investigating in clinical trials.

We may also recommend a stem cell transplant, which can often cure cancer that has returned or allow you to live a long time without it. We’re a world leader in all the versions of this procedure. Stem cell transplants are not the right choice for everyone, but we’ll assess whether one could be right for you.

Treatment Approaches for T cell Lymphoma

If you have T cell lymphoma, you may benefit from MSK’s unique and dedicated approach to this illness. For example, since T cell lymphoma often affects the skin, the expertise of our dermatologists, and the fact that they work in the same suite as our medical oncologists, can be invaluable. And as with other types of lymphoma, we have clinical trials specifically for this disease.