Lymphomas: Treatment for Non-Hodgkin Lymphomas at Memorial Sloan Kettering

Pictured: Paul Hamlin Paul Hamlin, Clinical Director of Memorial Sloan Kettering’s Lymphoma Outpatient Unit, is one of our many experts in the diagnosis and treatment of lymphomas.
Pictured: Anas Younes
Video

People with lymphoma generally tolerate treatments such as radiation therapy and chemotherapy relatively well but new drugs with fewer side effects may be available soon.

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The number of treatment options for people with non-Hodgkin lymphomas is growing rapidly and includes traditional chemotherapy medicines as well as new FDA-approved drugs and agents available only through clinical trials.

The approach our team shapes for you is based on such factors as the specific subtype of disease you have, whether it’s slow growing or aggressive, and whether it’s confined to one lymph node area or is affecting several places in your body.

Various diagnostic tests also help in customizing your treatment. And if you have disease that 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

For people with slow-growing lymphoma who have no symptoms, we may recommend active surveillance, in which we regularly monitor the cancer with physical exams, blood tests, and CT scans for signs of progression. We continuously reevaluate our approach if the cancer becomes more active.

Active surveillance works well if you’re not experiencing any disease symptoms or discomforts, and if treatments are unlikely to cure the disease. Many of our patients undergo active surveillance for years, never requiring any type of treatment.

At some point you might need treatment for your slow-growing lymphoma. For lymphomas that are not currently curable, we work with you to stop or control the cancer while minimizing side effects and preserving your quality of life.   

Radiation Therapy

Many types of lymphoma are highly sensitive to radiation and can be cured with much lower doses and smaller radiation fields than used in years past.

We may recommend radiation therapy if your lymphoma is confined to one lymph node or organ, such as the stomach. We also use it in combination with chemotherapy to reduce the risk of recurrence or to treat diseased areas that don’t respond to chemotherapy.

Thanks to advances in sophisticated intensity-modulated radiation therapy (IMRT), we’re able to deliver radiation to tumors with pinpoint precision.

Chemotherapy for Advanced or Aggressive Non-Hodgkin Lymphomas

Chemotherapy has long been a reliable and effective approach for treating people with non-Hodgkin lymphomas, or NHLs, that are advanced or aggressive. Chemotherapy consists of medicine given intravenously or by mouth to kill rapidly dividing cells throughout the body.

The most commonly used chemotherapy regimen for aggressive B cell NHL is R-CHOP, which is named after the medicines included in the mix: cyclophosphamide, doxorubicin, and vincristine.

Another commonly used regimen is a combination of the corticosteroid prednisone and the drug rituximab, a monoclonal antibody that binds to B cells (including most lymphoma B cells). Rituximab helps the immune system destroy the cancer cells and makes the chemotherapy more powerful.

We’re also developing new treatment strategies based on our understanding of the biology of lymphomas and the recognition that patients may require different treatments based on the genetic and biochemical composition of their tumors.

As a comprehensive hospital with vast experience in focusing solely on treating people with cancer, we’re skilled at identifying and managing chemotherapy-related side effects and helping to preserve quality of life.

New Non-Chemotherapy Agents

Today we can treat lymphomas and other cancers with drugs that differ from traditional chemotherapy in many ways. Often these newer agents are:

  • More powerful
  • More specific (targeted), resulting in fewer side effects
  • Designed to use the immune system to treat the cancer
  • Taken by mouth instead of through injection into a vein
  • Taken alone or combined with chemotherapy

The FDA has approved a number of these non-chemotherapy drugs; clinical trials to explore new ones are under way.

Treatment for Diffuse Large B Cell Lymphoma (DLBCL)

Our doctors have shown a significant increase in length of life by using a risk-adapted therapy approach for people with DLBCL, an aggressive cancer that can arise in the lymph nodes, gastrointestinal tract, testes, thyroid, skin, breasts, bones, or brain.

Some people receive R-CHOP (a chemotherapy regimen named after the medicines included in the mix: cyclophosphamide, doxorubicin, and vincristine), while others who are at high risk for recurrence get additional therapy to prevent relapse.   

In addition, we’re studying how new targeted therapies interact with chemotherapy to make it more effective. This promises to dramatically change how we cure this common type of lymphoma.

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

In many people, non-Hodgkin lymphomas return months or years after initial treatment with chemotherapy or radiation. In these situations and depending on the specific case, we may recommend chemotherapy, treatments that boost the immune system or use it to keep the cancer away, or other approaches currently under investigation in clinical trials.

We may offer you a stem cell transplant, which can often cure cancer that has recurred or allow you to live a long time without the disease. Our institution is a world leader in this field for lymphomas as well as other cancers. Stem cell transplants can result in serious side effects, however, and are not the right choice for everyone.

With autologous transplantation, your own stem cells are harvested and returned to you after they are put through intensive chemotherapy, producing healthy new blood cells. Or you may receive a transplant of stem cells from another person, called allogeneic transplantation. Our doctors are experts in tailoring the amount of chemotherapy you receive as part of your transplant regimen.

T Cell Lymphomas: Our Dedicated Program

T cell lymphomas are relatively rare and account for only about 5 percent of all lymphomas. If you have this disease, you may benefit from MSK’s unique and dedicated approach to this illness.    

For example, since T cell lymphomas often affect the skin, the expertise of our dermatologists, and the fact that they work in the same suite as our medical oncologists, can be invaluable.   

As with other types of lymphomas, we have clinical trials specifically for this disease.