Proper care of patients with any of the many types of lymphoma is critically dependent on a correct diagnosis and evaluation of the disease.
Doctors at Memorial Sloan-Kettering employ an array of sophisticated technologies such as cytogenetic, molecular, and immunohistochemistry studies to characterize tumor cells precisely and identify the most appropriate course of treatment for individual patients.
Our translational approach to drug discovery enables researchers to test promising new agents that originate in our laboratories very early in their development. We can then combine drugs that show promise in early trials with other agents to improve the effectiveness of therapy.
The Leading Edge in Therapy
Memorial Sloan-Kettering researchers demonstrated that more patients with diffuse large B-cell lymphoma can receive potentially curative bone marrow transplantation when they first receive a combination treatment called ICE (ifosfamide, carboplatin, etoposide). ICE also improves tumor response rate and reduces toxicity in patients with relapsed or refractory, aggressive disease. Our doctors have recently found that by adding rituximab to the ICE regimen (RICE), they can further improve the response rate.
Our doctors have designed a unique autologous stem cell transplant program for patients with Hodgkin's disease that includes total lymphoid irradiation, which treats the potential sites of disease but spares the normal tissues, like the lung, providing benefit without added toxicity. We have also devised ways to predict which patients with Hodgkin's disease can benefit from autologous transplantation as it is currently performed, and which patients will require newer, more intensive therapies. We have developed a similar prognostic model for non-Hodgkin's lymphoma.
The advances made with peripheral blood stem cell transplantation have also resulted in the development of new techniques for allogeneic transplant in which lower doses of chemotherapy and radiation can be used. These "mini-allo" or "non-myeloablative" transplants have been developed at Memorial Sloan-Kettering for selected patients with lymphoma, leukemia, and multiple myeloma, as well as for patients with kidney cancer and metastatic melanoma.
We also have a program to test the effectiveness of biological agents including vaccines, interferon, novel cytotoxic agents, and angiogenesis inhibitors in the treatment of lymphoma. We are one of the leading centers in the evaluation of 131I-tositumomab (Bexxar) for the treatment of indolent and transformed non-Hodgkin's lymphoma, and are exploring several strategies for integrating radioimmunotherapy into the treatment of mantle cell lymphoma and other types of lymphoma.
Physicians now routinely use combined chemotherapy and radiation therapy to treat lymphomas, an approach conceived and tested here at Memorial Sloan-Kettering. Our investigators developed a sophisticated high-dose chemoradiotherapy program to treat patients who have not responded to standard therapy and also helped set the standard for treatment of AIDS-associated lymphoma.
We are one of a very few centers with specialized expertise in lymphoma radiation oncology. Our team is also a world leader in clinical research in radiation oncology for lymphomas, and in the training of the next generation of radiation oncologists devoted to these diseases. Among the treatments pioneered or perfected at Memorial Sloan-Kettering are:
- A risk-adjusted treatment plan integrating ICE chemotherapy, comprehensive radiotherapy (unique to Memorial Sloan-Kettering), and high-dose chemotherapy followed by stem-cell transplantation. The long-term outcome of these patients is regarded as among the best in the country. We are now investigating whether adding rituximab to the ICE regimen (RICE) can further improve the response rate.
- Accelerated involved-field (targeted irradiation) and total lymphoid irradiation for stem cell transplants. In this way, the irradiation treats the potential sites of disease but spares normal tissues.
- Intensity modulated radiation therapy (IMRT), which minimizes the dose of radiation to normal organs and allows re-irradiation of critical areas, has been used at Memorial Sloan-Kettering to treat bulky Hodgkin's and non-Hodgkin's lymphomas.
- The use of low-dose irradiation as a stand-alone therapy in the treatment of certain kinds of lymphoma, such as mucosa-associated lymphoid tissue (MALT) lymphoma. Our doctors were the first to develop this approach and have the largest successful experience with it, sparing our patients unneccessary surgery or chemotherapy.
Our team also has expertise using total-skin electron beam therapy for the treatment of cutaneous (skin) lymphomas and mycosis fungoides (a slow-growing and chronic type of skin lymphoma).
Decoding the Genetics of Lymphomas
Scientists here are looking closely at genetics as a basis for more effective treatment strategies. For example, our researchers are testing genetically altered stem cells to improve bone marrow transplants. We also test for gene mutations that may make patients react adversely to certain therapies.
Investigators here are also examining the molecular evolution of tumors in lymphomas. The ability to identify molecular alterations and biological markers will help physicians understand how tumors behave, so that they can diagnose them more effectively, and develop highly targeted therapies. Scientists at Memorial Sloan-Kettering have also developed powerful new methods to track minimal residual disease in patients with lymphoma.
