Let's Talk About Lymphoma Treatment
It’s a challenging disease but there are a host of promising therapies to manage it. We asked our experts to share the latest options on your road to recovery.by Sunny Sea Gold Health Writer
If you’ve been diagnosed with lymphoma, you’re undoubtedly worried. But you should know that despite it being a serious disease, lymphoma has one of the best track records for successful treatment of almost any type of cancer. Your medical care team will go over all your options and offer recommendations, but if you want to get a head start (or confirm the info they’ve already shared with you), this is a great place to begin. Take a look at what lymphoma treatment will likely entail.
Our Pro Panel
We went to some of the nation’s top experts in lymphoma to bring you the most up-to-date information possible.
Jasmine Zain, M.D.
Director of the T Cell Lymphoma Program
City of Hope Comprehensive Cancer Center
Los Angeles, CA
Dhimant Patel, M.D.
Hematologist and Oncologist
Aurora BayCare Medical Center
Green Bay, WI
Faisal Saghir, M.D.
Hematologist and Medical Oncologist
Northwestern Medicine Kishwaukee Hospital
In order to diagnose lymphoma, a doctor will usually surgically remove a bit of tissue, or sometimes an entire lymph node, and send it to a lab to be tested. Other than a biopsy though, you probably won’t have surgery for lymphoma, since there often are no hard tumors to remove.
CAR T therapy genetically modifies a person’s immune cells so that they attack the cancer. To do this, T cells are removed from your blood and sent to a lab, where a specific gene is added to them. Large numbers of these modified T cells are then given back to the person through an IV.
Corticosteroids are medications that reduce inflammation. When used in combination with chemotherapy, corticosteroids stop allergic reactions and reduce side effects. Studies have shown that chemotherapy for lymphoma works better when people take a steroid, too.
Targeted medications—sometimes called “biological therapies”—are medications that target specific proteins or genes in your cancer cells to limit growth. Targeted drugs reduce damage to healthy cells and tissues, compared to chemotherapy.
Remind Me, What’s Lymphoma?
Lymphoma is a cancer of the blood and the lymphatic system, which includes lymph nodes (like the ones in your neck that get swollen when you have a bad cold), the spleen, bone marrow, and an immune gland in the chest called the thymus. Lymphoma starts when infection-fighting white blood cells called lymphocytes mutate and start to grow out of control.
While there are 70 (yes, 70) different subtypes of the disease, all of them fall under two large umbrellas:
The first is known as Hodgkin’s lymphoma (also sometimes called “Hodgkin’s disease” and named after Thomas Hodgkin, the doctor who first described it in 1832). It’s the smaller of the two umbrellas—an estimated 8,000 Americans are diagnosed with Hodgkin’s lymphoma each year.
The second type is known as non-Hodgkin lymphoma. This type of cancer is significantly more common than Hodgkin’s and affects about 74,000 people each year.
Like any cancer, lymphoma is a serious condition, and if you have it, it’s understandable that you feel worried.
Here’s what you need to know: Your odds of beating this disease are high—higher than many other forms of cancer. The average five-year survival rate (defined as the percentage of people who live at least five years after diagnosis) for people with Hodgkin’s lymphoma is 87%. The average five-year survival rate for people with non-Hodgkin lymphoma is 71%.
If you’re diagnosed at the earliest stages, you have an even better outlook—92% of people with Hodgkin’s lymphoma and 82% with NHL are getting on with their lives five years and beyond after diagnosis.
Does Lymphoma Always Require Treatment?
If your lymphoma is a slow-growing type—sometimes called “indolent lymphoma” or “low-grade”—and it’s not causing you any symptoms or discomfort, your doctor may suggest “active surveillance” or “watchful waiting” rather than treatment with medications. That means basically what it sounds like: Keeping an eye on things without pulling the treatment trigger until things progress. In the meantime, you’ll get regular imaging or blood tests to keep close tabs on your situation.
Slow-growing lymphomas are very hard to get rid of for good, but they do respond well to treatment, when they reach that stage. People with this type of lymphoma often get treatment when they need to, then go back to active surveillance until they need treatment again.
What Role Does Chemotherapy Play?
Chemotherapy is one of the most common treatments for lymphoma. In a nutshell, chemo drugs kill cancer cells. Although some medicines are in pill form, chemo is usually delivered directly into someone’s bloodstream through an IV “infusion” or injection at a clinic or doctor’s office.
Doses are given in bursts—or “cycles”—of a few weeks at a time so that patients are able to rest and recover from each treatment before having another. The length of time a person will need chemotherapy treatments can vary, but it often lasts anywhere from four to six months.
There are many different chemotherapy medications used to fight lymphoma. Which ones your doctor recommends, and at what dosages, will depend on your particular type of lymphoma. Chemo drugs can be used by themselves or in combination with other chemotherapy medications. Some chemotherapy medications used in treating lymphoma include:
Alkylating agents (Bendamustine, Chlorambucil, Cyclophosphamide, Ifosfamide)
Anthracyclines (Doxorubicin, Liposomal doxorubicin)
Anti-metabolites (Cytarabine, Gemcitabine, Methotrexate, Pralatrexate)
Platinum drugs (Carboplatin, Cisplatin, Oxaliplatin)
Purine analogs (Cladribine, Fludarabine, Pentostatin)
Side Effects of Chemotherapy
You probably know that chemotherapy can cause unpleasant side effects. That said, other new medications can be prescribed at the same time to help you feel better and make treatment easier. Some side effects of chemotherapy may include:
Diarrhea or constipation
Fertility issues. Some chemo drugs can cause premature menopause or infertility. Women who want to have kids after treatment may choose to freeze their eggs before starting chemo.
Higher cholesterol or blood sugars
Higher risk of infections
Nerve damage. Certain chemo meds can damage your nerves, creating tingling and numbness. Some drugs can also damage cells of the heart if used for a long time.
Skin rash or hives
What Is R-CHOP?
Chemotherapy drugs are often combined to treat lymphoma. Because different mediations kill cancer cells in different ways, these combos usually work better than single medications. One of the most common combinations used to treat non-Hodgkin lymphoma is called R-CHOP, which is an acronym for:
What’s the Role of Corticosteroids?
Corticosteroids are medications that reduce inflammation. (Cortisone is a common corticosteroid—you may know someone who’s been given a cortisone shot to help treat joint pain or a sports injury.)
When used in combination with chemotherapy, corticosteroids stop allergic reactions and reduce side effects. Studies have shown that chemotherapy for lymphoma works better when people take a steroid, too. Common corticosteroids used in lymphoma are:
Orapred, Millipred (prednisolone)
Baycadron, Decadron (dexamethasone)
Side Effects of Corticosteroids
Most side effects of steroids go away when you stop taking them. Some common ones are:
High blood sugar
If taken for many years, corticosteroids may lead to Cushing syndrome, a metabolic disease that can cause diabetes, fatigue, and other issues.
What Are Targeted Therapies for Lymphoma?
Targeted medications—sometimes called novel therapies or biological therapies—are medications that target very specific proteins or genes in your cancer cells to limit growth.
Targeted drugs are being used more and more frequently to treat lymphoma because they reduce damage to healthy cells and tissues, compared to chemotherapy. Some targeted medications used in treating lymphoma include:
Proteasome inhibitors: Velcade (bortezomib)
Antibody treatments: Arzerra (ofatumumab), Gazyva (obinutuzumab), Rituxan (rituximab)
Programmed cell death inducers: Venclexta (venetoclax)
Cell signal blockers: Imbruvica (ibrutinib), Torisel (temsirolimus), Zydelig (idelalisib)
Checkpoint inhibitors: Keytruda (pembrolizumab), Opdivo (nivolumab)
Immunomodulators: Revlimid (lenalidomide)
Side Effects of Targeted Therapies
Side effects are different depending on the drug, but some may include:
Higher risk of infections
Diarrhea or constipation
Tingling in limbs (peripheral neuropathy)
What Is CAR T Therapy?
A new treatment causing excitement in the medical community, CAR T (chimeric antigen receptor T cell) therapy is used for aggressive types of non-Hodgkin lymphoma and works by genetically modifying a person’s immune cells so that they attack the cancer.
To do this, lymphocytes known as T cells are removed from a person’s blood. Then in a lab, a gene for a receptor that binds to another receptor on lymphoma cells is added to the T cells. Large numbers of these modified T cells are grown in the lab and then given back to the person through an IV.
While this specialized, rare therapy hold much promise for the future of lymphoma treatment, it comes with its own unique set of circumstances. For instance, the treatment requires hospitalization, is only provided at certified centers of excellence, and can be very costly.
Side Effects of CAR T Therapy
Common side effects of CAR T therapy include a racing heartbeat and low blood pressure. Some people also develop an immune reaction known as “cytokine release syndrome” that causes flu-like symptoms including fever, headache, chills, muscle soreness, and nausea. There’s also a chance of longer-lasting neurologic complications such as confusion, difficulty speaking, and loss of balance.
Radiation for Lymphoma Treatment
Radiation treatments use high-energy x-rays to kill cancer cells and help lower the chances that the cancer will come back. Radiation isn’t used in all lymphoma cases, but when it is, it’s done through a machine that points a beam of radiation at the area where cancer cells are concentrated. Treatments are given frequently (sometimes daily) and tend to last for several weeks. Radiation can help with pain and other symptoms of lymphoma.
Side Effects of Radiation
Some people have few if any side effects from radiation treatment; others have them all. Side effects can show up right away, or weeks or months after treatment. They usually resolve on their own, but some can stick around. The most common side effects are redness, blistering, or peeling of skin in the area being treated, plus nausea, diarrhea, and fatigue. See your doctor if they don’t disappear after a few weeks.
Am I a Good Candidate for a Bone Marrow Transplant?
Bone marrow transplants, also known as stem cell transplants, are sometimes used to treat lymphoma that has come back. It is a procedure in which a patient receives healthy stem cells to replace damaged stem cells.
Here’s how it works:
Before a stem cell transplant, the patient receives high doses of chemotherapy, and sometimes radiation therapy, to prepare the body for transplantation.
Stem cells called hematopoietic cells live in the bone marrow and make your blood cells.
In a stem cell transplant, healthy hematopoietic cells are collected from either you or a donor and given to you through an IV.
These cells travel to the bone marrow and grow into healthy red and white blood cells and platelets.
When your own cells are transplanted, it’s called an autologous transplantation; if the cells come from a donor (usually a sibling), that’s called an allogeneic transplantation.
Side Effects of Bone Marrow Transplant
Transplants tend to cause fairly severe side effects similar to those experienced with chemotherapy. Bleeding and serious infections can also happen. The most dangerous complication only happens in allogeneic transplants of donor stem cells: It's called graft-versus-host disease (GVHD),and it occurs when donor immune cells start to attack your tissues. GVHD is treatable but is potentially deadly.
Does Surgery Play a Role?
In order to diagnose lymphoma, a doctor will usually surgically remove a bit of tissue, or sometimes an entire lymph node, and send it to a lab to be tested. If the biopsy area is easily accessible, you’ll probably just get some numbing medication and have a quick in-office procedure. If the area is deep in your chest or abdomen, you may need to be put to sleep for the procedure.
If only part of a lymph node or other tissue is taken out, it’s called an incisional biopsy. If an entire lymph node is removed, it’s called an excisional biopsy.
Other than biopsy, surgery plays a pretty limited role in treatment for lymphoma. In rare cases when lymphoma starts in another organ—spleen, stomach, skin—rather than a lymph node, your doctor may want to go in and surgically remove areas of cancer cells.
Anything Else to Know About Lymphoma Treatment?
Lymphoma treatment can be daunting and the terminology is confusing. It may be a good idea to enlist the help of a friend or loved one to go to appointments with you at first—it can be hard to keep everything straight when you are feeling unwell or are scared. Your appointment buddy can take detailed notes and write down questions for you to ask next time.
And remember that, although side effects of treatment can be pretty unpleasant, doctors now have a lot of ways to help ease your discomfort such as anti-nausea medications. Don’t worry about putting up a brave front. If you’re struggling with symptoms, let your doctors know so they can help you find some relief.
Indolent Lymphoma: Lymphoma Action. (n.d.) “Active Monitoring (Watch and Wait).” lymphoma-action.org.uk/about-lymphoma-treatment-lymphoma/active-monitoring-watch-and-wait
Lymphoma and Chemotherapy: Memorial Sloan Kettering Cancer Center. (n.d.) “Non-Hodgkin Lymphoma Treatment.” mskcc.org/cancer-care/types/lymphoma/treatment/non-hodgkin-lymphoma
Targeted Drugs and Immunotherapy: American Cancer Society. (2019). “Immunotherapy for Non-Hodgkin Lymphoma.” cancer.org/cancer/non-hodgkin-lymphoma/treating/immunotherapy.html__
Lymphoma and CAR T Therapy: Dana-Farber Cancer Institute. (n.d.) “CAR T-Cell Therapy for Lymphoma.” dana-farber.org/cellular-therapies-program/car-t-cell-therapy/car-t-cell-therapy-for-lymphoma/
Lymphoma and Radiation: American Cancer Society. (2019). “Radiation Therapy for Non-Hodgkin Lymphoma.” cancer.org/cancer/non-hodgkin-lymphoma/treating/radiation-therapy.html
Lymphoma and Stem Cell Transplant: American Cancer Society. (2019). “High-Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin Lymphoma.” cancer.org/cancer/non-hodgkin-lymphoma/treating/bone-marrow-stem-cell.html
Lymphoma and Surgery: American Cancer Society. (2018). “Surgery for Non-Hodgkin Lymphoma.” cancer.org/cancer/non-hodgkin-lymphoma/treating/surgery.html