More treatment options to better meet your needs
The treatment of lymphoma is complex. That’s why it’s essential to seek care from a team of specialists. Every member of our Lymphoma team has extensive experience in diagnosing and treating lymphoma.
The team includes hematologists/medical oncologists, surgeons, radiation therapy physicians, radiologists, pharmacists, pathologists, nuclear medicine physicians, physician assistants, nurse practitioners and, in some cases, bone marrow transplant specialists — all working together to give you the best chance of survival and best quality of life.
The treatment plan they develop for you will depend on several things:
- The precise type and subtype of your lymphoma
- Any known genetic or molecular characteristic of your cancer
- How much cancer is present at diagnosis
- Whether the disease is aggressive or slow-moving, and how far it has spread
- Whether the disease has come back (recurred) after treatment, or is resistant (has not responded to previous treatments)
- Whether you have any additional medical conditions (for example, hearing problems or diabetes)
- Treatment-related side effects
- Your age
- Treatment goals — either cure or long-term disease control and quality of life
Sometimes a combination of treatments works best.
The lymphoma team holds weekly meetings with members of the Transplant & Cellular Therapy team and research scientists, to review the cases of all patients who might be eligible for new clinical trials or candidates for bone marrow transplant. Your case will be reviewed from many perspectives to ensure that all options have been considered carefully and that the very best treatment plan is created for you.
In addition, twice a month the Lymphoma team holds a tumor board meeting to review challenging lymphoma cases and discuss multidisciplinary treatment planning. The meeting is open to oncologists in the community, who can present difficult cases to the Roswell Park team and discuss diagnostic and treatment options.
Types of treatment
Treatments can vary widely for different lymphoma subtypes. They may include:
Watchful waiting is also sometimes called active surveillance. Through careful monitoring, some patients with slow-growing disease may be able to avoid treatment — and its side effects — until the disease begins to progress. If you have a slow-growing lymphoma that is not life-threatening and not causing symptoms, this may be an option for you.
Immunotherapy strengthens your immune system to fight the cancer.
- Monoclonal antibody therapy: Most Roswell Park patients with B-cell non-Hodgkin lymphomas receive chemotherapy plus a monoclonal antibody called rituximab (Rituxan®) to fight the lymphoma cells more effectively. Other antibodies targeting different targets on the surface of the lymphoma cells are also being used to treat patients with different subtypes of NHL.
- Antibody-drug conjugate: An antibody-drug conjugate combines a drug with a type of immunotherapy called a monoclonal antibody. A monoclonal antibody is a protein made in a laboratory that can zero in on a cancer cell, latch onto it and either kill it directly or deliver chemotherapy or radioactive substances to kill it.
One example of an antibody-drug drug conjugate is brentuximab vedotin, an FDA-approved drug for patients whose Hodgkin lymphoma has progressed (continued to get worse) after a bone marrow transplant, or for patients who cannot undergo transplant and whose disease has not responded after at least two rounds of chemotherapy. Brentuximab vedotin is also used for CD30-expressing non-Hodgkin lymphomas (such as diffuse large B-cell lymphoma, cutaneous T-cell lymphoma and some forms of systemic T-cell lymphoma) that have not responded to standard treatments.
Polivy™, another antibody-drug conjugate, grew out of research at Roswell Park and was approved by the FDA in June 2019 for patients with diffuse large B-cell lymphoma (DLBCL) that is refractory (does not respond to treatment) or recurrent (has returned after treatment) following two previous treatments. Polivy is designed to target CD79b, a protein produced by most of the immune cells affected by B-cell lymphoma. It provides a treatment option for many patients who cannot be treated with other available drugs. Our patients had access to Polivy through clinical trials even before it was FDA-approved, and information generated by those trials led to the drug’s approval.
- Immunomodulatory agents stimulate the immune system to destroy cancer cells. Lenalidomide (Revlimid®) is a type of immunomodulatory agent that works well in some patients with non-Hodgkin lymphoma, by shutting down the growth of new blood vessels that would “feed” the cancer. Research shows that this drug can be an effective choice for patients with B-cell lymphoma who are elderly or too sick to go through chemotherapy, or whose disease has not responded to previous treatments.
Roswell Park researchers were the first to show that lenalidomide increased the cancer-killing effects of the monoclonal antibody rituximab (Rituxan®). This work paved the way for using rituximab in combination with lenalidomide to manage follicular lymphoma and mantle cell lymphoma. In addition, the Roswell Park group was the first to notice that lenalidomide triggered a clear clinical response in subtypes of diffuse large B-cell lymphoma.
Roswell Park researchers are now studying the effectiveness of combining lenalidomide with other drugs to provide an additional treatment choice for patients with lymphoma.
- CAR T-cell therapy against the CD19 antigen: This involves collecting your own T-cells, re-engineering them so they are better able to fight your cancer, multiplying them into an army of millions and giving them back to you. Roswell Park is an authorized center for all three FDA-approved CAR T-cell therapies.
Targeted therapies are designed to attack the cancer cells only, usually without affecting healthy cells, so they are associated with minimal side effects. Our researchers are working continually to develop new targeted therapies that will help turn the tide for our lymphoma patients, and these are offered through clinical trials.
We offer our patients treatment with targeted antibodies that have been armed with a radioactive atom (radioimmunotherapy) or chemotherapy drugs (drug conjugates). These armed antibodies attach themselves to the lymphoma cells, which are then killed by the radioactivity or by the delivery of the chemotherapy agents inside the cancer cells.
More than 40 different chemotherapy drugs are available to treat non-Hodgkin lymphoma; often these are used in various combinations. The choices of drugs and combinations that will work best for you will depend on the specific type of NHL you have, how extensive the disease is, and whether your disease responded to previous therapy or has relapsed (returned after remission). One type of chemotherapy, histone deacetylase inhibitors, cause chemical changes that prevent tumor cells from dividing.
Radiation is commonly used in the treatment of non-Hodgkin lymphoma, but this will depend on your specific circumstances. If you have slow-growing NHL, you may receive radiation either by itself or in combination with chemotherapy. Radiation may also be given as an alternative treatment if you cannot tolerate chemotherapy, or it may be combined with high-dose chemotherapy if your disease has relapsed.
Bone marrow transplant
Depending on the type of lymphoma and/or the response to initial therapy, a hematopoietic stem cell transplant — also called a bone marrow transplant —(BMT) may be an option. This can cure some people with lymphoma.
Our physicians work closely with Roswell Park’s BMT specialists to monitor the status of all of our lymphoma patients on an ongoing basis, to identify patients who might benefit from the procedure. This helps ensure that everything is in place and ready to go if a transplant should be necessary. We were among the first centers in the world to routinely offer blood and marrow (stem cell transplants), and we consistently have excellent patient survival results.