Patients with non-Hodgkin lymphoma (NHL) are identified as being high risk or low risk, depending on whether the disease is aggressive or slow-moving (also known as indolent or low-grade), or how likely it is to recur (come back) after previous successful treatment. Your care will be assigned to one of those groups based on unique characteristics of your cancer, and your treatment plan will be designed on the basis of the information provided by our extensive pathology reports.
Depending on your pathology results, your treatment for non-Hodgkin lymphoma may include:
- Watchful waiting (monitoring but no treatment)
- Targeted therapy
- Drugs that boost the immune system (immunomodulatory drugs)
If those options do not work well, or if your disease is very advanced, we will consider blood or marrow transplant.
If you have a slow-growing lymphoma that is not life-threatening and not causing symptoms, active surveillance (also called watchful waiting) might be an option for you. This strategy involves monitoring the disease closely without starting active treatment. You and your doctor can discuss treatment options when the disease becomes active again. By postponing treatment while the disease is stable (not progressing), you can avoid the side effects associated with active treatment and enjoy a better quality of life.
Targeted therapies are drugs that attack specific molecules that help the cancer grow. Over the past several years, new targeted therapies have been developed for treating a variety of NHL subtypes.
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 surface targets are also being used to treat patients with different subtypes of NHL.
We also offer our patients treatment with targeted antibodies that have been armed with a radioactive atom; this is called radioimmunotherapy. The antibodies locate and attach themselves to the lymphoma cells, which are then killed by the radioactivity.
For many patients with non-Hodgkin lymphoma, drug therapy with lenalidomide (Revlimid®) produces good results. Lenalidomide has direct activity againt NHL cells, stimulates the immune system, and shuts down the growth of new blood vessels that would feed the cancer. Research shows that this drug, which is widely used for treatment of multiple myeloma and myelodysplastic syndromes, can be an effective choice for patients with B-cell lymphomas who are elderly or too sick to go through chemotherapy, or whose disease has not responded to previous treatments. Lenalidomide also appears to increase the cancer-killing effects of rituximab. Roswell Park researchers are investigating the value of combining lenalidomide with other drugs to provide an additional treatment choice for patients with lymphoma.
The goal of chemotherapy is to destroy the abnormal cells and induce (cause) disease remission in a process called induction. 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 previous successful treatment) after remission.
Our patients receive induction therapy in a state-of-the art outpatient clinic with a team of nurses who have special training and experience in this aspect of patient care.
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.
Blood or Marrow Transplantation
Blood or marrow transplantation (BMT) with high- or low-dose chemotherapy may be an option if your lymphoma does not respond to treatment or recurs (returns) after standard treatment. Roswell Park offers the most experienced adult BMT service in Western New York, performing 160-180 transplants every year. Because BMT can be a treatment option for lymphoma patients who have aggressive disease or who have relapsed following other treatment, our physicians work closely with our BMT specialists to evaluate the status of all of our lymphoma patients on an ongoing basis, to determine who might benefit from the procedure. This helps ensure that everything is in place and ready to go if a transplant should be necessary.
Outcomes for patients treated through the Blood and Marrow Transplant Center at Roswell Park are among the highest in the nation. The 2014 Center for International Blood and Marrow Transplant Research report shows that Roswell Park achieved higher than expected one-year survival ratings for allogeneic blood and marrow transplants.
Roswell Park’s BMT unit and its 14 private patient rooms are HEPA-filtered to maintain the most stringent protection against airborne pathogens. The nursing staff is specially trained in the management and care of BMT patients, who have special needs because of their weakened immune systems.
Roswell Park offers two types of BMT for eligible patients with non-Hodgkin lymphomas:
- For an autologous transplant, your stem cells are collected in advance, at a time when you have little or no evidence of disease in your blood. Then any residual lymphoma in your body is destroyed with chemotherapy and/or radiation, and afterward, the stem cells that were collected previously are given back to you, in a procedure called a rescue.
- For an allogeneic transplant, your diseased bone marrow is destroyed with chemotherapy and/or radiation, and afterward, you receive stem cells from a healthy donor in a procedure called a rescue. All patients between the ages of 4 and 75 are carefully considered as potential BMT candidates, depending on the unique circumstances of each patient and their disease.