Treatment for Non-Hodgkin’s lymphoma

Summary

A large number of treatment options are available for people with non-Hodgkin’s lymphoma (NHL). The types of standard treatment for NHL includes radiation therapy, immunotherapy, chemotherapy, surgery, targeted therapy, stem cell/bone marrow transplant, vaccine therapy. Treatment for NHL can also depend on the grade of NHL.

Introduction

Significantly, a large number of treatment options are available for people with non-Hodgkin’s lymphoma (NHL). However, a team of health care providers who specialize in the treatment of lymphoma should plan the treatment of patients with NHL. By all means, treatment of NHL in adults can cause side effects. Below described are the types of standard treatment for NHL:

Radiation therapy

Radiation therapy (RT) plays a diverse and an important role in the current treatment of NHL. Therefore, it remains the most potent monotherapy intervention for both aggressive and indolent subtypes. It is also noteworthy that in the field of radiation oncology practice, significant changes have been made over the past few decades. However, modern treatments have become safer and more appropriate^​1​.

Chemotherapy

The gold standard for first-line treatment of aggressive NHL is combination chemotherapy with doxorubicin, cyclophosphamide, prednisone, and vincristine. To ameliorate chemotherapy-induced neutropenia, doctors use Haematological growth factors, such as granulocyte colony-stimulating factor (G-CSF). However, this helps in an easy administration of the chemotherapy. Furthermore, it can also help decide a desired dose for chemotherapy sessions^​2​.

Immunotherapy

Immunotherapy is an evolving method of treating non-Hodgkin’s lymphoma. However, to enhance the immune response against tumors, various pharmaceuticals have developed vaccines using patient-specific tumor antigens. Above all, the success of rituximab, a monoclonal antibody against CD20 against malignant B cells, has formed the basis of immunotherapy research^​3​.

Targeted therapy

With the development of targeted therapeutics, some patients with lymphoma have become cured, but the treatment of refractory and recurrent diseases remains challenging. Targeted NHL treatments, such as monoclonal antibodies (mAbs), immune checkpoint inhibitors, chimeric antigen receptor (CAR) T cell therapy, and specific antibodies, are also important^​4​.

Surgery

Surgery is not often used as the primary treatment because of the effectiveness of chemotherapy, radiation therapy, biological therapy, and hematopoietic stem cell transplantation. However, it may be useful in primary splenic lymphoma to confirm or refute a definitive radiological diagnosis using biopsy, removing cancer tissue from the affected region, and splenectomy. Emergency abdominal surgery provides relief and diagnosis for acute NHL complications^​5​.

Stem cell/bone marrow transplant

Stem cells collected before and stored can be used for transplantation during marrow-ablative antitumor therapy so that patients with NHL can regain hematopoiesis^​6​.

Vaccine therapy

Several studies have suggested that immunological mechanisms may influence NHL, particularly low histological grade NHL. Several promising lymphoma tumour antigen vaccines have been reported to prevent cure or remission while reducing chronic and acute toxicity^​7​.

Treatment for NHL based on the grade of NHL

Treatment of Low-Grade Non-Hodgkin’s Lymphoma 

In low-grade stage I-II NHL patients, radiation therapy alone may be curative. However, recurrence may be reported after ten years. These lymphomas frequently recur in locations other than the original site of treatment, such as extranodal or other lymph node sites. Depending on whether the disease site is above or below the diaphragm, a single monotherapy such as irradiation or an inverted “Y” field irradiation may be used. The complete lymphatic examination will not be recommended as a first-line treatment for early low-grade lymphoma. This is due to the fact that its benefits have yet to be clinically proven. Patients may also undergo bone marrow transplantation at a later stage of the disease for other reasons.

The treatment of all types of stage III and IV low-grade lymphoma remains controversial. Despite the low-risk level that combination chemotherapy can provide, single-agent chemotherapy is still routinely used in many centres. However, as an alternative to patients with mild symptoms or who do not wish to take the anticipated approach without treatment, it may be offered. Another type of common (stage III-4) low-grade disease is a multiple drug combination with or without radiation therapy.

Treatment of Intermediate-Grade Non-Hodgkin’s Lymphoma

Prior to the development of effective combination chemotherapy regimens, radiation therapy alone was the primary intervention in patients with localised (stage I-II) moderate NHL. Since then, the inclusion of cytotoxic agents in treatment protocols has had clear benefits and may actually replace radiation therapy in such patients. However, targeted use of radiation therapy to reduce tumor mass is clinically beneficial and is still widespread. But, patients with stage III-IV moderate lymphoma require combination chemotherapy as an immediate intervention.

Treatment of High-Grade Non-Hodgkin’s Lymphoma

The diagnosis of high-graded NHL (WF subtypes H–J) requires aggressive and immediate action. In other words, these patients have a rapidly progressing disease that can double in days or hours depending on histology. Essentially, their treatment consists of intensive-doses such as chemotherapy and prophylactic central nervous system therapy with or without radiation therapy. Central nervous system containment is essential because the blood-brain barrier prevents the administration of systemic chemotherapy in this compartment and prevents the destruction of micrometastases. However, these patients are also excellent candidates for transplantation, as the high tumor growth rate dramatically responds to the over-intensity of the transplant staging regime^​8​.

References