Treatment for lymphoma starts by determining which type of lymphoma you have and what parts of your body lymphoma is affecting, called staging. Your doctor will also take into account how well you might tolerate the treatment and your personal preferences.
Aggressive types of lymphoma are usually more curable, and you’ll start treatment right away.
Indolent (slow-growing) types of lymphoma are usually chronic, and you may wait to start treatment while under your doctor’s close supervision.
Once your doctor has determined the type of lymphoma and what parts of your body it is affecting, they will tailor conventional and new therapies for you based on the histological (tissue) diagnosis and the unique genetic features of your disease.
If you have indolent lymphoma you might not need immediate treatment if you’re generally healthy and the lymphoma isn’t causing symptoms or interfering with other organs. Your doctor might call this watchful waiting, active surveillance, or “watch-and-wait.”
During this time your doctor will keep an eye on your disease through frequent check-ups and lab tests, and visual tests like CT scans.
If the test results show the cancer is growing, or if your symptoms worsen, your doctor will start treatment.
Watchful waiting does not necessarily affect survivability for most people with indolent lymphoma.
Lymphoma and Fertility
Lymphoma is often diagnosed in people in their 20s who may not have started families or aren’t finished having children. Lymphoma treatment can cause infertility. We work with fertility preservation specialists to help if you want to have children after treatment.
You might take medicine to treat lymphoma.
Chemotherapy uses medications to stop cancer growth and spread and to prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die.
Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This action is why chemotherapy causes side effects like hair loss. You’ll either get chemotherapy through an IV in our infusion center, through a pill, or through the fluid in your spinal cord or surrounding your brain (intrathecally).
Your doctor will do tests like tumor molecular profiling to determine which drugs or drug combinations will best fight your disease with the lowest possible toxicity and side effects.
Chemotherapy drugs are generally given in cycles, with a period of treatment followed by a period of rest.
Your immune system is powerful. We now know how to harness that power to fight cancer. Our medical oncologists are using immunotherapy strategies alone and in combination with other treatments—backed by research being done in our labs and clinics. We are learning to better predict and select the best immunotherapy for your individual biology and unique cancer type.
You might have immunotherapy in combination with traditional chemotherapy, depending on the type and stage of your cancer.
Scientists have developed new drugs to target genes, proteins, and the tissue environment that encourages cancer cells to grow. These are called targeted therapies.
Unlike chemotherapy, targeted therapy does not harm all the cells in your body. That’s why they may have fewer side effects.
Targeted therapy is sometimes combined with regular chemotherapy or other medications to increase the chance that the cancer will respond and decrease the risk of it coming back.
Stem Cell Transplant
Lymphoma is caused by a malfunction in the white blood cells produced by your bone marrow. You might have a stem cell (bone marrow) transplant if lymphoma comes back or if treatment isn’t working well enough, called refractory disease.
Stem cells are part of your bone marrow. They can become any type of blood cell your body needs—red blood cells, white blood cells, or platelets. A stem cell transplant regenerates your bone marrow’s ability to create healthy cells.
Many factors go into your decision to have a stem cell transplant. Your experienced care team will walk you through the pros and cons of this decision based on your specific situation.
Before you have the transplant procedure, you will have high-dose chemotherapy called the “conditioning regimen.” After the conditioning regimen, which wipes out your bone marrow, your noncancerous stem cells will be given back to you by infusion.
Stem cell transplants can have serious side effects including graft versus host disease. Your care team is highly experienced in treating this illness and others. We’re also at the forefront of science to develop new therapies for this illness.
Another treatment option if your lymphoma comes back or does not respond to conventional therapy is cellular therapy. This broad category of treatment involves reprogramming immune cells to specifically attack and kill the lymphoma cells before infusing this “product” into the patient.
Currently, approved cellular therapies in lymphoma involve “autologous” T-cells: this means that patients will have some of their own immune cells removed and sent to a manufacturer, where they are modified with a “chimeric antigen receptor” specific for the lymphoma, then replicated to large numbers. This is called chimeric antigen receptor T-cell therapy, or CAR T-cells for short.
This manufacturing process can take several weeks or more, so your physician may give you another treatment to keep the lymphoma from growing out of control while you await your CAR T-cells. When the CAR T-cells are ready to infuse, you will receive some chemotherapy as part of the “lymphodepleting” regimen about 4 or 5 days before infusion, to make room for the CAR T-cells to expand and grow in your body.
Cellular therapy is associated with potential serious and unique side effects including cytokine release syndrome and neurotoxicity. You may be admitted to the hospital for monitoring before your product infusion. Our team is highly experienced in monitoring for and treating these complications both in and out of the hospital.
In the future, these “living drugs” may also include products made from non-T-cell immune cells or “off-the-shelf" products made from healthy donors that do not require a manufacturing time for each patient.
You might have radiation therapy as part of your treatment, sometimes in combination with or after chemotherapy, to directly target cancer in lymph nodes and surrounding tissue. Radiation therapy can also be used to target lymphoma outside of lymph nodes, including highly effective treatment of lymphoma of the stomach, eye, and skin. Recent advances in technologies allow our expert radiation oncologists and radiation therapists to effectively treat much smaller and more targeted parts of the body than has been done in the past, which minimizes side effects.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncology specialists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy.
Your care team will discuss if radiation therapy is right for you based on your unique situation, including:
- The stage and subtype of lymphoma
- If the lymphoma is relapsed (grows again after remission) or refractory (cancer cells continue to grow after the first treatment)
- Your overall health, and if you have any other conditions like diabetes, anemia, or heart disease
- If you are pregnant
If you have any questions about radiation therapy for lymphoma, you can contact our radiation therapy team at (212) 305-7077.
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of cancer patients. Clinical trials can often offer patients the newest and most innovative therapies before they are widely available. Columbia Cancer offers many clinical trials for lymphoma, some of which are only available at our center. You can talk to your care team about whether a clinical trial is an option for you.