Treatment Approaches for Relapse Vary by Lymphoma Type
- Doctors divide non-Hodgkin lymphoma into fast-growing and slow-growing types to determine treatment
- Fast-growing cancers are treated more aggressively with combinations of four or five anti-cancer drugs
- Between 50% and 70% of people may achieve complete remission on this treatment
- Those who don’t achieve remission will need to go on a second therapy
“We hope for all of our lymphoma patients that the first therapy you receive will be your last therapy. That is, that we can treat you and cure you with first-line therapy,” Dr. Catherine Diefenbach, medical oncologist at NYU Langone Health, tells SurvivorNet.
Read MoreTreating By Cancer Type
Non-Hodgkin lymphoma isn’t one disease, it’s many diseases — over 68 kinds — Dr. Diefenbach says. Each type is treated differently, and doctors need to be well-versed in the various therapies available to them. “For this reason, it’s very important that if you have a diagnosis of lymphoma, you’re treated by a lymphoma specialist.”To answer the question of what to do next if your cancer returns, your doctor will look at your lymphoma type. “In general, non-Hodgkin lymphomas are divided into aggressive or indolent lymphomas. And the approach to these lymphomas is very different,” Dr. Diefenbach says.
Aggressive Lymphomas
Aggressive lymphomas such as diffuse large B-cell lymphoma, mantle cell lymphoma, and Burkitt lymphoma grow very quickly, but they are treatable and potentially curable, she says. Because the cancers are so quick growing, doctors treat them first with a combination of four or five cancer drugs. Examples are R-CHOP, which includes the monoclonal antibody rituximab (Rituxan), three chemotherapy drugs, and the steroid prednisone. Another combination is R-EPOCH, which includes Rituxan, four chemotherapy drugs, and prednisone.
For the even more aggressive Burkitt lymphoma, doctors add Rituxan to three chemo drugs and the steroid dexamethasone in a combination called hyper-CVAD, or dexamethasone plus the chemotherapy drugs cisplatin and high-dose cytarabine, which is called DHAP.
“After these multi-agent chemotherapy regimens, approximately 50% to 70% of patients will obtain a complete remission and stay in remission,” Dr. Diefenbach says. “However, between 30% and 50% of patients with aggressive lymphoma will relapse and require at least a second line of therapy.”
Slow-Growing Lymphomas
The other type of non-Hodgkin lymphoma, called indolent lymphomas, grow slowly. They don’t always require treatment, Dr. Diefenbach tells SurvivorNet. “However, they are not curable by conventional means of describing curability.”
A few factors go into deciding whether indolent lymphoma needs treatment. One is whether you have bulky disease, meaning that you have large tumors that measure at least 4 inches across. Bulky disease requires more intensive treatment.
Another question that goes into the determination is whether the cancer is threatening any of your vital organs, such as your liver or brain. Your doctor will also consider whether you have very large lymph nodes that look unsightly or affect your quality of life.
People in these situations will need to go on treatment. “When we treat them, they often have an excellent response to therapy,” Dr. Diefenbach says. However, she says that in time — sometimes decades later — the cancer does come back. Your doctor will monitor you closely with regular exams to ensure that if your cancer does ever return, you’ll be able to get on a treatment quickly.
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