Treatment After Relapse: Combatting Non-Hodgkin Lymphoma the Second Time Around

The point of having a stem cell transplant is to give you high enough doses of chemotherapy — higher than you were exposed to during your first treatment — to get rid of your cancer cells.

You’ll first undergo a few rounds of treatment with chemotherapy, which could be a platinum-based chemotherapy drug such as cisplatin (Platinol) to wipe out as much of your cancer as possible. Your doctor might call this treatment “salvage chemotherapy.”

If you respond to the salvage chemotherapy, then your doctor will talk to you about a stem cell transplant if you are a good candidate and otherwise healthy and fit enough to get one. The aim is to get you as close to a complete remission as possible, Dr. Jain says.

The stem cell transplant allows you to get high doses of chemotherapy. Getting rid of your unhealthy blood cells is kind of like “resetting the immune system,” he adds.

When you get powerful chemotherapy drugs, they destroy not only abnormal blood cells, but healthy ones too. After your chemo, you’ll get an infusion of healthy new stem cells to replace the ones that chemotherapy damaged. Stem cells are the early cells in your bone marrow that grow into infection-fighting white blood cells, oxygen-carrying red blood cells, and blood-clotting platelets.

The transplant is usually autologous, which means that the stem cells come from your own body before you start chemotherapy. Ideally, the stem cell transplant will put you into a long-term remission, which would essentially be a cure, Dr. Jain says.

If You Don’t Go Into Remission

The promise that a stem cell transplant will lead to a long-term remission sounds exciting, but not everyone gets there. Only about half of people who get salvage chemotherapy will even respond to the treatment well enough to have a stem cell transplant.

“And then after the stem cell transplant, half of patients may relapse again,” Dr. Jain says.
“Overall, we would say about 25% to 35% of patients who relapse may have a long-term remission or cure from the standard type of therapy.”

Those numbers might seem low, but Dr. Jain says he still recommends a stem cell transplant to people who are good candidates because it offers the possibility of a cure.

So what happens if you don’t qualify for a stem cell transplant, or you have this therapy and then relapse again? A new treatment might offer a solution.

CAR T-Cell Therapy

In the last few years, doctors have added a groundbreaking new treatment to their arsenal for non-Hodgkin lymphoma. It’s called chimeric antigen receptor (CAR) T-cell therapy.
“This is an exciting form of therapy where we take patients’ immune system cells, their T cells, which are normally involved in fighting off cancers, and we send them to a manufacturer,” Dr. Jain explains.

Those T cells are genetically modified, multiplied into the millions, and returned to you. Once inside your body, the newly modified cells are able to recognize and eliminate your cancer.

CAR T-cell therapy is approved for certain kinds of aggressive non-Hodgkin lymphoma that either haven’t responded to treatment or that relapsed after treatment, including:

• Diffuse large B-cell lymphoma
• Primary mediastinal B-cell lymphoma
• High-grade B-cell lymphoma
• Transformed follicular lymphoma
• Mantle cell lymphoma

Ask your doctor whether CAR T-cell therapy is an option for you. If it isn’t, there may be a clinical trial of another new treatment that you can join.

Learn more about SurvivorNet's rigorous medical review process.

---