- What’s New in Non-Hodgkin Lymphoma Research and Treatment?
- Non-Hodgkin Lymphoma Treatment
- Active Surveillance for Indolent (Slow-Growing) Lymphoma
- Chemotherapy for Non-Hodgkin Lymphoma
- Targeted Therapies for Non-Hodgkin Lymphoma
- Immunotherapy for Non-Hodgkin Lymphoma
- CAR T Cell Therapy
- Radiation Therapy for Non-Hodgkin Lymphoma
- Stem Cell Transplantation for Non-Hodgkin Lymphoma
- Lymphoma Treatment
- Non-Hodgkin lymphoma
What’s New in Non-Hodgkin Lymphoma Research and Treatment?
Research into the causes, prevention, and treatment of non-Hodgkin lymphoma (NHL) is being done in many medical centers throughout the world.
Scientists are making a lot of progress in understanding how changes in the DNA inside normal lymphocytes can cause them to develop into lymphoma cells. Once this is understood, drugs may be developed that block these processes.
Progress in understanding DNA changes in lymphoma cells has already led to improved and highly sensitive tests for detecting this disease. Some of these tests are already in use, and others are being developed. They may be used to:
- Detect lymphoma cells in a biopsy sample
- Determine what type of lymphoma a person has
- Help determine if a lymphoma is likely to grow and spread, even within a certain subtype of lymphoma
- Help figure out if a certain treatment is likely to be helpful
- Help determine if a lymphoma has been destroyed by treatment or if a relapse is likely
For example, in recent years, genetic tests have shown that there are different subtypes of diffuse large B-cell lymphoma (DLBCL), even though they look the same under the microscope. These subtypes seem to have different outcomes (prognoses) and responses to treatment. The hope is that such tests can be used to help guide treatment decisions.
Much of the research being done on NHL is focused on looking at new and better ways to treat this disease.
Many new chemotherapy drugs are being studied in clinical trials. In recent years, these studies have led to the approval of drugs such as bendamustine (Treanda) and pralatrexate (Folotyn) for use against certain types of lymphoma. Other studies are looking at new ways to combine drugs using different doses or different sequences of drugs.
Stem cell transplants
Researchers continue to improve stem cell transplant methods, including new ways to collect the stem cells before the transplant.
Autologous transplants (which use the patient’s own stem cells rather than cells from a donor) have the risk of reintroducing lymphoma cells back into the patient after treatment. Researchers are testing new and improved ways to separate out the last traces of lymphoma cells from the stem cells before they are returned to the patient. Some of the new monoclonal antibodies developed for treating lymphoma may help remove these remaining cells.
Researchers are also studying the effectiveness of non-myeloablative (reduced-intensity) stem cell transplants in people with lymphoma. This approach may allow more people to benefit from stem cell transplants, especially those who are older or in poor health.
As researchers have learned more about lymphoma cells, they have developed newer drugs that target specific parts of these cells. These targeted drugs are different from standard chemotherapy drugs, which work by attacking rapidly growing cells. Targeted drugs may work in some cases where chemotherapy doesn’t, and they often have different side effects.
Some targeted drugs, such as ibrutinib (Imbruvica), acalabrutinib (Calquence), and idelalisib (Zydelig), are already being used to treat some types of NHL, and are being studied for use against other types.
Some other targeted drugs that have shown promise against lymphoma in early studies include:
- Phosphatidyl-inositide 3 kinase (PI3K) inhibitors, such as duvelisib, tenalisib, and buparlisib
- BCL-2 inhibitors, such as venetoclax (Venclexta)
- Janus kinase (JAK) inhibitors, such as ruxolitinib
- Tyrosine kinase inhibitors, such as crizotinib, for lymphomas that express the ALK protein.
These and many other targeted drugs are now being studied in clinical trials.
Doctors have known for some time that people’s immune systems may help fight their cancer. Scientists are now trying to develop ways to encourage this immune reaction. Some types of immunotherapy are already being used to treat lymphoma, as discussed in Immunotherapy for Non-Hodgkin Lymphoma.
Monoclonal antibodies: Lymphoma cells have certain proteins on their surface. Monoclonal antibodies can be made to target these proteins and destroy the lymphoma cells while causing little damage to normal body tissues. This treatment strategy has already proven effective. Several such drugs, including rituximab (Rituxan), are already used to treat lymphoma.
Some newer antibodies are attached to substances that can poison cancer cells, and are known as antibody-drug conjugates (ADCs) or immunotoxins. They act as homing devices to deliver the toxins directly to the cancer cells. For example:
- Brentuximab vedotin (Adcetris) is made up of an antibody to CD30 that is attached to a cell poison. It has been shown to help treat patients with anaplastic large cell lymphoma (ALCL), and is now being studied for use against other types of lymphoma.
- Moxetumomab pasudotox targets the CD22 antigen on certain lymphoma cells, bringing along a toxin known as PE38. It’s being used in clinical trials to treat hairy cell leukemia (HCL).
Other ADCs are now being studied as well, including polatuzumab vedotin.
Immune checkpoint inhibitors: Immune system cells normally have substances that act as checkpoints to keep them from attacking other healthy cells. Cancer cells sometimes take advantage of these checkpoints to avoid being attacked by the immune system. Some newer drugs, such as pembrolizumab (Keytruda) and nivolumab (Opdivo), work by blocking these checkpoints, which can boost the immune response against cancer cells. These drugs have shown promise in treating several types of cancer, and are now being studied for use against some types of lymphoma.
Chimeric antigen receptor (CAR) T-cell therapy: In this treatment, immune cells called T cells are removed from the patient’s blood and altered in the lab to have specific receptors (called chimeric antigen receptors, or CARs) on their surface. These receptors can attach to proteins on the surface of lymphoma cells. The T cells are then multiplied in the lab and given back into the patient’s blood, where they can seek out the lymphoma cells and launch a precise immune attack against them.
This technique has shown encouraging results in early clinical trials against some hard-to-treat lymphomas. Doctors are still improving how they make the T cells and are learning the best ways to use them. There are two FDA approved CAR T-cell therapies for certain kinds of advanced or recurrent large B-cell lymphoma. CAR T-cell therapy for other types of non-Hodgkin lymphoma is only available in clinical trials at this time.
Lymphoma vaccines: Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, lymphomas. The goal is to create an immune reaction against lymphoma cells in patients who have very early disease or in patients whose disease is in remission. One possible advantage of these types of treatments is that they seem to have very limited side effects. So far, there have been a few successes with this approach, and it’s a major area of research in lymphoma treatment. At this time, lymphoma vaccines are only available in clinical trials.
Non-Hodgkin Lymphoma Treatment
Many treatment options are now available for non-Hodgkin lymphoma. These include traditional chemotherapy, targeted drugs, and novel therapies that are available only through clinical trials.
At Memorial Sloan Kettering, we design a treatment strategy specifically tailored for you, based on (but not limited to):
- the type of non-Hodgkin lymphoma you have and whether it is aggressive (fast growing) or indolent (slow growing)
- the stage or extent of your disease
- the molecular and genetic features of your disease
- your overall health status, including your age, physical fitness, and other medical conditions
- your personal goals and preferences
Doctors Who Treat Non-Hodgkin Lymphoma
At MSK, you will be treated by a team of doctors, including medical oncologists, radiation oncologists, radiologists, and more.
See a full list of our lymphoma doctors.
Active Surveillance for Indolent (Slow-Growing) Lymphoma
Slow-growing lymphoma is also called indolent lymphoma. If you have this type of lymphoma and aren’t experiencing any symptoms, your doctor may recommend an approach called active surveillance. This means your doctor will watch for any signs of change in your regular physical exams, blood tests, and imaging studies. Many of the patients in our active surveillance program don’t require any type of treatment for years.
If your lymphoma becomes more active and needs to be treated, we’ll come up with a new treatment plan together.
Ready to Fight, but My Doctor Says to Wait: Watchful Waiting after a Lymphoma Diagnosis The watch and wait approach to treatment, also called active surveillance, is common for lymphomas that pose no immediate threat to a patient’s health. But the tactic can leave some patients initially feeling anxious. Learn more
Chemotherapy for Non-Hodgkin Lymphoma
Chemotherapy has been an effective approach for treating and potentially curing patients with non-Hodgkin lymphoma for many decades. Chemotherapy kills the rapidly dividing cancer cells throughout the body.
For people with aggressive B cell non-Hodgkin lymphoma, we commonly recommend a chemotherapy treatment called R-CHOP. It is named after the medicines included in the mixture:
- rituximab (Rituxan®), a monoclonal antibody that helps your immune system destroy the cancer cells and makes the chemotherapy more powerful
- cyclophosphamide (Cytoxan® and Neosar®)
- doxorubicin hydrochloride (Adriamycin® and Rubex®)
- vincristine sulfate (Oncovin® and Vincasar Pfs®)
- prednisone (Deltasone®, Liquid Pred®, Meticorten®, and Orasone®)
You may receive R-CHOP alone or along other treatments, such as surgery and radiation therapy.
Targeted Therapies for Non-Hodgkin Lymphoma
We’re developing new treatment strategies based on our understanding of why and how lymphoma develops and grows. Biologically targeted drugs can turn off the molecular pathways that drive your lymphoma to grow and divide. These new treatments can often be more effective and less toxic than traditional chemotherapy. At MSK, we have many clinical trials with biologically targeted drugs to improve treatment options for people with non-Hodgkin lymphoma.
Immunotherapy for Non-Hodgkin Lymphoma
MSK is an international leader in the development of immunotherapy for the treatment of cancer. This innovative approach works by strengthening the immune system’s ability to fight disease. Examples of novel immunotherapies that are being used to treat lymphoma include chimeric antigen receptor (CAR) T cell therapy, bispecific T cell engager (BiTE®) antibody therapy, and immune checkpoint inhibitors, such as nivolumab (Opdivo®).
CAR T Cell Therapy
VIDEO00:57 Learn how CAR T cell therapy works. Video Details
CAR T cell therapy is an exciting and powerful treatment now available for some patients with diffuse large B-cell lymphoma (DLBCL). When a person with DLBCL relapses after prior therapy or stops responding to treatment, a stem cell transplant used to be the only option. CAR T cell therapy is another potentially lifesaving option that could now be offered if you are not a candidate for stem cell transplantation, or if your disease relapses after a stem cell transplant.
CAR T cells are sometimes called “living drugs.” That’s because the treatment uses your own cells to treat your cancer. With CAR T therapy, your immune cells are filtered from your blood. Then they are sent to a lab where they are armed with new proteins that teach them to recognize cancer. Afterward, your newly supercharged cells are multiplied and infused back into your blood, where they can seek out and destroy your cancer.
Memorial Sloan Kettering is one of only a select few institutions equipped to administer CAR T cell therapy safely. Our doctors and nurses have unparalleled expertise in caring for patients who are receiving this treatment. Our clinical staff — including our bone marrow transplant service — has vast experience in minimizing risks and managing side effects. Memorial Sloan Kettering scientists played a pioneering role in developing the science and technology of CAR T cell therapy, and they are working hard to improve and expand it.
Call 1-888-MSK-CART to learn more about treatment of certain forms of lymphoma.
What is CAR T? Explore how MSK scientists and clinicians are using an immunotherapy called chimeric antigen receptor (CAR) T cell therapy to beat cancer. Learn more
Radiation Therapy for Non-Hodgkin Lymphoma
Many types of lymphoma are highly sensitive to radiation therapy. These varieties can be treated with much lower doses of radiation on smaller areas of the body than in the past.
At MSK, our radiation oncologists apply the most sophisticated and modern technology to give focused radiation that reduces long-term side effects as well as the risk of damage to healthy cells. Intensity-modulated radiation therapy (IMRT), which was developed at MSK, uses advanced computer programs to calculate and deliver radiation directly to cancer cells from different angles. A PET-CT simulator helps us plan the treatment. This image gives us real-time information about how active the disease is and where it is in the body. It allows us to determine the radiation treatment position that will be the most accurate and safe. In addition, we are one of the few centers in the country that offer Total Skin Electron Beam radiation, a very effective treatment for patients with lymphoma in their skin.
Stem Cell Transplantation for Non-Hodgkin Lymphoma
In a stem cell transplant — also called a bone marrow transplant — a patient’s blood-forming stem cells are replaced by adding new ones into the bloodstream. Often the goal of a stem cell transplant is either to cure lymphoma that has returned after initial therapy or to allow a patient to live a long time without therapy. Because of the expertise of MSK’s transplant team, patients often have excellent results with both autologous (using the patient’s own cells) and allogeneic (cells from a donor) stem cell transplantation.
Clinical Trial Access
You may be eligible to participate in clinical trials of new targeted therapies and ways to minimize common cancer-related symptoms before they become widely available at other hospitals.
Advanced Therapies Available
We are one of the few centers authorized to administer a new class of FDA-approved treatments called CAR T-cell therapy (brand names: Yescarta and Kymriah). Our researchers are also exploring differences among lymphomas that will lead to improved therapies.
Support for You and Your Family
Our comprehensive support services are here for you throughout your treatment. We help minimize the side effects of treatment and offer support to help you cope with the emotional and psychological effects of diagnosis and treatment. You may also benefit from our services that focus on nutrition, guided imagery, anxiety control, and meditation. Our cancer survivorship and chronic care clinic pulls together a range of resources specially designed to help you after your treatment ends or while you are undergoing active surveillance for your chronic condition. View all of our cancer support groups on our event calendar.
Our commitment to our patients is to provide the most advanced treatments for all types of cancers of the blood, including lymphomas.
Clinical research trials represent some of the most advanced treatment options.
Lymphomas are blood cancers that develop in the lymphatic system. The lymphatic system is a network of tissues and organs that rid the body of toxins and waste. In addition, the lymphatic system transports infection-fighting white blood cells through the body.
Lymphomas are broadly categorized into two main types: Hodgkin lymphoma and non-Hodgkin lymphoma. Beyond that, there are many different subtypes, especially subtypes of non-Hodgkin lymphoma. Some lymphomas arise from B-lymphocytes, while others arise from T-lymphocytes. Lymphomas are also described by their growth rate; rapidly growing lymphomas are called “aggressive,” whereas slow growing lymphomas are called “indolent.”
Non-Hodgkin Lymphoma is the most common type of lymphoma. The American Cancer Society estimates that 60,000 people are diagnosed with this cancer every year in the United States.
Hodgkin Lymphoma is less common and tends to affect young adults in the prime of their lives… Thanks to remarkable advances in treatment, Hodgkin Lymphoma is now considered one of the most curable cancers. Combination chemotherapy regimens and sometimes radiation therapy are the modalities used to achieve these high cure rates. Targeted drugs and immunotherapy have recently become available for patients with relapsed disease; the role of these new drugs is being investigated in clinical trials. Rocky Mountain Cancer Centers’ experienced hematologists have been leading the way as new discoveries have brought dramatic changes and unprecedented hope for long-term survival to lymphoma patients.
When a patient is diagnosed with lymphoma, physicians often request a CT scan or PET/CT scan to determine where the lymphoma is located in the body. This information helps determine the stage of the lymphoma. RMCC offers state-of-the-art CT and PET/CT machines.
Treatment for both Hodgkin and non-Hodgkin lymphomas may involve a number of different modalities including chemotherapy, radiation therapy, targeted therapies, and immunotherapies.
Rocky Mountain Cancer Centers oncologists are experts at designing the right treatment plan for each patient, and they are committed to partnering with each patient throughout treatment.
RESEARCH AND CLINICAL TRIALS
At Rocky Mountain Cancer Centers, research is a crucial part of our mission. Our researchers have been instrumental in the development of many new therapies for lymphomas, and we are committed to advancing treatment through discovering new drugs.
Currently, we are participating in multiple trials of new and emerging therapies, as well as new ways to use existing therapies more effectively in combination with other treatments.
Go here to see our current Lymphoma Research Clinical Trials.
New FDA-approved CAR T-cell therapies
SCCA is one of the first cancer centers in the nation to offer both FDA-approved cellular immunotherapies for non-Hodgkin lymphoma. Tisagenlecleucel, known as the brand name Kymriah®, and axicabtagene ciloleucel (axi-cel), known by the brand name Yescarta®, are CAR T-cell therapies available only at certified treatment centers.
Bone marrow transplant for lymphoma
The Fred Hutch Bone Marrow Transplant Program at SCCA consistently achieves higher-than-expected transplant survival rates. We pioneered bone marrow transplants and have performed more than any other institution in the world.
A national leader in cancer care
SCCA is the leading cancer treatment center in the region and among the top nationally, according to U.S. News & World Report.
NCI comprehensive cancer center
We are a comprehensive cancer center, a designation from the National Cancer Institute that reflects our scientific leadership and the depth and breadth of our research to prevent, diagnose and treat cancer.