Treatment may involve any of the following modalities, chemotherapy, radiotherapy, immunotherapy and stem cell transplant. Very often, it is likely a combination of 2 or more of the above modalities. This is dependent on the subtype of lymphoma and various prognostic features of the lymphoma.
Chemotherapy
Chemotherapy drugs are also known as cytotoxics. In general, these drugs kill cells that rapidly divide/ grow. Thus, cytotoxics are highly effective for killing cancer cells but will also damage normal cells of the body which divide rapidly like the hair follicles and normal blood-forming cells in the bone marrow. These effects manifests as hair loss and temporary declines in blood cells (like red blood cells, white blood cells, platelets). Chemotherapy is often combined with monoclonal antibody therapy in Non-Hodgkin’s Lymphoma.
Immunotherapy
Immunotherapy is treatment that uses the patient’s own immune system, or medications made from components of the immune system, to fight the disease. There are many forms of immunotherapy. In the case of Non-Hodgkin’s Lymphoma the main form is with monoclonal antibodies (also known as ‘biologics’). In the most common form of Non-Hodgkin’s Lymphoma, an entity known as diffuse large B-cell lymphoma, the combination of monoclonal antibody and chemotherapy is the mainstay of treatment. This combination of also used in other types of Non-Hodgkin’s Lymphoma.
There are different monoclonal antibodies that target different proteins and therefore different types of lymphoma cells. Because of the specificity of these drugs, there is no ‘one size fits all’ when using these treatments and careful selection of the appropriate therapy according to the Non-Hodgkin’s Lymphoma type is crucial.
Apart from monoclonal antibodies, other immunotherapies including checkpoint inhibitors are also used but usually in the setting of relapsed disease.
Stem Cell Transplantation
A person with recurrent lymphoma may receive stem cell transplantation, usually as second-line treatment. A transplant of blood-forming stem cell allows a person to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both lymphoma cells and healthy blood cells in the bone marrow. Later, the patient receives healthy blood-forming stem cells through a flexible tube placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.
Stem cell transplants take place in the hospital. The stem cells may come from the patient’s own self or from a healthy donor.
Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill Non-Hodgkin’s Lymphoma cells. It can shrink tumours and help control pain. Radiation is also sometimes used in the first-line therapy in patients with stage I or stage II disease, where the lymphoma is localised to one region or one side of the diaphragm.