Treatment

Treatments

Lymphomas are cancers that affect the white blood cells of the lymph system, part of the body’s immune system. They have a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer. That’s why careful diagnosis is so important. Often cases are referred to Siteman for second opinions and you would undergo a careful review of your biopsy material or might need a new biopsy to determine the precise subtype of your cancer for picking the best treatment.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our physicians are principle investigators in these trials, which cover medical, surgical and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

Because many of our patients come from over 100 miles away, when you meet with a hematologic oncologist, you might also see a radiation oncologist or be referred for a bone marrow and stem cell transplant at the same visit and get imaging studies done.

Different types of lymphoma respond to different treatments, so depending on your type, treatments will vary.

  • Non-Hodgkin Lymphoma: The most common type of lymphoma, non-Hodgkin lymphoma, has 35 different subtypes, which help determine the best treatment. For treatment purposes, the subtypes are divided into how fast they grow: highly aggressive, intermediate and low-grade or indolent, which is the slowest growing. Sometimes, indolent types can be watched for years without treatment.

Six types of standard treatment are used: radiation, chemotherapy, targeted therapy (monoclonal antibodies or proteasome inhibitors), plasma apheresis to remove extra plasma and antibody proteins from the blood, biologic therapy (interferon) and active surveillance. Clinical trials may include vaccine therapy and high-dose chemotherapy with stem cell transplant.

  • AIDS-Related Lymphoma: Treatment is a combination of AIDS treatment and lymphoma treatment. . Patients who have AIDS-related lymphoma are usually treated with lower doses of drugs than lymphoma patients who do not have AIDS. Highly-active antiretroviral therapy (HAART) is used to slow progression of HIV to allow some patients to safely receive anticancer drugs in standard or higher doses. Patients also receive medicine to prevent and treat potentially serious infections.
  • Primary CNS Lymphoma: In this type of lymphoma, malignant cells form in the lymph tissue of the brain and spinal cord. It usually does not spread beyond the central nervous system. Standard therapies include radiation, chemotherapy and steroid therapy.
  • Cutaneous Lymphoma: This disease is a subset of non-Hodgkin lymphoma in which lymphocytes become malignant and affect the skin. Often cutaneous lymphoma can be treated only with topical preparations. Six types of standard treatment are used: photodynamic (light) therapy in conjunction with an injected drug that only becomes active when laser light is shone on the skin, radiation therapy, chemotherapy, topical medications, biologic therapy (interferon) and targeted therapy.
  • Hodgkin Lymphoma: Only 7,500 cases are diagnosed in the U.S., making this rarer than non-Hodgkin. There are two main types of Hodgkin lymphoma: classical and nodular lymphocyte predominant. Treatment is determined by whether the condition is considered early favorable, early unfavorable, advanced favorable, advanced unfavorable or recurrent. Standard treatment includes chemotherapy, radiation, and surgery to remove an affected organ. Clinical trials also include chemotherapy with stem cell transplant.

Medical Treatment

Chemotherapy

Chemotherapy involves the administration of drugs, either orally or intravenously to kill cancer cells. Over the last five years, several new drugs have increased the options for physicians treating patients with lymphoma. Even aggressive non-Hodgkin lymphomas can often be cured with chemotherapy. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given by itself, or as part of a bone marrow and stem cell transplant.

Intravenous forms of treatment may require the placement of a Port-a-Cath. The catheter and port are inserted under the skin into the internal jugular vein right around the collar bone in a patient who will be getting multiple chemotherapy treatments. This allows for giving treatments without damaging the veins or increasing the risk of the medicine leaking out of the vein. It can also be used to draw blood samples to monitor therapy. The port into the catheter lies just under the skin and isn’t noticeable from the outside. When the nurse wants to give chemotherapy, the skin is cleaned and the needle is inserted through the skin into the port to deliver the medicine. It stays in place for the duration of treatment.

Targeted therapy: As researchers have learned more about cancerous changes in cells, they have developed newer drugs that specifically target these changes, blocking different proteins that signal cancer cells to grow. 

Immunotherapy: Biological therapy, sometimes called immunotherapy, is a treatment that uses materials made by the patient’s own body or in a laboratory to stimulate the immune system to fight disease. Siteman researchers are now participating in clinical trials to test this form of therapy.

Donor lymphocyte infusion: Extra lymphocytes may, in some cases, be given from the donor providing your stem cell transplant.

Surgery

In uncommon types of lymphoma, surgery may involve removal of the spleen, a single lymph node or isolated area of involvement outside the lymph node.

Radiation Therapy

Radiation oncology at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis has active trials to use radiation to improve the efficacy of chemotherapy or immunotherapy. There are active efforts to minimize the duration of radiation therapy and amount of radiation to normal tissues to reduce long-term side effects. No one should be over or undertreated. Siteman is a leader in using shorter radiation durations than the national average with the same outcomes.

External beam radiation therapy: Ninety-five percent of radiation treatment at Siteman is external beam from outside the body. Siteman fine-tunes the radiation planning with 3D- conformal or intensity modulated radiation therapy techniques, with the aids of CT or MRI simulator to precisely target therapy. External beam radiation therapy can also be used as part of preparation for stem-cell transplant.

MR-guided adaptive radiation therapy:  Siteman Cancer Center is the first in the world to be able to deliver MRI-guided external beam radiation therapy. Many patients with lymphomas that are difficult to visualize on X-ray or CT scan have been treated with such technology to date. This technology allows radiation oncologists to be able to adapt treatment if needed to accommodate for anatomy changes and to assess for the position of critical structures.

Proton Beam Therapy: The S. Lee Kling Proton Therapy Center at the Siteman Cancer Center is the only proton therapy center located in Missouri and the surrounding region. It houses the world’s first compact proton beam accelerator. Proton beam therapy’s main advantage is that radiation specialists can control radiation beams by depth, shape and the amount of radiation given. In other external radiation therapies, radiation beams pass through a patient to a defined location and then exit the body on the other side, leaving deposits of radiation all along their path. Because proton therapy allows for depth control, the majority of radiation is held until the beam hits the precise area targeted, and little to no radiation is delivered beyond the tumor target. This treatment is ideal for patients with tumors that are located near sensitive structures or tissues, such as the heart, brain or spinal cord. Proton therapy can be used as a solo treatment option, or it can be used in combination with other radiation therapies or chemotherapy.

Radioimmunotherapy: This treatment uses antibodies to deliver targeted radiation to kill lymphoma cells. It can be used as a solo treatment or as a combination with chemotherapy to treat low grade or high grade lymphoma.