TREATMENT OF NON-HODGKIN LYMPHOMA

Depending on the type and extent/stageing of the lymphoma and other factors, treatment options for NHL include:

Chemotherapy for Non-Hodgkin Lymphoma: use of anti-cancer drugs usually injected into a vein (IV) or taken by mouth and may be used alone or combined with other treatments, like immunotherapy drugs or radiation therapy.

Some of the drugs more commonly used to treat lymphoma :


Alkylating agents
Corticosteroids
Platinum drugs
Purine analogs
Anti-metabolites
Anthracyclines
Others

Often drugs from different groups are combined. MOST COMMON COMBINATION IS CHOP: cyclophosphamide, doxorubicin (also known as hydroxydaunorubicin), vincristine (Oncovin) and prednisone.

Chemo is often combined with an immunotherapy drug, especially rituximab (Rituxan).

Intrathecal chemo: To treat lymphoma that might have reached cerebrospinal fluid (CSF) and tissues around the brain and spinal cord, chemo may also be given into the CSF. The chemo drugs most often used for intrathecal chemo are methotrexate and cytarabine.

Other drugs used to treat lymphoma Other types of drugs useful in treating some types of lymphoma, work differently from standard chemo drugs. For example, immunotherapy and targeted therapy drugs helpful for some lymphomas:

  1. 1. Mucosa-associated lymphoid tissue (MALT) lymphoma: usually starts in the stomach, linked to infection with the bacterium H. pylori.
  2. 2. splenic marginal zone B-cell lymphoma: the infection treatment with anti-viral drugs can sometimes shrink these lymphomas, or even make them go away.

Immunotherapy for Non-Hodgkin Lymphoma: treatment that either boosts the patient’s own immune system or uses man-made versions of parts of the immune system to kill lymphoma cells or slow their growth.

Monoclonal antibodies: designed to attack a specific target, on the surface of lymphocytes (the cells in which lymphomas start).

Antibodies that target CD20: CD20 antigen, a protein on the surface of B lymphocytes. These include:

Antibodies that target CD19: Tafasitamab (Monjuvi) is an antibody directed at the CD19 antigen, a protein on the surface of B lymphocytes.

Antibodies targeting CD52: Alemtuzumab (Campath) is an antibody directed at the CD52 antigen useful in some cases of peripheral T-cell lymphomas.

Antibodies that target CD30: Brentuximab vedotin (Adcetris) is an anti-CD30 antibody attached to a chemotherapy drug (an antibody-drug conjugate) acts like a homing signal, bringing the chemo drug to lymphoma cells.

Antibodies that target CD79b: Polatuzumab vedotin (Polivy) is an anti-CD79b antibody attached to a chemotherapy drug (an antibody-drug conjugate) finds the lymphoma cell and attaches to the surface protein CD79b and destroys it.

Immune checkpoint inhibitors: pembrolizumab (Keytruda) work by blocking checkpoints, which can boost the immune response against cancer cells.

Immunomodulating drugs : Drugs such as thalidomide (Thalomid) and lenalidomide (Revlimid) work against certain cancers by affecting parts of the immune system, used to help treat certain types of lymphoma, usually after other treatments have been tried.

Chimeric antigen receptor (CAR) T-cell therapy: immune cells called T cells are removed from the patient’s blood and engineered in the lab to have specific receptors (called chimeric antigen receptors, or CARs) and can attach to proteins on the surface of lymphoma cells;this precise immune attack against them.

Axicabtagene ciloleucel (Yescarta, also known as axi-cel) : type of CAR T-cell therapy approved to treat people with:

Tisagenlecleucel (Kymriah, also known as tisa-cel) : treat diffuse large B-cell lymphoma, high grade B-cell lymphoma, and diffuse large B-cell lymphoma arising from follicular lymphoma, after trying at least two other kinds of treatment.

Lisocabtagene maraleucel (Breyanzi, also known as liso-cel): ): is approved to treat adults with diffuse large B-cell lymphoma, primary mediastinal large B-cell lymphoma, high grade B-cell lymphoma, and follicular lymphoma grade 3B, after at least two other kinds of treatment have been tried.

Brexucabtagene autoleucel (Tecartus, also known as brexu-cel): is approved to treat adults with mantle cell lymphoma that has come back or is no longer responding to other treatments.

Targeted Therapy Drugs for Non-Hodgkin Lymphoma: changes in lymphoma cells that help them grow, have allowed to developed newer effective drugs to specifically target these changes. Like : Proteasome inhibitors, Histone deacetylase (HDAC) inhibitors, BTK inhibitors, PI3K inhibitors, EZH2 inhibitor, Nuclear export inhibitor

Radiation might be used to treat non-Hodgkin lymphoma (NHL) in certain different situations:

Surgery for Non-Hodgkin Lymphoma : often used to get a biopsy sample for diagnosis and classify a lymphoma, but it’s rarely used as a form of treatment. For more information about treating cancer with surgery, consult Dr Gaurav Dixit (International Hemat0-Oncologist)






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