Lymphoma Treatment Approaches
At City of Hope, patients are provided treatments based on the latest evidence available and up-to-date clinical guidelines.

Factors that determine the therapy regimen include:

  • Type of lymphoma
  • Stage of lymphoma
  • Prior therapies, if any
  • Patient’s characteristics, such as age and overall health
  • Choice of the patient and care provider, if multiple treatment options are available

Based on these factors, the lymphoma treatment regimen may include one or more of the following:

Chemotherapy

Chemotherapy, or the use of cancer-fighting drugs, is often an essential component of lymphoma treatment because a systemic approach is necessary to kill cancerous cells circulating throughout the lymphatic system. Chemotherapy is usually given in cycles, starting with treatment over several days. It is then followed by a few weeks without treatment so that the patient can recover from side effects, such as anemia and low white blood cell count. The sequence is then repeated until the disease is in remission and then the regimen may be continued to prolong survival or reduce likelihood of relapse.

Standard chemotherapy drugs used for lymphoma may include one or more of the following:
 
  • bleomycin (Blenoxane®)
  • cyclophosphamide (Cytoxan®)
  • dacarbazine (DTIC-Dome®)
  • daunorubicin doxorubicin (Adriamycin®)
  • etoposide (VP-16, VePesid®)
  • mechlorethamine (Mustargen®, a.k.a. nitrogen mustard)
  • prednisone
  • procarbazine (Matulane®)
  • vinblastine (Velban®)
  • vincristine (Oncovin®)
 
Additionally, City of Hope researchers and clinicians are constantly developing new regimens to improve the effectiveness of existing drugs or building new drugs that are more powerful against lymphoma. In particular, City of Hope’s Lymphoma Specialized Program of Research Excellence is focused on creating therapies that are less toxic to the patients. This allow patients to tolerate more potent doses of chemotherapy and open up new treatment options for groups prone to side effects, such as older patients.
 

Immunotherapy

By modifying the immune system, the patient’s own disease-fighting cells can be used to track and attack lymphoma cells throughout the body. This can dramatically enhance outcomes, whether used alone or in combination with other therapies.
 
Immunotherapy approaches being used or studied at City of Hope include:
 
Monoclonal Antibodies
 
Unlike standard chemotherapy that typically affects both cancerous and normal cells, monoclonal therapies are highly targeted drugs that can hone in on cancer cells. After attaching to the cell, the antibody can interfere with the lymphoma’s growth, be used as a delivery or targeting mechanism for other cancer therapies and/or trigger an immune response against  the lymphoma.
 
These antibodies can work alone or can be given in combination with chemotherapy. Common monoclonal antibody treatments include:
 
  • rituximab (Rituxan®)
  • tositumomab (Bexxar®)
  • ibrituomab (Zevalin®)
 
City of Hope has developed novel ways of delivering radiation utilizing monoclonal antibodies, part of the immune system, that have been combined with small amounts of radioactive substances. These radio-labeled antibodies allow doctors to target lymphoma cells directly while minimizing damage to normal tissues. City of Hope was one of the first programs to use radioimmunotherapy as part of a transplant regimen to improve the safety and efficacy of the treatment.

Adoptive T-Cell Therapy
 
T-cells are a powerful part of the immune system, and new approach being studied at City of Hope involves redirecting T-cells to recognize cancer cells specific to lymphoma. T-cells are extracted from lymphoma and then genetically modified so they recognize, target and destroy the cancer cells. Studies are ongoing for this novel approach for a number of lymphomas, particularly ones that are recurrent, relapsed or refractory.
 

Stem Cell Transplantation

City of Hope is a leader in the use of stem cell transplantation to treat lymphoma and other blood disorders. Since the program began in 1976, more than 12,000 transplants have been performed and it has been recognized for superior survival outcomes for nine consecutive years—the only transplant center in the United States with such an achievement.
 
Transplants are sometimes performed early in the course of treatment to improve long-term results or it may be utilized when other treatments are not working.
 
In this procedure, a patient undergoes intensive chemotherapy, and sometimes radiation therapy, to destroy the cancer-causing cells followed by an infusion of healthy new stem cells. The stem cell transplant may be either autologous (extracted from the patient’s own body) or allogeneic (using stem cells taken from another person.)

 
In autologous transplants, a patient donates and receives back his or her own stem cells, typically collected from peripheral (circulating) blood. City of Hope has pioneered the use of early autologous stem cell transplantation in patients with aggressive non-Hodgkin lymphoma to avoid relapse after initial treatment. This is also the most effective treatment for most patients with a lymphoma recurrence.
 
Patients with Hodgkin or AIDS-related lymphomas are sometimes good candidates for autologous stem cell transplantation. City of Hope is currently conducting studies using genetically engineered autologous stem cells to provide additional resistance against HIV infection for patients with AIDS-related lymphoma.

 
For some patients, particularly those whose disease have advanced extensively throughout the body and bone marrow, an allogeneic transplant is preferred, using stem cells from a matched donor or cord blood.

In allogeneic transplants, the donor is preferably a relative with a matching stem cell type. Alternatively, a matched unrelated donor who has a similar genetic type may be used. At City of Hope, 45 percent of allogeneic transplants come from volunteer donors who are unrelated to the patient.
 
One known complication of allogeneic transplants is graft versus host disease (GvHD), in which the newly transplanted cells does not recognize the recipient’s body as their own and forms an immune response against it. City of Hope is on the forefront of tackling this side effect and is constantly improving allogeneic transplant protocols to reduce GvHD risk and minimizing its impact if it does occur.

City of Hope physicians also specialize in “mini” stem cell transplants for patients who cannot tolerate the side effects associated with a standard stem cell transplantation, such as older patients or patients with other medical conditions. These transplants rely less on the heavy doses of chemotherapy and radiation and more on the antitumor effects of the graft itself. This novel approach has patients who otherwise ineligible, including patients in their 70s, to be treated with this lifesaving procedure.
 
 

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. City of Hope is the first in the western United States to treat lymphoma using the Helical TomoTherapy System®, which reduces the unwanted exposure of normal tissues and reduces potential complications. The system combines radiation delivery with real-time imaging, allowing doctors to deliver a higher dose of radiation with greater precision. This significantly improves outcomes and reduces side effects compared to traditional whole-body irradiation, which unnecessarily exposes healthy tissues.

Surgery

Because lymphoma spreads throughout the lymph system, surgery plays a limited role in treating this disease.  However, in localized tumors, such as those arising in the spleen or stomach, surgical removal may be useful. For some lymphomas of the skin, surgical excision may be part of first-line treatment.

Living With Cancer

In addition to curative treatments, City of Hope lymphoma patients and their loved ones can also access the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals can help with a variety of wellness issues, including managing side effects, maintaining emotional/social/spiritual well being, staying healthy during/after treatment and building caregiving skills. Learn more about patient and caregiver support services.

More Information / Become A Patient

If you would like to learn more about our lymphoma treatment options or would like to be treated at City of Hope, please visit our Become a Patient page or call us at 626-256-HOPE (4673) to speak with one of our patient specialists.