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Questions to Ask Your Doctor About Your Cancer
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General Lymphoma Treatment

The treatment of lymphoma depends on many factors, the most important of which are the type of disease, its stage, its site (location), whether the lymphoma is slow- or fast-growing, and the age and general health of the individual. Other factors that may enter into the treatment plan include symptoms, whether surgery was used in staging the disease, and pregnancy.

Fortunately, many advances have been made in the treatment of both Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) in recent years. Over 75% of newly diagnosed HD patients are cured by the latest methods of chemotherapy and radiation therapy, and the survival statistics for NHL patients are improving.

Treatment plans for children vary according to the age, physical development, and sexual maturity of the individual child.

General Treatment Options
In general, there are five options available for the treatment of adult lymphoma:

1. Chemotherapy - to kill lymphoma cells using strong anticancer drugs
2. Radiation therapy - to kill lymphoma cells by exposure to high-energy radiation
3. Stem cell transplantation (SCT) - to enable treatment with high doses of chemotherapy and radiation therapy
4. Biological therapies - that use naturally occurring substances of the immune system to stop lymphoma progression
5. Surgery - to remove confined, lymphomas outside the lymph nodes (extranodal) in organs such as the thyroid or stomach

Oncologists (cancer specialists) administer these treatments in a variety of combinations. Each method has its advantages and drawbacks. It usually is worthwhile to get a second opinion about treatment before entering into a specific program. In some instances, a second opinion may be required by the patient's insurance company. For example, stem cell transplantation (SCT) is very costly (more than $100,000) and entails a long stay in the hospital. Some insurance companies still consider this to be an "experimental" procedure and will not pay for SCT-related expenses.

Biological Therapies
One of the biological therapies used for the treatment of lymphoma is interferon therapy. Interferons are a class of proteins that are released by virus-infected cells. They help normal cells to make antiviral proteins. Interferons also help the body to reduce tumor cell proliferation (growth and reproduction), while strengthening the body's immune response.

Interferon-alpha (INFa)
INFa is a type of interferon that may be used to treat lymphoma. Research indicates that interferon can cause tumors of some NHL types to shrink. For example, interferons have been found to be active as single agents against follicular lymphoma, low-grade T-cell lymphoma, and hairy leukemia/lymphoma. Yet experts remain uncertain about the benefits of interferon, and there are questions about its suitability in combination with chemotherapy. Interferons generally are ineffective as single agents against intermediate- or high-grade lymphomas.

Interferon-alpha can be given by a number of methods - that is, by injection into a vein, into a muscle, or under the skin - although subcutaneous (under the skin) injection is the customary route. Often IFN-a is started at a low dose (e.g., 3 MU daily), with gradual increases over time. Unfortunately, though, this drug is not without side effects. Possible IFN-related complaints include fevers, shivers, muscle aches, bone pain, headaches, concentration difficulties, fatigue, nausea, vomiting, and general "flu-like" symptoms when starting the drug. Such symptoms usually last for 1 to 2 weeks, but may be lessened by drugs such as acetaminophen. Side effects recur if the INF-a dosage is increased, but they are temporary and usually improve after INF-a therapy is completed.

Monoclonal antibodies
Monoclonal antibodies are laboratory-made antibodies (infection-fighting immune system proteins) that can be designed to seek and destroy lymphoma cells. These antibodies are now being tested in clinical trials with NHL patients. The monoclonal antibodies are directed against antigens (molecules that cause an immune response by antibodies) on the surfaces of lymphoma cells. Once the lymphoma cells are "tagged" by the antibodies, they are attacked and removed by the body's immune system. One monoclonal product (Rituxan or rituximab) - which recognizes the antigen CD20 - has received approval from the Food and Drug Administration (FDA) for the treatment of follicular lymphoma (see Types of Lymphoma). Patients receive four intravenous (IV) antibody treatments over a 3-week period. Side effects associated with the use of antibodies may occur rapidly after the first dose and often involve fever, nausea, headache, and chills/rigidity. More severe reactions may occur, but they are not the same as the side effects seen during chemotherapy. Monoclonal antibody therapy usually is reserved for patients with NHL that has returned or has not responded to chemotherapy.

Surgery
Surgery plays little role in the treatment of HD, and it rarely is used as a therapeutic option for NHL. For some lymphomas that arise in organs outside of the lymph nodes (extranodal) such as the thyroid or stomach, surgical resection (cutting away) of the tumor may be considered. However, surgery is associated with complications such as adhesions (abnormal "joining" of organs and tissues by fiber-like bands), nerve injury, and cosmetic effects, and it does not prevent tumor regrowth. Surgery may be used to insert a venous access device, a plastic tube that is surgically implanted into a large vein in the chest or upper arm, to reduce the need for repeated needle sticks during drug injections or removal of blood samples.

Surgical staging with laparotomy (incision through the abdominal wall) and splenectomy (removal of the spleen) are the most accurate means of determining HD spread in patients who show disease above the diaphragm, the large abdominal muscle that controls breathing, and who are candidates for radiation therapy alone. The primary danger of splenectomy, especially in people with compromised immune systems, is sepsis - infection in the blood or tissues). Microorganisms commonly involved in such sepsis include pneumococci, meningococci, E. coli, Haemophilus influenzae, and staphylococci.

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