hodgkin lymphoma treatment | Relapse lymphoma

Relapse lymphoma

Lymphoma: Frequent relapses

Lymphoma is a cancer that tends to recur, especially in the first two years after treatment. Lymphoma Relapse occur:

Or in case of resistance to treatment;
Depending on the type of lymphoma (aggressive lymphomas are known to repeatedly recur).
Lymphoma: Relapse in case of resistance to treatment
Some patients are resistant to Hodgkin's lymphoma treatments or to the treatment of non-Hodgkin's lymphoma. This is mainly the case in stage III or IV Hodgkin's disease. In these extended forms, relapses of lymphoma are possible with:

Serious recurrences if they occur in the year following diagnosis (late relapses are less severe);
Difficulties in treating them because patients have already undergone heavy treatment;
Recurrences in areas that have already been treated with radiation and which cannot be irradiated again;
Aggravation of initial lymphoma with Viscera (s).
The only possible solution is the renewal of the initial high-dose treatment taking into account the doses already administered. This intensive chemotherapy should be followed by an autografting of stem cells. In addition, in the case of relapse in a non-irradiated area, radiotherapy can be set up.

Lymphoma: Relapse depending on the type of lymphoma

Some lymphomas are more likely to re-offend than others. This is particularly the case for follicular lymphomas, but this is especially the case for aggressive non-Hodgkin lymphomas such as:

Diffuse lymphoma with large B cells;

The lymphoma of the mantle;

Burkitt's lymphoma;

Peripheral T-lymphoma;

Lymphoblastic lymphoma;

Anaplastic lymphoma (especially when it is negative ALK);

CNS (central nervous system) brain or lymphoma lymphoma.

Treatment of lymphoma relapses

Chemotherapy

The treatment of non-Hodgkin (NHL) lymphoma relapses is mainly based on chemotherapy. It is used if, during the initial treatment, the patient was receptive. Indeed, in this case there is a great chance for a new session to prove effective.

The medications used are different than the first time. They can be combined or not with monoclonal antibodies. Generally, fludarabine or polychemotherapy are administered as they exist in the CVP or CAOP protocols.

Immunochimiothérapie

Sometimes, chemotherapy is associated with an external radiation therapy designed to relieve any pain or symptoms of recurrent lymphoma.

On the other hand, it is not uncommon for immunotherapy to be used to treat the recurrence of an indolent NHL. Rituximab is the most commonly used biological drug, either alone or associated with other medications.

Autografting of stem cells for a second relapse

The autografting of stem cells is envisaged in some patients whose indolent NHL has recurred. We turn to this option when the association of chemotherapy with immunotherapy remains without effect.

In the specific case of Hodgkin lymphomas (LH), if the autograft is a failure (relapse or patient refractory to treatment), other monoclonal antibodies are used. The last to have been authorised, in June 2017, is particularly effective. This is the pembrolizumab.

The CAR-T cells in case of a third relapse

The CAR-T cell technology (for Chimeric antigen Receptor) is a immunotherapy in which T lymphocytes are taken from a patient and then genetically altered so that they can recognize cancer cells and thus Destroy.

This technique is effective in the third-line treatment of large-cell diffuse B lymphoma in patients who are unable to undergo autologous stem cell transplantation and in which lymphoma reoffends for the third time, and/or In which conventional treatments remain without effects.

While the Immunochimiothérapie does not allow more than 10% remission, the CAR-T cells get a rate of 50%.

However, these medicines are not yet on the European market, their authorisation being under consideration. They were licensed in 2017 in the United States, but their current price is between 373 000 and 475 000. However, they may be available in France from 2018 as part of a temporary authorisation for use (ATU) at the same time as clinical trials will be conducted.