non hodgkin's lymphoma treatment | Non-Hodgkin's lymphoma treatment

Non-Hodgkin's lymphoma treatment

The treatment of non-Hodgkin's lymphoma must be well suited for better prognosis. It comes in several methods that can be used alone or combined. Among them is:

chemotherapy;
Immunotherapy;
Radiation therapy
The Autograft.
Nonetheless, the preferred treatment of NHL is immunochimiothérapie, which combines chemotherapy with monoclonal antibody immunotherapy.

Good to know: surgical treatment is exceptional. It is especially interesting in the diagnostic framework to perform a biopsy.

How to diagnose cancer

Variability in responses to treatment of non-Hodgkin lymphomas
The response to non-Hodgkin (NHL) Lymphoma treatments varies according to different factors, including:

of the NHL type;
of the lymphoma stage;
The number of potential extra-ganglion locations (if organs, bone marrow or central nervous system are affected, the chances of recovery are less good than in the case of localized lymphoma);
Of the patient's age (younger patients often respond better to the treatment of lymphoma than the elderly, especially since they are more supportive of the adverse effects of treatment);
General health status
blood test results:
Rate of LDH, or LDH, an enzyme that intervenes in the production of energy within cells and gives a good idea of the degree of eventual spread of an NHL at the level of the liver,
Rate of beta-2 Microglobulin (B2M),
Hemoglobin levels for follicular lymphomas.
Large disparities can therefore exist and the prognosis is therefore equally varied. In addition to these different parameters, oncologists and hematologists cannot predict with certainty how lymphoma will evolve and what the response to treatment in a particular patient will be.

Lymphoma Diagnosis
Treatment of NHL by polychemotherapy
The chemotherapy used to treat the NHL uses a set of medications, hence the term polychemotherapy. The interest of these combinations is to destroy cancer cells in many ways and make them more vulnerable while reducing the amount of adverse reactions and the risk of drug resistance.

NHL: chemotherapeutic treatment According to two main protocols
The NHL treatment protocols are tailored to each patient. For example:

The ABVP protocol (Adriamycin, bleomycin, vinblastine, and prednisone) is used for localized lymphomas (stage I and II).
For stage III and IV lymphomas, the BEACOPP protocol (bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin, Procarbazine, prednisone) is preferred and the rituximab can be added.
Nevertheless, there are many other treatments, the most suitable of which will be chosen during the multidisciplinary consultation meeting.

Rate of chemotherapy in the treatment of NHL
Some non-Hodgkin, aggressive lymphomas have an interest in being treated with methotrexate by intravenous injections, in addition to the protocols cited. Treatment will be done in the form of cures (or cycles, treatment periods followed by a rest interval) since only one dose is not enough to eliminate all cancer cells.

Again, chemotherapy cycles vary depending on many factors (NHL stage, type of lymphoma, medications used, response obtained, magnitude of adverse reactions, etc.). The rhythm between two cycles is usually:

14 to 21 days for large cell diffuse lymphomas;
21 to 28 days or more for others.
Induction treatment will be followed by a consolidation treatment. The latter is sometimes intensive and followed by an autograft.

For indolent lymphomas that are likely to recur, a two-year, monoclonal antibody-based maintenance treatment (including rituximab) is put in place.

Treatment of NHL by immunotherapy
Immunotherapy (or biological therapy) brings together all the treatments that support the immune system in its fight against cancer. The different immunotherapeutics encountered are:

Monoclonal antibodies, including rituximab;
Radioimmunotherapy that combines monoclonal antibodies with radiation therapy;
Interferons that stimulate the cells of the immune system to fight cancer and prevent its proliferation.
Good to know: New anti-cancer drugs, the BH3 mimetic, have also been developed. They intervene on the mechanism of apoptosis (programmed cell death which should in principle lead to the destruction of tumors) in order to remake it function normally. This new approach makes it possible to treat 25% of malignant tumours, including lymphomas.

Treatment of non-Hodgkin lymphomas by radiotherapy
Radiotherapy is a local approach that can only act on the treated area (unlike chemotherapy that has a global action). Early NHL often respond very well to radiation therapy. It is therefore interesting to treat non-Hodgkin localized lymphomas, whether ganglion or extra-ganglion. Irradiation is therefore directed:

Either to the lymph nodes and surrounding areas in the case of ganglionic lymphoma;
Or the area of origin of lymphoma when it is an extra-ganglionic lymphoma.
Radiation therapy is often used as a complement to chemotherapy to help destroy lymphoma cells and reduce the risk of relapse. This association allows to treat aggressive lymphomas or large tumors.

Finally, radiation therapy helps to relieve the symptoms caused by some severe lymphomas. In fact, rays can reduce the size of a tumor and relieve the pressure exerted on neighbouring organs. They can also reduce the swelling of swollen lymph nodes and thus reduce the pain they cause.

Good to know: the irradiation sessions only last a few minutes during which the patient must remain stationary.

Treatment of non-Hodgkin lymphomas by autografting
The autograft is a stem cell transplant, the ones that give birth to the elements of the blood:

red blood cells;
white blood cells;
The platelets.
This transplant is necessary when the doses of chemotherapy have been very high and they have destroyed both cancer cells and healthy cells. The graft will therefore allow the opted to recover a normal blood structure after it has been severely damaged.

Good to know: we are talking about autograft (the one used in case of lymphoma) when the patient receives his own stem cells. So there is no risk of incompatibility.

Therapeutic Abstention in the event of an NHL
Therapeutic forbearance is a choice that can be made in the treatment of non-Hodgkin indolent lymphomas. For example, some follicular lymphomas that do not cause symptoms and are limited in scope can benefit from therapeutic forbearance. In this case, the patient continues to live with lymphoma in a normal way as long as no symptoms of lymphoma manifest. However, he should consult regularly with his doctor for follow-up visits and to carry out exams. If we see that the lymphoma is evolving, a treatment can be put in place.