What is the treatment for Lymphoma?
Treatments for lymphoma include chemotherapy, immunotherapy, radiotherapy, or other targeted drug therapy. Doctor shall decide the appropriate treatment plan for patients according to their general health, specific subtype of lymphoma and the stage of lymphoma. In special situations, doctor may use bone marrow or peripheral blood stem cell transplantation, chimeric antigen receptor (CAR) T-cell therapy or enroll the patients to clinical trials.
Chemotherapy is a widely used treatment for lymphoma. It kills the cancer cells by receiving oral or intravenous injection of anti-cancer drugs. However, chemotherapy can also damage healthy cells and tissues, causing a number of side effects and discomfort.
Radiotherapy is the use high-energy radiation produced from an X-ray machine to kill cancer cells on the affected area. It can be given alone or alongside with chemotherapy for better treatment outcome and reduction of side effects.
Apart from the traditional radiotherapy and chemotherapy, “immunotherapy” has become an important treatment for lymphoma. Immunotherapy is the use cells or antibodies of the immunity system to treat cancer. For example, since majority of B-cell type non-Hodgkin's lymphomas bears an antigen, CD20, on the cell surface, immunotherapy drugs that are specifically designed to target this CD20 surface antigen have been developed. They include Rituximab and Obinutuzumab (Gaxyva). Rituximab and obinutuzumab are monoclonal antibodies that can recognize and attach itself onto the surface CD20 antigen of B-cell lymphoma. It then stimulates immune response to kill the lymphoma cells. Ritxumab and obinutuzumab are effective and have fewer side effects for treatment of B-cell lymphomas. They can also combine with chemotherapy to improve treatment outcome. Monoclonal antibodies targeting at other antigens have also been developed for clinical use.
Bone marrow or peripheral blood stem cell transplantation in lymphoma is the use of high dose chemotherapy and/or radiotherapy followed by re-infusion of bone marrow or peripheral blood stem cells from the patients themselves or donated by their close families. However, the risk of this treatment is relatively high, thus it is usually used on selected patients with recurrent cancer.
Major breakthroughs in the treatment of lymphoma in recent years include the development of new targeted drugs and chimeric antigen receptor (CAR) T-cell therapy. These targeted drugs can block the B-lymphocytes growth pathway (such as Bruton tyrosine kinase inhibitors) or through other mechanisms to control certain types of lymphomas. They can also be combined with other drugs such as monoclonal antibodies to improve the response.
In CAR T-cell therapy, T cells are taken from a patient’s blood and sent to a laboratory. There, technologies are used to engineer T cells to express the chimeric antigen receptor, which allows the modified T-cells to identify and kill cancer cells after reinfused into the patient’s blood stream. CAR T-cell therapy has been demonstrated to be effective in certain types of B-cell lymphomas.
The clinical condition, treatment required and response to medication for each patient may vary. Doctors will base on their clinical judgement and patients' condition to prescribe appropriate treatment and care plan. If a patient is considered suitable for receiving CAR-T cell therapy, a referral will be made to the HA's Central Assessment and Prioritisation Panel, which will review patients' condition and other relevant considerations to confirm the eligibility of referral. All eligible cases intended for receiving CAR-T cell therapy in HA under the registered indications are required to go through the central assessment before the start of the Therapy.