Can Marginal Zone Lymphoma Be Cured
Treatment usually depends both on the type of lymphoma and the stage (extent) of the disease, but many other factors can be important as well. Diffuse large B-cell lymphoma (DL BCL) tends to grow quickly.
2. Obinutuzumab
Most often, the treatment is chemotherapy (chemo), usually with a regimen of 4 drugs known as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), plus the monoclonal antibody rituximab (Rituxan). For DL BCL that is only in 1 or 2 lymph node groups on the same side of the diaphragm (the thin muscle that separates the chest from the abdomen), R-CHOP is often given for 3 to 6 cycles, which might be followed by radiation therapy to the affected lymph node areas.
After several cycles, doctors may get imaging tests such as a PET/CT scan to see how well treatment is working. People who have a higher risk of the lymphoma coming back later in the tissues around the brain and spinal cord may be treated with chemo injected into the spinal fluid (called intrathecal chemotherapy).
For younger patients with a higher risk of the lymphoma coming back based on the International Prognostic Index (IPI) score, high-dose chemo followed by a stem cell transplant might be an option. Most doctors feel that if a transplant is done as part of the first treatment, it should be done in a clinical trial.
Stem cell transplants are not effective unless the lymphoma responds to chemo. DL BCL can be cured in about half of all patients, but the stage of the disease and the IPI score can have a large effect on this.
Sometimes, the doctor will order a biopsy of the chest tumor to confirm that lymphoma is still present before starting radiation. Another treatment option is 6 cycles of dose-adjusted topside, doxorubicin and cyclophosphamide with vincristine, prednisone and rituximab (DA-EPOCH-R) which typically does not require any radiation.
(Source: imagebank.hematology.org)
If the primary mediastinal B cell lymphoma does come back or does not respond to chemo, immunotherapy with the drug pembrolizumab may be an option. This type of lymphoma often grows slowly and responds well to treatment, but it is very hard to cure.
If treatment is needed for follicular lymphoma that is only in 1 lymph node group or in 2 nearby groups that are both above or below the diaphragm (the thin muscle separating the chest from the abdomen), the preferred treatment is radiation therapy to the lymph node areas affected by lymphoma (called involved site radiation). If treatment is needed, the most common option is a monoclonal antibody (rituximab or obinutuzumab) combined with chemo.
The chemo can be a single drug (such as bendamustine) or a combination of drugs, such as the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CVP (cyclophosphamide, vincristine, prednisone) regimens. This might include continuing the monoclonal antibody (rituximab or obinutuzumab) for up to 2 years, or treatment with ibritumomab.
Further treatment may lower the chance that the lymphoma will come back later and may help some patients live longer, but it can also have side effects. The main difference is where the cancer cells are (the blood and bone marrow for CLL, and the lymph nodes and spleen for SLL).
If the lymphoma isn’t growing quickly or causing any problems, it can be watched closely without treatment for a time. Which treatment is used depends on a person’s age and health, as well as on whether the cancer cells have certain chromosome changes.
(Source: wiki.clinicalflow.com)
Because current treatments for this type of lymphoma aren't likely to cure it, patients might want to consider taking part in a clinical trial. Mantle cell lymphomas that have spread more widely when they are first diagnosed are treated with chemo plus rituximab.
If the lymphoma responds well to these initial treatments, a stem cell transplant may be a good option, followed by rituximab for 3 years. Less intense chemo regimens, such as bendamustine with rituximab, may be used for people who are older or who have other health issues.
For mantle cell lymphomas that don’t respond or that come back after initial treatment, chemo with drugs such as bendamustine, bortezomib (Decade), carbine, clofarabine, or thalidomide (Realized) may be used, sometimes along with other chemo drugs or with rituximab. Other options include the use of a targeted drug, such as ibrutinib (Imbruvica), acalabrutinib (Sequence), or zanubrutinib (Bruins), as well as the CAR T-cell therapy brexucabtagene autoleucel (Tenants).
Other targeted drugs such as venetoclax (Vendetta) and idealism (Zelig) have also shown promising results in some early studies. Early-stage gastric MALT lymphomas are treated with antibiotics combined with drugs that block acid secretion by the stomach (called proton pump inhibitors).
About 2 out of 3 of these lymphomas go away completely with antibiotic treatment, but it can sometimes take several months to be effective. For these early-stage gastric MALT lymphomas, treatment is usually either radiation therapy to the stomach or rituximab.
If the lymphoma is large, is causing symptoms, or is growing, it can be treated with radiation therapy to the stomach, rituximab, chemo, chemo plus rituximab, or the targeted drug ibrutinib (Imbruvica). The chemo drugs used are the same as those used for follicular lymphoma, and may include single agents such as chlorambucil or clofarabine or combinations such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CVP (cyclophosphamide, vincristine, prednisone).
This rare type of lymphoma is generally slow growing (indolent), and it often doesn’t need to be treated right away. If it does need treatment, it is usually treated the same way as follicular lymphoma (which also tends to grow slowly).
If treatment is needed for lymphoma that is only in 1 lymph node group or in 2 nearby groups on the same side of the diaphragm (the thin muscle separating the chest from the abdomen), the preferred treatment is radiation therapy to the lymph node areas affected by lymphoma (called involved site radiation). Other choices include treatment with rituximab (Rituxan), chemo, or both, which might be followed by radiation therapy.
The chemo can be a single chemo drug (such as bendamustine or clofarabine) or a combination of drugs, such as the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CVP (cyclophosphamide, vincristine, prednisone) regimens. Other options for initial treatment include rituximab alone or chemo alone (either one or several drugs).
Further treatment may lower the chance that the lymphoma will come back later and may help some patients live longer, but it can also have side effects. Nodal marginal zone B-cell lymphoma can also change into a fast-growing diffuse large B-cell lymphoma (DL BCL), which would require more aggressive chemotherapy (see above).
About 1 in 3 people with this type of lymphoma have chronic hepatitis C virus (CV) infection. If that doesn’t work, or if a person isn’t infected with CV, surgery to remove the spleen can sometimes lead to a long-term remission.
Hyper-CVAD (cyclophosphamide, vincristine, doxorubicin , and dexamethasone), alternating with methotrexate and cytarabine (Arab) CODEX (cyclophosphamide, vincristine , doxorubicin, and high-dose methotrexate), alternating with IVAN (ifosfamide, topside , and cytarabine ) EPOCH (topside, prednisone, vincristine , cyclophosphamide, and doxorubicin) An important part of the initial treatment of this disease is making sure a person gets plenty of fluids, as well as drugs like allopurinol, to help prevent tumor lysis syndrome (described in Chemotherapy for Non-Hodgkin Lymphoma).
This lymphoma begins in the brain or spinal cord. It often develops in older people or those with immune system problems caused by AIDS or drugs given to keep transplanted organs from being rejected. For people in reasonably good health, high IV doses of the drug methotrexate have been shown to be the most effective treatment.
This is given along with the drug leucovorin and IV fluids, which help limit serious side effects. For those who aren’t able to tolerate this treatment, other, less intensive chemo regimens or radiation therapy alone may be tried.
An issue with radiation therapy to the brain, especially in older patients, is that it can often cause mental changes. If CNS lymphoma keeps growing or comes back after treatment, further options may include chemo (using different drugs), radiation therapy, or a stem cell transplant if the person is healthy enough.
Most often doctors treat these cancers with radiation therapy, chemotherapy (chemo), or a combination of the two. Problems with thinking, concentration, and memory are possible side effects from radiation to the brain and spinal cord.
Depending on the type of lymphoma, chemo may be used alone or in combination with radiation therapy, especially if it has grown outside the eye or spread to other places in the body. Intraocular chemo gets higher doses of the drug to the tumor without causing severe side effects in other parts of the body.
(Source: www.hematologi.net)