What are the treatment options for lymphoma?

From the Guidelines

Lymphoma treatment should be tailored to the specific type and stage of lymphoma, with a focus on minimizing morbidity, mortality, and improving quality of life. The treatment approach varies depending on the lymphoma subtype, stage, patient age, and overall health status. For example, in the case of follicular lymphoma, rituximab in combination with chemotherapy is recommended for advanced stages III and IV disease, as it achieves complete remission and long progression-free survival 1.

Treatment Approaches

• For Hodgkin lymphoma, the standard regimen often includes ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) chemotherapy given every two weeks for 2-6 months, sometimes followed by radiation to affected areas.
• For aggressive non-Hodgkin lymphomas like diffuse large B-cell lymphoma, R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone) is commonly used, administered every 21 days for 6-8 cycles 1.
• Indolent lymphomas may be managed with watchful waiting initially, followed by single-agent rituximab or bendamustine-rituximab combinations when treatment becomes necessary.

Considerations

• Treatment decisions should prioritize minimizing morbidity, mortality, and improving quality of life, taking into account the patient's age, overall health status, and lymphoma subtype.
• Regular follow-up with blood tests and imaging is essential to monitor treatment response, and supportive care including anti-nausea medications, growth factors to boost blood counts, and prophylactic antibiotics may be needed throughout treatment to manage side effects and complications.
• For patients with relapsed disease, brentuximab vedotin is approved for treatment, and high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care 1.

Monitoring and Follow-up

• Regular monitoring of thyroid function, testosterone, and oestrogen levels is recommended, particularly in younger patients who had intensive chemotherapy.
• CT scans and previously pathologic radiographic tests must be carried out once to confirm the remission status, and surveillance scans are not indicated unless clinical symptoms occur 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1. 1 Non–Hodgkin's Lymphoma (NHL) RITUXAN is indicated for the treatment of adult patients with: Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent Previously untreated follicular, CD20-positive, B-cell NHL in combination with first line chemotherapy and, in patients achieving a complete or partial response to a rituximab product in combination with chemotherapy, as single-agent maintenance therapy Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy. Previously untreated diffuse large B-cell, CD20-positive NHL in combination with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or other anthracycline-based chemotherapy regimens RITUXAN is indicated for the treatment of pediatric patients aged 6 months and older with: Previously untreated, advanced stage, CD20-positive diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), Burkitt-like lymphoma (BLL) or mature B-cell acute leukemia (B-AL) in combination with chemotherapy.

Rituximab (IV) can be used to treat lymphoma in the following ways:

• As a single agent for relapsed or refractory, low-grade or follicular, CD20-positive, B-cell Non-Hodgkin's Lymphoma (NHL)
• In combination with first-line chemotherapy for previously untreated follicular, CD20-positive, B-cell NHL
• As single-agent maintenance therapy for patients achieving a complete or partial response to rituximab in combination with chemotherapy
• As a single agent for non-progressing, low-grade, CD20-positive, B-cell NHL after first-line CVP chemotherapy
• In combination with CHOP or other anthracycline-based chemotherapy regimens for previously untreated diffuse large B-cell, CD20-positive NHL
• In combination with chemotherapy for previously untreated, advanced stage, CD20-positive diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), Burkitt-like lymphoma (BLL) or mature B-cell acute leukemia (B-AL) in pediatric patients aged 6 months and older 2

From the Research

Treatment Options for Lymphoma

• Lymphoma is a group of malignant neoplasms of lymphocytes with more than 90 subtypes, and its treatment depends on the subtype and stage of the disease 3.
• Non-Hodgkin lymphoma is treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 3.
• Hodgkin lymphoma is treated with combined chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), Stanford V (a chemotherapy regimen consisting of mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone), or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) with radiotherapy 3, 4.

Salvage Therapy for Relapsed/Refractory Lymphoma

• For patients with relapsed or refractory B-cell non-Hodgkin lymphoma, salvage therapy with R-DHAX (rituximab, dexamethasone, cytarabine, and oxaliplatin) has been shown to be effective and safe 5.
• The treatment of relapsed or refractory Hodgkin lymphoma typically involves salvage chemotherapy followed by high-dose therapy and an autologous stem cell transplant, or treatment with brentuximab vedotin 4.

Novel Therapies for Lymphoma

• Novel therapies, including targeted agents and immunotherapy-based approaches, have recently been approved for relapsed/refractory lymphoma and have led to improved outcomes 6.
• The use of rituximab, an anti-CD20 monoclonal antibody, has been established as a viable treatment option for patients with relapsed or refractory indolent non-Hodgkin lymphoma, and as a standard first-line treatment option when combined with CHOP chemotherapy in elderly patients with diffuse large B-cell lymphoma 7.

Considerations for Treatment

• The choice of treatment for lymphoma depends on various factors, including the subtype and stage of the disease, as well as the patient's overall health and performance status 3, 4.
• Patients with lymphoma should receive routine surveillance to monitor for complications and relapse, in addition to age-appropriate screenings recommended by the U.S. Preventive Services Task Force 3.