Lymphoma treatment encyclopedia: a comprehensive explanation from chemotherapy to bone marrow transplantation

Author: Han Bing, Chief Physician, Peking Union Medical College Hospital

Reviewer: Zhang Yu, researcher at Chinese Center for Disease Control and Prevention

Lymphoma, a cancer that originates from the lymphatic system, poses a great challenge to the medical community due to its complexity and diversity. Unlike a single type of cancer, lymphoma covers a variety of subtypes, ranging from slow-growing indolent lymphomas to rapidly developing aggressive lymphomas, each with its own unique biological characteristics and treatment needs.

In the process of treating lymphoma, accurate pathological diagnosis and classification are the first thing to rely on. Clarifying the type of lymphoma is the cornerstone of developing a treatment plan, because different types of lymphoma respond very differently to treatment. For example, there are significant differences in the treatment of Hodgkin's lymphoma and non-Hodgkin's lymphoma. The former often uses the ABVD regimen (the four letters of the name come from the four drugs of the therapy, doxorubicin, bleomycin, vinblastine, and dacarbazine) as the first choice, while the latter uses a variety of regimens including CD20 monoclonal antibodies combined with chemotherapy depending on the cell source.

In addition to the classification, the staging of lymphoma is also a key factor in determining the treatment plan. For patients with early-stage (stage I and II) lymphoma, radiotherapy or local resection can be used in some cases, but for certain types of lymphoma, systemic chemotherapy should be considered even in the early stages. For patients in stages III and IV, chemotherapy is usually the preferred treatment option. In addition, for patients with indolent lymphoma, if the symptoms are not obvious, a waiting and observation strategy can be adopted to avoid the side effects of overtreatment.

As the basis of lymphoma treatment, chemotherapy is of great importance. Chemotherapy drugs are distributed throughout the body through the blood circulation, which can effectively kill or inhibit the growth and spread of lymphoma cells, thereby achieving the purpose of controlling the disease and prolonging survival. For highly aggressive lymphomas, such as Burkitt's lymphoma, timely initiation of chemotherapy is crucial to controlling the progression of the disease.

The choice of chemotherapy regimen should be based on the patient's specific situation, lymphoma type and stage, etc. Taking Hodgkin's lymphoma as an example, the classic ABVD regimen is still the first-line treatment option for many patients; while for non-Hodgkin's lymphoma, especially B-cell lymphoma, drugs containing CD20 monoclonal antibodies combined with chemotherapy have become the mainstream.

However, chemotherapy is not the only treatment. Surgery and radiotherapy also play an indispensable role in the treatment of lymphoma. The application of surgery in the treatment of lymphoma is mainly concentrated in two aspects: one is the diagnosis stage, through surgical operation to obtain pathological tissue to clarify the diagnosis; the other is to treat complications, such as intestinal perforation, bleeding and other problems that occur during chemotherapy. It is worth noting that because lymphoma is a systemic disease, simple surgical removal of local lesions cannot achieve the purpose of radical cure.

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Radiotherapy is mainly used to treat large local masses or specific types of lymphoma. After adequate systemic chemotherapy, radiotherapy for residual local tumors can achieve the purpose of eradication. In addition, for certain types of lymphoma, such as NK/T lymphoma, the combination of chemotherapy and radiotherapy can significantly improve the treatment effect.

For lymphoma patients, especially those with bone marrow involvement or high risk of relapse, bone marrow transplantation becomes a key part of the treatment plan. Autologous hematopoietic stem cell transplantation uses the patient's own stem cells to remove residual lesions through a series of complex procedures to achieve deep remission of the disease. For patients with bone marrow involvement or high-risk patients, allogeneic hematopoietic stem cell transplantation is riskier but a powerful means of saving lives. Through bone marrow or stem cell transplantation from healthy donors, lymphoma lesions can be completely removed, bringing new life to patients.

In addition, the physical and mental state of lymphoma patients during treatment should not be ignored. Maintaining a positive attitude, communicating closely with doctors, and timely feedback on treatment responses are the keys to successful treatment. In terms of lifestyle, patients should pay attention to healthy diet, regular work and rest, and avoid fatigue and infection risks, especially during radiotherapy and chemotherapy. Regular review and follow-up to ensure timely monitoring of the disease are essential to prevent recurrence and adjust treatment plans. When visiting lymphoma patients, avoid sending flowers to reduce the risk of infection, control the number and number of visits, and keep the environment clean. These details all reflect meticulous care for patient safety.

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