[How Much Do You Know About Cancer] World Lymphoma Day: What are the treatments for lymphoma?

A new start after a century, towards a new journey of cancer prevention and treatment! September 15th, today is the 18th World Lymphoma Day.

Lymphoma patients face a variety of challenges during the treatment process. Timely and effective popular science education on lymphoma can help patients better treat and manage themselves, while raising the public's awareness and attention to cancer prevention and treatment, and fully realizing the journey to health on the road to the new era.

Chemotherapy is the main treatment for lymphoma

The development of modern medicine has given humans a variety of methods to fight tumors, especially lymphoma. At present, the main treatment for lymphoma is still systemic drug therapy, namely chemotherapy.

Chemotherapy is a treatment method that uses chemical drugs to kill tumor cells, inhibit the growth and reproduction of tumor cells, and promote the differentiation of tumor cells. These special drugs can kill tumor cells and are sometimes called cytotoxic drugs. Chemotherapy is a systemic treatment method that has therapeutic effects on primary lesions and metastatic lesions (including subclinical metastatic lesions). However, while chemotherapy kills tumor cells, it will also have a certain killing effect on normal cells and immune (resistance) cells. Chemotherapy kills tumor cells in proportion, which is why chemotherapy requires multiple courses of treatment.

In early-stage lymphoma, the number of tumor cells is small, and the number of residual tumor cells after one killing is small. Therefore, after 4-6 courses of treatment, the tumor cells can be basically completely eliminated. For the same reason, advanced lymphoma requires more courses of treatment. Based on this reason, chemotherapy still cannot completely eliminate tumor cells. This is why radical chemotherapy needs to be combined with radiotherapy and immunotherapy: through a combination of multiple means, it is hoped to completely eliminate the residual tumor.

Some chemotherapy drugs are given as tablets. Others are injected into a muscle or under the skin. Some are given into the spinal cord (intrathecally), but most are given intravenously. Intravenous injections may be given over a few minutes or may be infused over a large volume of fluid over several hours. Several drugs may be given at the same time.

Classification of lymphoma

In my country, Hodgkin's lymphoma accounts for 9%-10% of lymphomas. It is a group of malignant tumors with relatively good treatment effects. It is divided into two categories, with a total of five types, namely four classical Hodgkin's lymphomas and one Hodgkin's lymphoma dominated by nodular lymphocytes. Among classical Hodgkin's lymphomas, nodular sclerosis type and mixed cell type are the most common. The treatment plan is relatively simple and economical, the treatment effect is good, and the long-term survival rate is also relatively high.

Limited-stage (stage I-II, early-stage) Hodgkin's lymphoma can choose a combination of chemotherapy and radiotherapy, or ABDV chemotherapy alone, with a 10-year survival rate of 70%-80%. However, for early-stage patients with more adverse prognostic factors and advanced-stage patients, the BEACOPP regimen is the preferred first-line treatment, and radiotherapy can be combined when necessary, with a 10-year survival rate of 50%-60%.

Nodular lymphocyte-predominant Hodgkin's lymphoma has the best prognosis, with a ten-year survival rate of 95%. Unfortunately, this type of lymphoma is relatively rare, accounting for less than 10% of Hodgkin's lymphoma.

In my country, non-Hodgkin's lymphoma accounts for about 90% of all lymphoma cases, and the incidence rate has increased year by year in the past decade. Non-Hodgkin's lymphoma is divided into two major categories: B-cell type and T/NK-cell type. B-cell lymphoma accounts for about 70%, which is further divided into three major categories: highly aggressive, aggressive, and indolent lymphoma; T/NK-cell lymphoma accounts for about 30%, which is mainly divided into two major categories: highly aggressive and aggressive. With the continuous development of basic and clinical research, the classification of lymphoma is being further refined and improved.

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma, accounting for more than 40%. This is also a group of lymphomas that are expected to be cured. Patients in stage I-II without dangerous prognostic factors can choose the chemotherapy regimen of Rituximab + CHOP for 3-4 cycles, and can be combined with local radiotherapy according to the condition. Those who are not suitable for radiotherapy can undergo 6-8 cycles of chemotherapy.

Patients with stage III-IV and dangerous prognostic factors should undergo 6-8 cycles of chemotherapy. Rituximab is the first immunotherapy drug used in clinical treatment. Although it is expensive, it can increase the treatment efficacy and overall survival rate of diffuse large B-cell lymphoma by 15%-20%. Unlike traditional chemotherapy drugs, it has less toxicity to the blood system and liver and kidney functions. The official application of Rituximab has helped humans realize the dream of targeted treatment of malignant tumors for the first time.

T/NK cell lymphoma is another major category of non-Hodgkin's lymphoma, which includes many types and is more common in my country and other Asian countries. Unfortunately, this type of lymphoma has poor response to existing chemotherapy regimens. However, since there is no therapeutic target of Rituximab on the surface of this type of lymphoma cells, Rituximab cannot be used. Even patients with effective initial treatment are prone to relapse or disease progression. Therefore, most patients in stages III-IV, especially those with multiple adverse prognostic factors, are recommended to continue high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation for consolidation treatment after achieving remission. Some pathologies even require consideration of allogeneic hematopoietic stem cell transplantation.

Despite many intensive treatments, the long-term survival rate of patients with this type of lymphoma is still very low, with a five-year survival rate of less than 30%, making them a "difficult family" in lymphoma treatment. For this reason, many new drugs have been developed in this field in recent years, and many clinical trials are underway. The preliminary results of some new drugs are very encouraging.

Indolent lymphoma is also a major type of non-Hodgkin's lymphoma, including a variety of B-cell and T-cell subtypes. This group of lymphomas develops relatively slowly, and patients can survive with the disease for a long time, and it does not even affect the patient's quality of life. At present, even high-intensity treatment cannot guarantee a cure for this group of lymphomas, and proper observation or low-intensity chemotherapy can prolong the patient's disease-free survival time, allowing the patient to live a more optimistic and closer life to that of a healthy person. Therefore, in the absence of severe symptoms or discomfort and the disease is not progressing rapidly, the treatment time can be appropriately postponed. However, some patients with indolent B-cell lymphoma may develop into an aggressive type of lymphoma, at which time they need active treatment.

Different types of lymphoma have different treatment principles, treatment plans and courses. Even for the same type, different stages, different locations and prognostic conditions, and different ages, the treatment is not exactly the same. The patient's different physical and disease conditions will affect the choice of treatment plan and the adjustment of drug dosage.
Certain cell therapies are not used as routine treatments for lymphoma. Patients undergoing initial treatment should mainly receive regular chemotherapy or radiotherapy. For some relapsed and refractory patients or patients who are not suitable for conventional treatments, they can be selected based on their condition.

author

Jiang Wenqi

Professor, chief physician, and doctoral supervisor at the Affiliated Cancer Hospital of Sun Yat-sen University. Graduated from the Department of Clinical Medicine of Shanghai Medical University in 1982. He has served as the vice president of the Affiliated Cancer Hospital of Sun Yat-sen University, and is currently the director of the Department of Internal Medicine, the director of the Lymphoma Research Center, and the director of the Academic Committee of the National Center for Clinical Trials of New Anti-tumor Drugs. He is currently the deputy secretary-general of the Chinese Anti-Cancer Association, the chairman of the Lymphoma Professional Committee of the Chinese Anti-Cancer Association, the next chairman of the Clinical Tumor Chemotherapy Professional Committee of the Chinese Anti-Cancer Association, the vice president of the Oncology Branch of the Chinese Medical Doctor Association, and the expert in the review of clinical diagnosis and treatment pathways of oncology in the Ministry of Health. His main research directions are the treatment mechanism and clinical application of immunotherapy and molecular targeted therapy for malignant tumors, as well as the research and clinical evaluation of new anti-tumor drugs. He is the editor-in-chief of academic monographs such as "Oncology", "Tumor Biotherapy", "Malignant Lymphoma" and "Oncology Prescription Drug Manual".

This article is excerpted from the popular science series of books of the Chinese Anti-Cancer Association, "How Much Do You Know About Cancer - Lymphoma", which selects the most frequently asked questions by outpatients and inpatients, and provides vivid, concise, accurate and authoritative answers, so that every patient can "have this book in hand and ask for nothing else".

Disclaimer: This article is for disease education purposes and cannot replace hospital visits.

The opinions are for your reference only.

Please consult your attending physician for specific treatment methods.