- Lymphoma affects the lymphatic system, the network of vessels and nodes that carry infection-fighting white blood cells, called lymphocytes, throughout the body. It ranks as the most common blood cancer and third most common childhood cancer.
- Lymphomas are generally classified as Hodgkin's lymphomas (formerly known as Hodgkin's disease) or non-Hodgkin's lymphomas. In both types of cancer, the lymphatic cells begin to grow abnormally, producing lymph nodes that are larger than normal.
- Hodgkin's lymphoma follows a more predictable pattern than non-Hodgkin's lymphoma and often has a more limited spread. Non-Hodgkin's lymphomas are more likely to involve many different areas of the body.
- Some lymphomas are highly curable (e.g. Hodgkin's lymphoma, diffuse large B-cell lymphoma) with standard chemotherapy and antibody treatments, which can be given without a hospital stay and are only minimally toxic. Other types of lymphomas can be managed effectively for many years with mild treatments but tend to recur repeatedly with traditional therapies.
Key Research From the Fred Hutchinson Research Center:
This lymphoma program includes nationally prominent clinician researchers who have helped craft the National Cancer Center Network treatment guidelines for malignant lymphomas, including Oliver Press, David Maloney, Dr. Ajay Gopal, Stephen Petersdorf, John Pagel, and Andrei Shustov. They are experts in establishing the correct diagnosis of lymphoma, determining the extent of involvement of the disease, and recommending the best treatment program.
Their investigators are active participants in many nationwide and international clinical trials that are developing promising new therapies for lymphomas. Among the treatment approaches being investigated are new chemotherapy drugs; new biologic agents; new monoclonal antibodies, which bind to cancer cell-specific antigens and launch a targeted attack against cancer cells; radiolabeled monoclonal antibodies, which can deliver radiation specifically to cancer sites; and new methods of stem cell transplantation.
Developing less-toxic therapies for non-Hodgkin's lymphoma
Dr. Ajay Gopal and colleagues have discovered new ways to tailor treatment for non-Hodgkin's lymphoma, particularly in older people, so that it’s gentler on healthy organs.
By working with radioactively tagged antibodies, proteins that can be created to bind to a certain specific substance — in this case, tumors — physicians were able to deliver very high doses of radiation to tumor sites while sparing the surrounding organs. More traditional treatments like total-body irradiation or high-dose chemotherapy target healthy cells as well as tumor cells, so researchers believe the targeted approach would be a safer and more effective treatment for older people.
Measuring quality of life after stem-cell transplantation
Many patients who undergo bone-marrow or stem-cell transplantation face a decline in mental skill and physical coordination after treatment, but studies by Karen Syrjala and colleagues have shown that these effects are largely temporary. A more recent analysis shows that most patients show even further improvement in brain function between one and five years after transplant.
One study concluded that most patients can expect a return to normal function within a year of their transplant. Another study found that survivors of stem-cell transplantation for blood cancers like lymphoma can expect to be just about as healthy 10 years later as adults who have never had a transplant. It is, however, very important for transplant survivors to get regular primary care and health monitoring in the years after a transplant.
Using the immune system to boost treatment
Drs. Oliver Press, Stanley Riddell and Phil Greenberg are leading research about treatment of lymphomas through an approach known as adoptive T-cell immunotherapy. This method involves a form of gene therapy in which a patient's own immune cells, called T lymphocytes, are modified by inserting a gene that allows the T lymphocytes to recognize and kill the patient's lymphoma.
Press and colleagues have also developed a therapy for follicular lymphoma, a slow-growing form of non-Hodgkin's lymphoma that is usually at an advanced, incurable stage when diagnosed. The treatment consists of six cycles of a popular four-drug chemotherapy regimen for lymphoma, followed by treatment with Bexxar, the trade name for a radioactively-tagged antibody, to destroy cancerous cells.
Pioneering transplantation treatments for blood cancers
Our researchers have pioneered and perfected many of the most significant treatments for lymphoma, leukemia and other life-threatening blood diseases. One of the Hutchinson Center’s founders, Dr. E. Donnall Thomas, won the Nobel Prize in 1990 for his groundbreaking work in bone-marrow transplantation, one of the greatest success stories in cancer treatment.
- Another major breakthrough came near the turn of the 21st century, when Dr. Rainer Storb and colleagues invented a radically different approach to bone-marrow transplantation that offers hope for older or otherwise medically unfit blood-cancer patients whose bodies cannot withstand the rigors of a conventional transplant.
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Unlike traditional bone-marrow transplants, this reduced-intensity treatment – sometimes called the "mini transplant" or non-myeloablative stem-cell transplant – does not wipe out bone marrow and involves minimal doses of radiation. That means patients do not lose their hair or experience severe nausea or other side effects, and the procedure typically can be performed hospital stay.
- A study by Dr. Marco Mielcarek and colleagues found that lymphoma, leukemia and other blood-cancer patients who underwent mini transplants experienced similar outcomes regardless of whether they received stem cells from a tissue-matched relative or an unrelated donor. The finding was significant because historically, researchers had observed a link between conventional bone-marrow transplants from unrelated donors and decreased overall survival rates for those patients. Furthermore, only about 30 percent of blood-cancer patients who might benefit from stem-cell transplants have a tissue-matched relative.
Helping to advance new drugs
Our researchers pioneered use of an antibody to target treatment for some forms of non-Hodgkin's lymphoma. Work by Dr. David Maloney was instrumental in the development of Rituximab, the first medication of its kind approved in the United States for the treatment of malignant disease—and the one of the world’s best-selling anticancer drugs. About half of patients treated with this drug, who typically have slow-progressing lymphomas, see their cancers go into remission, but most will eventually relapse, and the drug does cause side effects. Since then, our researchers have been testing combination therapies that mix other chemotherapy agents with Rituximab.
*Fred Hutchinson Cancer Research Center www.frchc.org
