MD Anderson is committed to helping people with non-Hodgkin lymphoma live longer, healthier lives – and we’re making great strides toward advanced therapies that minimize side effects.
Our Lymphoma and Myeloma Center has shaped the way lymphoma and myeloma are treated throughout the world.
We were leaders in many of the clinical trials that led to the treatments that are commonly used in lymphoma. The clinical trials that our group lead now may provide early access to treatments that eventually become the best new treatments for tomorrow.
We have found the most successful way to treat indolent (slow-growing) Non-Hodgkin lymphoma often is with strategies that limit or avoid the use of chemotherapy and have less impact on your body.
If you are diagnosed with non-Hodgkin lymphoma, your doctor will discuss the best options to treat it. This depends on several factors, including:
- Type of lymphoma
- Stage and category of disease
- Your age and general health
Every lymphoma is different. There are over 60 different types of lymphoma and each one should be treated in slightly different ways. Every patient is different. Our experts focus only on taking care of patients with lymphoma. Your treatment for non-Hodgkin lymphoma cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Chemotherapy kills fast-growing cells, including cancer cells. This is the treatment most often used for non-Hodgkin lymphoma. And since chemotherapy may lower certain types of blood cells, a transfusion of a type of drug called blood cell growth factors may be needed. Liposomal drug delivery is an advanced way of giving chemotherapy that may help it be more effective.
Radiation therapy uses focused beams of energy to kill cancer cells. Radiation therapy may be used in early-stage lymphoma or to help symptoms such as pain. It is seldom the only treatment given.
Proton therapy delivers high radiation doses directly to the tumor site, with minimal damage to nearby healthy tissue. For some patients, this therapy results in better cancer control with fewer side effects.
The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Instead of attacking the disease itself, immunotherapy drugs help the body fight cancer. Sometimes they have fewer side effects than other treatments.
Immunotherapy for Non-Hodgkin lymphoma may include:
- Chimeric Antigen Receptor (CAR) T-cell therapy
- Monoclonal antibodies including rituximab
- Biological therapies that develop antibodies to help the body fight the cancer
- Immune modulators, such lenalidomide, that modify the environment of the tumor cell and allow the immune system to kill the cancer
- Targeted therapies that attack cancer cells by using small molecules to block pathways cells used to survive and multiply
- Small molecule treatments
Stem cell transplantation: If non-Hodgkin lymphoma does not respond to chemotherapy or if it returns, your doctor may recommend a stem cell transplant. A stem cell transplant is a procedure that replaces defective or damaged cells in patients whose normal blood cells have been affected by cancer. Also, since chemotherapy often destroys healthy cells in the blood and bone marrow, patients who have certain types of chemotherapy may need stem cell transplants.
Watchful waiting: This approach involves closely monitoring non-Hodgkin lymphoma without active treatment. Sometimes this is appropriate for some patients with low-grade lymphomas.
After completing a course of treatment, there are few words that sound better to a patient than “complete remission.” It’s an indication that the treatment has worked, and there is no evidence of cancer based on scans or lab tests.
However, there is a different phrase that can be somewhat confusing to patients – minimal residual disease (MRD). This term is used often by physicians when treating patients with blood cancers, such as leukemia, lymphoma or multiple myeloma.
MRD refers to cancer cells remaining after treatment that can’t be detected by those same scans or tests. But what exactly does it mean for patients?
To learn more about minimal residual disease, we spoke with leukemia specialist Ghayas Issa, M.D., of MD Anderson’s Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML) Moon Shot® team. Here’s what he shared.
How do you explain minimal residual disease to patients?
Minimal residual disease is a small number of cancer cells left in the body after treatment. These cells have the potential to come back and cause relapse in our patients.
In leukemia, for example, we look for response after chemotherapy treatment by looking under the microscope for cancer cells present in a bone marrow biopsy. When there are no cancer cells present, and the bone marrow is making normal cells, we call that a complete response.
However, we know that if we don’t do further treatment, a portion of these patients will experience a relapse. That means there were some leukemia cells hiding that we weren’t able to detect under the microscope. That is minimal residual disease, or perhaps a better term is measurable residual disease. Typically, these cells don’t cause any symptoms, but they have the potential to lead to a relapse.
If we can’t detect minimal residual disease under the microscope, how do we test for it?
We now have much more sensitive assays available to us that allow us to quantify MRD. These could include next generation genetic sequencing, where we can analyze bone marrow samples for genetic mutations. If there are mutations present, that means there is minimal residual disease, even though we can’t see anything under the microscope.
We can also use a technique called flow cytometry, which allows us look in the same samples for abnormal proteins on the surface of cells. By determining how many cells have abnormal proteins detected, we can get a better sense of residual cancer cells. Using these new assays, we routinely try to quantify whether a patient has MRD following standard treatment.
What are the implications for a patient who has evidence of minimal residual disease after treatment?
That’s difficult to say, because it’s not the same across all types of blood cancers. Some patients with MRD will have different responses than others. In general, if a patient has MRD, we need to do additional treatments to work toward the best outcome. If we do nothing, we know that the residual cells will cause a relapse.
It also depends on the timing of the MRD test. In my leukemia patients, if there is MRD after the first cycle of chemotherapy treatment, it tells me that I probably need to give more treatment — either a different medication or a different course of treatment. If there is still MRD after many rounds of chemotherapy, that is an indication that the patient may need to have a stem cell transplant, when otherwise it might not have been appropriate.
Ultimately, MRD is a marker that we need to be more aggressive in our treatment to try and prevent the cells from coming back.
What can cancer researchers learn from the residual cancer cells?
We can learn a great deal. These cancers can adapt to treatment, meaning the cancer we start with is not the same as what we have after treatment. By studying the minimal residual disease, we can learn more about what is left after treatment.
That helps us to do several things. First, it allows us to modify our treatment, either by adding medications that target specific vulnerabilities in the cancer cells, including medications that are especially good at killing even residual cells, or doing a stem cell transplant, which is able to take care of residual cells.
Currently, I work with a wonderful team through the MDS and AML Moon Shot to study these residual cancer cells in order to find new vulnerabilities. Through our research, we’re hoping to identify new treatments that we can use in the future to specifically eliminate minimal residual disease.
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