Lymphoma Treatment Is Changing Fast: What Patients Should Know

Dr. Andrew Ip is a board-certified hematologist and medical oncologist specializing in the treatment of lymphoma. He serves as the Director of Outcomes and Value-Based Research and the Associate Program Director for the Hematology & Medical Oncology Fellowship at the John Theurer Cancer Center.

In an interview with CURE, Ip answered common questions patients may have after a lymphoma diagnosis, including how doctors determine the type of lymphoma, what treatment options are available and how newer therapies are changing care.

CURE: I was just diagnosed with lymphoma. What should I know before starting treatment?

Ip: There are many different types of lymphoma, and some are very aggressive. That means they can put a person's health in danger over a short period of time if they aren't treated.

But I think lymphoma is a great disease to treat because many of the aggressive lymphomas are still curable.

When I meet with a new patient, that's the underlying tone that I try to give them. Yes, lymphoma can be aggressive and life-threatening, but it can also be highly curable.

I know it's a very difficult emotional journey for patients and their families. But in the lymphoma world, there is a very positive light because we have so many effective frontline treatments. Even patients whose lymphoma comes back can sometimes receive treatments with curative potential.

Why is it so important to know exactly what type of lymphoma I have?

Lymphoma isn't one disease. There are more than 70 types of non-Hodgkin lymphoma, and they can behave very differently.

Some lymphomas are aggressive, while others are indolent, or slow-growing. Getting the correct subtype is critical because it helps us determine the right prognosis and recommend the right treatment.

For patients with an indolent lymphoma, the approach can be very different. These lymphomas can often have a very good prognosis, and treatment may focus on controlling the disease and preserving quality of life rather than using highly toxic treatments.

For some chronic lymphomas, such as CLL, we don't even use traditional chemotherapy anymore in many cases. Instead, patients may receive targeted pills that are designed to attack the cancer while avoiding some of the effects associated with chemotherapy.

What are some of the biggest advances in lymphoma treatment?

Immunotherapy has been one of the biggest advances.

We traditionally think about the major pillars of cancer treatment as chemotherapy, radiation and surgery. About 12 or 13 years ago, immunotherapy became what we might call a fourth pillar.

In lymphoma, I think immunotherapy has become one of the strongest pillars over the last five years.

We've traditionally used treatments such as rituximab, which has immunotherapy properties. But now we're using more T-cell-directed therapies, including CAR T-cell therapy and bispecific antibodies.

These treatments are really changing the field.

What is CAR T-cell therapy, and how does it work?

CAR T-cell therapy is a form of treatment that uses the patient's own immune system.

We take T cells from the patient's blood and redesign them so they can recognize and attack cancer cells. We then give those modified T cells back to the patient.

CAR T-cell therapy has been very effective for certain B-cell non-Hodgkin lymphomas. It's particularly important because it has given some patients another potentially curative treatment option, including patients whose lymphoma has returned.

The challenge is that CAR T-cell therapy generally requires treatment at a specialized cancer center, so it isn't necessarily available everywhere.

What are bispecific antibodies, and how are they different from CAR T-cell therapy?

Bispecific antibodies are another type of T-cell immunotherapy. You may hear them called T-cell engagers or bispecific T-cell engagers.

Essentially, they help bring a patient's T cells together with the cancer cells so the immune system can attack the cancer.

One encouraging thing about these treatments is that they can often be given more easily in the community than CAR T-cell therapy. That could make them more accessible to patients who don't live near a specialized center.

We've seen very rapid progress with these therapies over the last several years, and I think we're going to see even more combinations and new ways of delivering T-cell immunotherapies.

What side effects should I expect from lymphoma treatment?

It depends on the treatment.

For patients receiving chemotherapy for aggressive lymphoma, we may see lower blood counts, which can increase the risk of infection. Some patients may need blood or platelet transfusions. Hair loss can also occur with certain chemotherapy regimens, although it is usually temporary.

Fatigue is another very common side effect. I hear about fatigue from patients receiving both chemotherapy and newer immunotherapies.

Immunotherapy has a different set of potential side effects. Because we're activating the immune system, it can sometimes become overactivated.

With CAR T-cell therapy and bispecific antibodies, patients can experience a significant inflammatory reaction. That's why we closely monitor patients, particularly during the first month of treatment.

The good news is that if patients don't experience a significant reaction early in treatment, they often do very well.

How do you decide which treatment is right for each patient?

That's really what I call the “art of medicine.”

There's the science and evidence-based medicine that guides what we recommend. We look at established guidelines and the treatments that have been shown to work.

But we also consider the individual patient and the latest research.

Sometimes there are newer treatments or combinations that are not yet included in treatment guidelines because there can be a six- or 12-month lag between new research and those treatments becoming part of standard guidelines.

Clinical trials are another important part of the conversation. If we have a clinical trial available that may be appropriate for a patient, we discuss it with them.

Trials can provide access to new treatments or combinations that could potentially improve outcomes.

Should I ask my doctor about a clinical trial?

I think clinical trials should at least be presented to patients when an appropriate trial is available.

The field of lymphoma is moving very quickly, and clinical trials give patients an opportunity to receive new treatments or combinations that may eventually become part of standard care.

Of course, whether a clinical trial is appropriate depends on the individual patient's lymphoma, previous treatments and overall situation.

What gives you hope for people living with lymphoma?

The lymphoma community is relatively small, but it's a very vibrant and strong community because we have so many survivors.

My message to patients and their loved ones is that we will continue to cure lymphoma and treat lymphoma.

It's a small but very close and growing community.

And I think that's something important for patients to remember: there are more survivors, more treatment options and more advances still coming.

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