Part II: Treating Lymphoma
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UV part ii Treating Lymphoma WhIle chemotherapy and radIatIon therapy continue to be mainstays of lymphoma treatment, more selective “magic bullet” approaches—particularly those involving antibodies directed against proteins found on lymphoma cells—have become frequent components of lymphoma therapy as well. Surgery is a rare option in some forms of lymphoma , and stem cell transplants are becoming more common. The choice of treatment depends on such factors as the type of lymphoma you have, the extent of disease, the presence or absence of painful or dangerous symptoms , and your overall condition. In Chapters 3, 4, 5, and 6, I describe, in turn, the different conventional approaches to lymphoma therapy, both treatments in common use and experimental treatments. Chapter 3 describes how chemotherapy works, some of the regimens used in treating the different kinds of lymphoma, and specific drugs. Chapter 4 addresses radiation therapy and surgery, Chapter 5 covers the newer, more selective therapies such as monoclonal antibodies and “targeted” drugs, and Chapter 6 describes the procedures involved in undergoing a stem cell transplant. Since many people are interested in nontraditional therapies, I discuss these approaches as well, in Chapter 7. Finally, Chapter 8 discusses some of the more common late effects of treatment that may be experienced by long-term survivors. These chapters will give you an idea of what to expect from treatment and how to cope with some of the side effects. These U 62 Treating Lymphoma chapters will not tell you which therapy is right for you. Every person with lymphoma is unique, and only an oncologist or hematologist who is familiar with a person’s case can determine the optimal treatment for that individual. Only a physician on the scene can establish what’s best for you. However, the information in these six chapters will help you speak knowledgeably with your physician about your choices. GENERAL APPROACHES Localized Hodgkin lymphoma without B symptoms (Stage I and contiguous Stage II—which means that the affected lymph nodes are in contact with each other) and localized indolent NHL are sometimes treated with radiation alone. Before chemotherapy, radiation was used to treat most lymphoma . Radiation can be delivered precisely to a defined location, such as the chest, while chemotherapy is systemic—it goes everywhere and can affect every tissue in the body. Because of this, radiation was initially viewed as “milder” than chemotherapy in terms of overall effects on health. When it first became apparent that both localized Hodgkin lymphoma and localized indolent lymphoma were sometimes curable with radiation alone and that chemotherapy could be administered later, in the event of a relapse, treating localized disease with radiation had more appeal than using chemotherapy, since doctors and, especially, patients are concerned with minimizing the chances of dangerous or unpleasant complications of treatment. As concerns started to surface about the long-term effects of radiation on Hodgkin’s survivors, however, physicians began to incorporate chemotherapy into the treatment of localized Hodgkin lymphoma, since this allowed them to reduce the amount of radiation required to effectively treat the disease. Thus, except for the lymphocyte-predominant form of the disease, localized Hodgkin lymphoma is now most commonly treated with a combination of radiation and chemotherapy. As more effective and less toxic chemotherapy regimens are developed, the approach to treating localized Hodgkin lymphoma may well shift toward chemotherapy and away from radiation. Most aggressive non-Hodgkin lymphomas are treated with chemotherapy from the start. As with localized Hodgkin lymphoma, chemotherapy and radiation may be used together; in this case, radiation is given to affected areas (if you have localized disease) or to areas of bulky disease (if you have generalized disease with a specific cancer “hot spot” that involves a large tumor). Chemotherapy may also be given in combination with antibodies. The com- Treating Lymphoma 63 V bination of different forms of treatment—such as chemotherapy and radiation or chemotherapy and antibodies—is frequently called “combined modality therapy.” Although it is convenient to discuss the different forms of treatment separately, many people with lymphoma are treated with such combined modality approaches; indeed, I was treated with all three of the modalities now in common use (chemotherapy, radiation, and antibodies). Advanced Hodgkin lymphoma (some Stage II, most Stage III, all Stage IV, and B symptoms at any stage) is generally treated with chemotherapy as well, sometimes in combination with radiation. With the possible exception of aggressive therapies involving bone marrow transplants or peripheral stem cell transplants, no therapy currently available has been demonstrated...


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