What Is Combination Therapy for Lymphoma?

There are many different ways to treat lymphoma. Your doctor will talk with you about the options that are best for you. They may include treatments like radiation, chemo, immunotherapy, and targeted therapy.

Combination therapy is when you get more than one kind of treatment that kills cancer cells. Research shows that combining cancer treatments works better than using just one to treat most types of lymphoma. You may get these different treatments at the same time, in a certain order, or within certain time frames. The goal is to kill more cancer cells and give you the best chance of staying cancer-free.

Is Combination Therapy Better?

Different kinds of treatments and different kinds of drugs attack and kill cancer cells in different ways. For instance, some treatments kill the cells directly, some keep them from multiplying, while others help the immune system find and destroy them. Combining treatments allows you to get different “modes of attack” so that more lymphoma cells are destroyed.

Some treatments also work better when you get them together. For instance, steroids help some chemo drugs work better, compared with when the chemo is given alone.

Sometimes, lymphoma becomes resistant to treatment, much the same way that germs can become resistant to antibiotics. Another plus of combination therapy is that using treatments that attack the lymphoma in different ways helps cut your chance of this.

How It Works for Lymphoma

There are different ways that doctors can use combination therapy against your lymphoma.

Drug combinations: You will likely get chemotherapy. It’s a common treatment for most kinds of lymphoma. Your doctor will probably want to give you a combination of different chemo drugs.

Different drugs attack lymphoma cells at different phases or stages. For instance, some drugs damage the DNA in cancer cells so they can’t divide and grow. Other drugs attach to certain proteins on cancer cells that tell the cells to grow and divide. Blocking these proteins stops the production of new lymphoma cells. Lymphoma cells grow constantly and quickly. Attacking them at different points in this process leads to more cancer cell death.

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Doctors often refer to drug combinations by the initials for the drugs. For instance, a common combination used for non-Hodgkin's lymphoma is called CHOP. It stands for these drugs:

  • Cyclophosphamide
  • Hydroxydaunorubicin (also called doxorubicin)
  • Oncovin (also called vincristine)
  • Prednisone

The first three drugs are chemo, and prednisone is a steroid. They work together, and each kills lymphoma cells in different ways.

Some people also get an immunotherapy drug called rituximab, too. Then the combination is called R-CHOP. Rituximab targets and kills the lymphoma cells in yet another way to kill as many as possible.

Many different kinds of drugs can be combined to treat lymphoma. You might get a combination of chemo drugs. Or a steroid, immunotherapy, or targeted therapy drug might be part of your treatment plan.

Combining types of treatment: For some kinds of lymphoma, it's best to use two different kinds of cancer treatment. The goal of combining these approaches is to destroy lymphoma cells while limiting damage to your healthy cells and tissues. Most people with lymphoma need more than one approach to do this.

You might get chemo and radiation. First, you get chemo, maybe along with an immunotherapy drug. Then you get radiation to the affected lymph nodes. This way you get “systemic” treatment, the chemo and immunotherapy, that travels through your blood to kill lymphoma cells throughout your body. You also get radiation treatment that’s aimed right the collections of lymphoma cells in your lymph nodes. This combination has been shown to be better than either chemo or radiation alone for many types of lymphomas.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on May 19, 2018

Sources

SOURCES:

National Cancer Institute: “Seer Training Modules, Combination Treatments,” “Adult Non-Hodgkin Lymphoma Treatment (PDQ) -- Patient Version.”

Merck Manual: “Professional Version, Modalities of Cancer Therapy.”

Chemoth.com: “Combination Chemotherapy - Medicine’s Attempt to Beat Darwin.”

American Cancer Society: “How Chemotherapy Drugs Work,” “What Is Targeted Cancer Therapy?”

Leukemia and Lymphoma Society: “Non-Hodgkin Lymphoma Chemotherapy and Drug Therapy.”

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines): “B-Cell Lymphomas Version 2.2018 -- April 13, 2018,” “Hodgkin Lymphoma Version 3.2018 -- April 16, 2018.”

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