Treatments for B-Cell Lymphoma

You have several treatment options if you have B-cell lymphoma. Your doctor will go over the choices, including chemotherapy, radiation, and immunotherapy.

Which treatment you and your doctor pick depends on:

  • The type of B-cell lymphoma you have
  • How fast it's growing
  • Where the cancer is found in your body
  • Your symptoms
  • Your age
  • Your overall health

With treatment, many people with B-cell lymphoma can go into remission, which means there are no signs of cancer left in your body.

Watch and Wait

If your lymphoma isn't widespread, doesn't cause any symptoms, or isn’t a risk to your health, you may not need to be treated right away. This approach is called "watch and wait."

Your doctor will monitor your cancer with regular checkups and tests. He may recommend starting treatment if there are signs your cancer is growing.

The advantage is that you avoid side effects that often go along with treatments like chemotherapy and radiation. Yet there is a slight risk your cancer could start to grow during this time. Your doctor will help you weigh the pros and cons of watch and wait.

Chemotherapy

Chemotherapy is the main way to treat most types of B-cell lymphoma. You can get this on its own, or combine it with radiation or immunotherapy.

Chemo uses drugs to kill fast-dividing cells in your body, including cancer cells. You get this medicine through a vein (IV), or you take it as a pill by mouth. If cancer has spread to your brain and spinal cord, chemo is put into the cerebral spinal fluid (CSF).

One of the most common chemotherapy routines for B-cell lymphoma is called CHOP. It takes that name from the first letter of the four drugs you take:

  • Cyclophosphamide (Cytoxan)
  • Hydroxydaunorubicin (Doxorubicin)
  • Vincristine (Oncovin)
  • Prednisone

Sometimes the immunotherapy drug rituximab (Rituxan) is added to chemotherapy. This combo is called R-CHOP.

Another common treatment is called CVP. You'll take these drugs:

  • Cyclophosphamide
  • Vincristine
  • Prednisone

There are several other chemotherapy drugs that you may get, depending on the type and stage of your disease

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You'll get chemotherapy in cycles. First you take a drug for a few days, and then you don't take any medicine for a few days to let your body recover.

There are side effects of chemotherapy, such as:

  • Hair loss
  • Nausea and vomiting
  • Diarrhea or constipation
  • Mouth sores
  • Increased risk of infection
  • Tiredness
  • Loss of appetite
  • Bleeding or bruising more than normal

Talk to your doctor about how to manage these problems if they happen to you.

Radiation Therapy

Radiation uses high-energy beams to kill cancer cells. It's sometimes the main treatment for early-stage B-cell lymphoma. Your doctor may suggest you combine it with chemotherapy or other treatments.

A machine delivers the radiation to the part of your body that's being treated. You often get radiation therapy for 5 days in a row for a few weeks.

You may have some side effects, such as:

  • Redness, irritation, and blisters on the skin in the treated area
  • Tiredness
  • Nausea
  • Diarrhea
  • Greater chance of infections if you get radiation after chemo
  • Dry mouth and mouth sores if you get radiation to the head or neck

 

Immunotherapy

Immunotherapy boosts the immune system -- your body's defense against germs -- to help fight the cancer. Doctors use monoclonal antibodies, a type of immunotherapy drug, to treat B-cell lymphoma.

Antibodies are proteins your body makes to fight infections. Monoclonal antibodies bind to substances on cancer cells and can alert your immune system to:

  • Attack or kill cancer cells
  • Help chemotherapy attack cancer cells
  • Slow the growth of cancer cells

You get these medicines through an IV or as a shot. You can get immunotherapy by itself or together with chemotherapy.

A few monoclonal antibody drugs treat different types of B-cell lymphoma:

  • Alemtuzumab (Campath) for small lymphocytic lymphoma (SLL)/chronic lymphocytic leukemia (CLL)
  • Obinutuzumab (Gazyva) for SLL/CLL and follicular lymphoma
  • Ofatumumab (Arzerra) for SLL/CLL that doesn't improve with other treatments
  • Rituximab (Rituxan) for diffuse large B-cell lymphoma (DLBCL), marginal zone B-cell lymphoma, and follicular lymphoma

You may get side effects from immunotherapy, including things like:

  • Itching and redness of the skin near the injection site
  • Fever and chills
  • Nausea
  • Tiredness
  • Headaches
  • Greater chance of infection

 

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CAR T-Cell Therapy

This is a new therapy that treats your cancer by using your own immune system cells. Your doctor removes infection-fighting T cells from you and sends them to a lab, where technicians genetically engineer them to make a chimeric antigen receptor (CAR). CARs seek proteins on the surface of cancer cells and attach to them.

The technicians grow large numbers of these engineered T cells, your doctor puts them back into you through an IV, and they find and kill cancer cells.

The FDA recently approved a CAR T-cell therapy for advanced lymphoma called axicabtagene ciloleucel (Yescarta). Doctors use it if your cancer is still growing after getting two other treatments. Your doctor might suggest it if you have one of these lymphomas:

  • Diffuse large B-cell lymphoma (DLBCL)
  • Primary mediastinal large B-cell lymphoma
  • High-grade B-cell lymphoma
  • Transformed follicular lymphoma

One potential side effect of axicabtagene ciloleucel is a condition called cytokine release syndrome (CRS). If you get CRS, you could have symptoms like:

  • Fever
  • Nausea
  • Headache
  • Rash
  • Fast heartbeat
  • Low blood pressure
  • Breathing problems

If you have a severe case of CRS, it could be life-threatening. If that happens, your doctor may treat you with tocilizumab (Actemra) or a combination of that drug and corticosteroids.

Targeted Therapy Drugs

These medications zero in on changes in your cancer cells that help them grow. You get the drugs through an IV infusion, injection under the skin, or you take them by mouth.

Your doctor might recommend a targeted drug if you've tried one or more other treatments and they haven't stopped your cancer from growing.

Targeted therapy drugs for B-cell lymphoma include:

  • Copanlisib (Aliqopa) for follicular lymphoma that has come back after treatment
  • Ibrutinib (Imbruvica) for mantle cell lymphoma, marginal zone lymphoma, and SLL
  • Idelalisib (Zydelig) for follicular lymphoma and SLL
  • Acalabrutinib (Calquence) for mantle cell lymphoma
  • Bortezomib (Velcade) for mantle cell lymphoma

Side effects of targeted drugs include:

  • Nausea and vomiting
  • Diarrhea or constipation
  • Fatigue
  • Less of an appetite

 

Stem Cell Transplant

Stem cell transplants allow doctors to use higher doses of chemotherapy. The higher doses kill cancer cells, but they also kill stem cells in your bone marrow. For some people, this treatment offers the best chance of a cure.

First you'll get very high doses of chemotherapy to kill as many cancer cells as possible. Chemotherapy damages blood-forming cells in bone marrow. So after you get this treatment, your doctor will give you a transplant of stem cells to replace the ones chemotherapy destroyed.

WebMD Medical Reference Reviewed by Louise Chang, MD on June 09, 2018

Sources

SOURCES:

American Cancer Society: "Chemotherapy for Non-Hodgkin Lymphoma," "High-Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin Lymphoma," "Immunotherapy for Non-Hodgkin Lymphoma," "Radiation Therapy for Non-Hodgkin Lymphoma," "Targeted Therapy Drugs for Non-Hodgkin Lymphoma," "Treating B-Cell Non-Hodgkin Lymphoma."

Leukemia & Lymphoma Society: "Watch and Wait."

Lymphoma Research Foundation: "Diffuse Large B-Cell Lymphoma: Treatment Options."

UpToDate: "Patient education: Diffuse large B cell lymphoma in adults (Beyond the Basics)," "Patient education: Follicular lymphoma in adults (Beyond the Basics)," "Treatment of relapsed or refractory diffuse large B cell lymphoma."

National Cancer Institute: "With FDA Approval for Advanced Lymphoma, Second CAR T-Cell Therapy Moves to the Clinic."

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