Therapy For Lymphoma

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Therapy For Lymphoma
Therapy For Lymphoma
Video: Therapy For Lymphoma
Video: Hodgkin’s Disease (Lymphoma); Diagnosis & Treatment 2023, February
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Lymphomas: therapy

Lymphomas encompass a large number of sometimes very different clinical pictures. The treatment to consider depends on a number of factors. With a precise diagnosis and consideration of various factors, the best individual therapy option is selected for each patient.

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  • What therapies are there?
  • What after-effects can occur after treatment of a lymphoma?
  • What do tumor board and clinical study mean?
  • Whom can I ask?
  • How are the costs going to be covered?

What therapies are there?

The choice of therapy depends on the type of lymphoma, the stage and course of the disease, as well as individual factors such as age, possible accompanying diseases and the general health of the person affected. The wishes of the patient are also taken into account.

More on the topic: Lymphoma: What is it?

Basically:

  • Hodgkin lymphomas, as well as aggressive non-Hodgkin lymphomas, tend to grow rapidly and continue to spread throughout the body. Therapy must therefore be started quickly after diagnosis.
  • Low-grade non-Hodgkin lymphomas (e.g. multiple myeloma, CLL) do not always need to be treated immediately. It may be possible to wait and then to monitor the progress in regular check-ups (“watch and wait”).
  • Aggressive lymphoma does not automatically mean that there is no chance of a cure. Rapidly growing tumors sometimes respond very well to the treatments and can - depending on the stage of the disease - regress completely.
  • Lymphomas with a low level of malignancy grow only very slowly; the progression of the disease can be stopped with appropriate treatment. However, complete cure is not always possible.
  • In order to get the best possible chance of recovery, several treatment methods are usually combined.

chemotherapy

Chemotherapy is the standard treatment for most forms of lymphoma. Various so-called cytostatics are combined with one another; these are active ingredients that prevent cancer cells from dividing and thus stop the disease from spreading. Chemotherapy is given in the form of tablets or as an infusion into a vein. The treatments take place repeatedly over a specified period (cycle).

Cytostatics are not targeted against cancer cells; they can also damage healthy cells in the body. This leads to different side effects. More on the topic: Cancer: Therapy

In the treatment of lymphomas, chemotherapy is increasingly being supplemented with antibody therapy.

Targeted Therapies

A number of different active substances fall into the group of targeted therapies. What they all have in common is that they target specific structures of the tumor cells and thus fight them. Some intervene in the metabolism of the cells, others block special growth signals, and there are different mechanisms of action. Whether treatment with targeted drugs is an option depends on the characteristics of the lymphoma cells. This is determined by means of modern diagnostic methods and the selection of therapy is adjusted accordingly.

The targeted therapies are used in addition to chemotherapy or radiation therapy, in some cases they can also replace them. The preparations are constantly being further developed and primarily administered in clinical studies, but some active ingredients have already been approved and proven in practice.

Antibody therapy

Antibody therapy is a newer form of immunotherapy. The administered antibodies recognize special surface structures (antigens) of the cancer cells, bind to them and trigger a targeted immune reaction. Use is only possible if the lymphoma cells have the appropriate antigen. One example of such an antibody is the active ingredient rituximab; it is directed against the surface structure CD-20, which is present on numerous tumor cells. Rituximab is used to treat various types of cancer and has also proven itself in the treatment of certain non-Hodgkin lymphomas. Antibody therapy in general is continuously tested in clinical studies.

Antibody therapy can also be carried out in conjunction with radioactive substances (radioimmunotherapy): The antibody that is administered is linked to a radioactive substance and can target it to the tumor cell and thus destroy it.

Immune Checkpoint Inhibitors

This new form of antibody therapy unfolds its effect in the following way: Within the immune system there are not only activating signal pathways (which contribute to triggering an immune reaction), but also inhibiting signal pathways - that is, the immune system is "slowed down" at certain points. As a result, subsequent immune reactions cannot take place. In a healthy body this is used, for example, to prevent autoimmune reactions. The recognition structures at which the immune cells are activated or deactivated are called checkpoints.

Some tumors make use of such checkpoints: by producing special proteins, they help to switch off certain signaling pathways. As a result, the immune system does not recognize the tumor cells as "sick" and cannot fight them. The tumor cells can thus escape the immune system.

This is where new active ingredients come into play: They can also influence certain checkpoints (CTLA-4, PD-1, PD-L1) and reactivate the signaling pathways that are switched off by the tumor cells. This allows the immune system to work again and actively fight the tumor cells.

Such immune checkpoint inhibitors can be used at an advanced stage and when the disease has relapsed - provided that the tumor cells have the appropriate antigen. Examples of active substances in this group are nivolumab, pembrolizumab, ipilimumab and atezolizumab. Some of them are only used in clinical studies; preparations have already been approved for certain patient groups.

New cellular therapies

Another new treatment option is the so-called CAR-T-cell therapy. The patient does not receive any artificially produced active ingredients; Instead, the body's own defense cells are removed, genetically modified in the laboratory and then given again as an infusion. The genetic change causes the immune cells to produce a protein (chimeric antigen receptor against CD19, CAR) that helps them to recognize the tumor cells and to target them against them. The changed immune cells continue to multiply in the body and thus form sustainable protection against the tumor cells.

CAR-T-cell therapy can be used in a special form of non-Hodgkin lymphoma (diffuse large-cell B-cell lymphoma) and in a form of leukemia in children (ALL). For certain patient groups, overall survival could be doubled with this form of therapy in clinical studies. Two active ingredients have now been approved in Europe (Tisagenlecleucel, Axicabtagen-Ciloleucel).

Small molecules

Active ingredients from the group of small molecules have the property that they penetrate the inside of the cell and can develop their effect there. These include, for example, the so-called tyrosine kinase inhibitors. They block an enzyme (tyrosine kinase) that transmits growth signals inside cancer cells. If the kinases are blocked, the tumor cell can no longer grow. An example of such an active ingredient is imantinib; it has been part of the standard therapy for chronic myeloid leukemia for years.

Are also available for some forms of lymphoma Small molecules are available (eg Ibrutinib, Venetoclax) that interfere with signaling pathways within the cell. They are increasingly complementing or replacing chemotherapy. Since they are taken as tablets, treatment can often take place on an outpatient or day clinic basis.

Immunotherapy with cytokines

Cytokines are the body's own messenger substances that support the immune system in fighting diseased cells. These include the various interleukins and interferons. They activate various immune cells and can also inhibit the growth of cancer cells.

Cytokines do not work equally well in all forms of lymphoma and in all patients; in addition, the rate of side effects is relatively high. They therefore increasingly play a subordinate role in the treatment of lymphoma.

radiotherapy

Radiation therapy is also used for some forms of lymphoma. High-energy ionizing rays are aimed at the cancer cells with the aim of destroying them and preventing the disease from progressing. Only the affected parts of the body are irradiated; which these are is determined in the course of diagnostics. The radiation itself is painless and only takes a few minutes; The treatments are repeated over several weeks.

Stem cell transplant

Stem cell transplantation is another treatment option. Here, healthy stem cells are transferred to the patient, with the help of which the blood-forming system can be rebuilt. In the best case scenario, permanent healing can be achieved. The stem cells can either come from a donor (allogeneic stem cell transplantation) or, with the help of special processing, from the person concerned (autologous stem cell transplantation).

Stem cell transplantation is a very intensive treatment that is associated with high-dose chemotherapy and involves various risks. It is not part of the standard therapy for lymphoma and is carried out as part of clinical studies. It is only possible in advanced stages or in the case of relapses. Not all those affected are suitable for this, especially age and general condition play a decisive role. More on the topic: stem cell transplantation.

What after-effects can occur after treatment of a lymphoma?

After the therapy of a lymphoma, different long-term effects can occur - depending on how intensive the treatments are, which preparations are used and which body regions are mainly affected. Under certain circumstances, infertility can occur if the organs in the pelvic area are irradiated. Chemotherapy can also affect fertility. If you wish to have children, options for later family planning should therefore be clarified before starting therapy (e.g. freezing sperm cells or egg cells).

Other possible long-term effects are sensory disturbances in the fingers and feet due to nerve damage (polyneuropathy), impairment of the thyroid function, fluid retention in the tissue (edema) and, in some cases, an increased risk of later cancer. The risk of cardiovascular disease also increases in some cases. The attending physicians provide individual information about which side effects and long-term effects can occur.

What do tumor board and clinical study mean?

Lymphomas are not uniform clinical pictures; numerous factors influence the course and severity. Accordingly, there are no generally applicable treatment strategies for all those affected; which therapy is best in each individual case is determined individually. Therefore, so-called tumor boards are held regularly as part of the care and treatment planning for lymphomas. A tumor board is a kind of conference at which experts from various disciplines work together to determine the best individual treatment strategy for each patient based on the latest scientific findings.

As part of the treatment, lymphoma patients are often recommended to participate in a clinical studyto participate. This term is often fraught with uncertainty. However, participation in such a study does not mean that the treatments are experimental or unsafe; clinical studies enable access to the latest treatment approaches and drugs. The participants are looked after very intensively and closely. Many patients with lymphoma can benefit enormously from this. In particular, if there are risk factors (e.g. certain genetic changes) or if the disease relapses, those affected should be treated in a clinical study. The attending physicians provide individual information on whether participation in a clinical study is possible and how it will proceed.

More on the subject:

  • How are Hodgkin lymphomas treated?
  • How are non-Hodgkin lymphomas treated?

Whom can I ask?

The lymphoma is treated by specialists in internal medicine who specialize in hemato-oncology. It should take place in a specialized center.

A list of oncolgic centers and departments across Austria can be found here.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Rehabilitation & cure
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

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