Treating T-Cell Non-Hodgkin Lymphoma
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2021-01-06
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Treating T-Cell Non-Hodgkin Lymphoma
Non-Hodgkin lymphoma (NHL) is generally divided into main 2 types, based on whether it starts in B lymphocytes (B cells) or T lymphocytes (T cells). There are many different types of T-cell lymphomas, and treatment can vary based on which type you have.
T-lymphoblastic lymphoma/leukemia
This disease can occur in both children and adults, and it can be considered either a lymphoma or a type of acute lymphoblastic leukemia (ALL), depending on how much of the bone marrow is involved. (Leukemias have more bone marrow involvement.)
Regardless of whether it’s labeled as a lymphoma or a leukemia, this is a fast-growing disease that’s treated with intensive chemotherapy (chemo), when possible.
Combinations of many drugs are used. These can include cyclophosphamide, doxorubicin (Adriamycin), vincristine, L-asparaginase, methotrexate, prednisone, and, sometimes, cytarabine (ara-C). Because of the risk of spread to the brain and spinal cord, a chemo drug such as methotrexate is also given into the spinal fluid. Some doctors suggest maintenance chemo for up to 2 years after the initial treatment to reduce the risk of recurrence. High-dose chemo followed by a stem cell transplant may be another option.
Treatment is typically given in the hospital at first. During this time, patients are at risk for tumor lysis syndrome (described in Chemotherapy for Non-Hodgkin Lymphoma), so they are given plenty of fluids and drugs like allopurinol.
For more details on treatment, see Treating Acute Lymphocytic Leukemia (Adults) and Treating Childhood Leukemia.
Although this lymphoma is fast-growing, if it hasn’t spread to the bone marrow when it’s first diagnosed, the chance of cure with chemo is quite good. But it is harder to cure once it has spread to the bone marrow.
Peripheral T-cell lymphomas
Cutaneous T-cell lymphomas (mycosis fungoides, Sezary syndrome, and others)
Treatment of these skin lymphomas is discussed in Treating Lymphoma of the Skin.
Adult T-cell leukemia/lymphoma
This lymphoma is linked to infection with the HTLV-1 virus. There are 4 subtypes, and treatment depends on which subtype you have.
The smoldering and chronic subtypes grow slowly. Like other slow-growing lymphomas (such as follicular lymphoma and small lymphocytic lymphoma), these subtypes are often watched without treatment as long as they aren’t causing problems other than mildly swollen lymph nodes. If treatment is needed, one option is interferon and the anti-viral drug zidovudine to fight the HTLV-1 infection. If the lymphoma is affecting the skin, it may be treated with radiation. Another option is chemo, using the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) or other combinations.
The acute subtype also can be treated with either anti-viral drugs or chemo (typically the CHOP regimen). If it responds well to treatment, a stem cell transplant might be considered.
Non-Hodgkin lymphoma (NHL) is generally divided into main 2 types, based on whether it starts in B lymphocytes (B cells) or T lymphocytes (T cells). There are many different types of T-cell lymphomas, and treatment can vary based on which type you have.
T-lymphoblastic lymphoma/leukemia
This disease can occur in both children and adults, and it can be considered either a lymphoma or a type of acute lymphoblastic leukemia (ALL), depending on how much of the bone marrow is involved. (Leukemias have more bone marrow involvement.)
Regardless of whether it’s labeled as a lymphoma or a leukemia, this is a fast-growing disease that’s treated with intensive chemotherapy (chemo), when possible.
Combinations of many drugs are used. These can include cyclophosphamide, doxorubicin (Adriamycin), vincristine, L-asparaginase, methotrexate, prednisone, and, sometimes, cytarabine (ara-C). Because of the risk of spread to the brain and spinal cord, a chemo drug such as methotrexate is also given into the spinal fluid. Some doctors suggest maintenance chemo for up to 2 years after the initial treatment to reduce the risk of recurrence. High-dose chemo followed by a stem cell transplant may be another option.
Treatment is typically given in the hospital at first. During this time, patients are at risk for tumor lysis syndrome (described in Chemotherapy for Non-Hodgkin Lymphoma), so they are given plenty of fluids and drugs like allopurinol.
For more details on treatment, see Treating Acute Lymphocytic Leukemia (Adults) and Treating Childhood Leukemia.
Although this lymphoma is fast-growing, if it hasn’t spread to the bone marrow when it’s first diagnosed, the chance of cure with chemo is quite good. But it is harder to cure once it has spread to the bone marrow.
Peripheral T-cell lymphomas
Cutaneous T-cell lymphomas (mycosis fungoides, Sezary syndrome, and others)
Treatment of these skin lymphomas is discussed in Treating Lymphoma of the Skin.
Adult T-cell leukemia/lymphoma
This lymphoma is linked to infection with the HTLV-1 virus. There are 4 subtypes, and treatment depends on which subtype you have.
The smoldering and chronic subtypes grow slowly. Like other slow-growing lymphomas (such as follicular lymphoma and small lymphocytic lymphoma), these subtypes are often watched without treatment as long as they aren’t causing problems other than mildly swollen lymph nodes. If treatment is needed, one option is interferon and the anti-viral drug zidovudine to fight the HTLV-1 infection. If the lymphoma is affecting the skin, it may be treated with radiation. Another option is chemo, using the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) or other combinations.
The acute subtype also can be treated with either anti-viral drugs or chemo (typically the CHOP regimen). If it responds well to treatment, a stem cell transplant might be considered.
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