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Understanding Treatments

Each person responds differently to treatment, as does each lymphoma type. Predicting response to treatment depends on many variables, including the exact type, stage and grade of lymphoma.

What can I expect from my treatment?

Hodgkin lymphoma is one of the most treatable types of lymphoma, especially if it is treated in early stage disease. Diffuse large B-cell lymphoma, a type of aggressive (fast-growing) NHL, is curable in 80% of people when the disease is localised to one area of the body. Follicular lymphoma, a type of indolent (slow-growing) NHL, is usually spread throughout the body upon diagnosis and can remain dormant for years or decades with little or no treatment. Follicular lymphoma is responsive to treatment and will often go into remission (cancer-free period) for a period of time following treatment; however, it often relapses.

Factors other than the lymphoma type, stage and grade can affect the success of treatment. Some of these are outlined in the following table:

 Treatment Options

Variable Definition Response Expected

Age

Whether a person is older or younger than 60 years of age

Younger people (younger than 60 years old) typically show better responses to treatment. Older people often cannot tolerate side effects and less aggressive treatments are occasionally chosen

Prior Therapy

Any previous cancer treatment the person has received

People who have had fewer previous cancer treatments are usually more responsive to new treatments

Performance Status

A term describing how well a person is able to perform daily tasks and activities

The better the performance status the more likely a person will successfully tolerate and respond to treatment

Blood Proteins

Proteins present in the blood that can be predictors of disease. For example, important blood proteins in NHL are lactate dehydrogenase (LDH) and beta 2  microglobulin (B2M), both of which indicate aggressive disease if present at high levels

People with normal levels of LDH or B2M tend to respond better to treatment compared with people with higher levels

 Extranodal Disease

A term describing lymphoma that has spread outside of the lymphatic system 

People whose lymphoma is contained within the lymphatic system typically show a better response to treatment

 Bulky Disease

Any lymphoma tumour that is greater than 10 cm in diameter 

The presence of bulky disease can indicate a more advanced stage of lymphoma. Smaller tumours often respond better to therapy than larger ones 

 Stage of Disease

The extent to which the cancer has spread in the body. The lymphoma stages are: stages 1 and 2 (involving a limited area) and stages 3 and 4 (advanced, more widespread involvement) 

People with stage 1 and 2 (limited stage) lymphoma usually have a better chance of a successful response to treatment 

Prognosis

Is a term used when predicting how a disease will likely progress after diagnosis and treatment. It refers to the outcome of the disease and the likelihood of recovery for that person. The prognosis given to you from your doctor is based on statistical research from hundreds or thousands of people who had the same type of cancer and other variables similar to yours. However, it is important to keep in mind that the prognosis is a prediction and does not always accurately reflect the course of disease for each person.

Doctors talk about results of treatment using certain terms that you may want to become familiar with. These are included in the glossary for easy reference but are also described here.

Primary therapy

  • Also called induction therapy. The first treatment given after a person is diagnosed with cancer. 

Treatment cycle

  • A term used to describe the administering of treatment (sometimes called a treatment round). It includes the duration of time the treatment is given and the rest period for the person to recover. For example, a treatment cycle may involve a combination of chemotherapy and the biologic therapy MabThera® given over one week, with three weeks of rest. This 4 week treatment cycle may be repeated 4, 6 or 8 times (i.e. over 4, 6 or 8 months).

Complete remission

  • Also called complete response. A term which means that all signs of the cancer have disappeared following treatment. 
    Partial remission: Also called partial response. The term used when a cancer has decreased in size by half or more but has not been completely eliminated. The cancer is still detectable and more treatment may be necessary.  

Improvement

  • The tumour size has decreased but is still larger than half of its original size.

Cure

  • The term used when no signs or symptoms of the disease have been present for a certain period of time and the tumour has been eradicated. The longer a person is in remission (absence of signs or symptoms of cancer), the higher the likelihood of a cure.

Stable disease

  • The cancer does not get better or worse following treatment. 

Refractory disease

  • A cancer that does not respond to treatment.

Disease progression

  • A worsening of the disease despite treatment. The term is often used interchangeably with the term treatment failure. 

Relapse

  • The return of cancer after a period of improvement. Lymphoma may recur in the same area as the original tumour or in another body area.

Remission

  • A person is said to be in remission if the tumour has diminished in size by half or more (partial remission) or is undetectable (complete remission). For some types of lymphoma, for example an aggressive lymphoma, a remission period of five or more years may be considered a cured. However, remission does not always imply that the cancer has been cured - indolent lymphomas are not commonly considered cured because these cancers can relapse even after a long period of remission.

Are there new treatments being developed?

Lymphoma is a very active area of research and many new treatments and combinations of existing treatments are being tested all the time. The goal of this research is to:

  • Find more effective treatments for lymphoma
  • Decrease the side effects of lymphoma treatments, including both short- and long-term toxicities
  • Find more effective ways of administering treatment.

Significant advances have been made and continue to be made in lymphoma treatment. New medicines are being developed whilst existing therapies are being used in different ways. The introduction of maintenance therapy in the treatment of indolent lymphoma, using the biologic therapy MabThera® (rituximab), represents a proactive approach to prevent remission rather than waiting for the disease to relapse. New hope for lymphoma is always on the horizon.

Useful Questions to Ask Before Receiving Cancer Treatment

As someone with lymphoma you have the right to take an active role in your treatment decisions. Here is a list of questions you can ask your doctor to aid in your understanding of your unique treatment plan:

  • How my type of lymphoma is normally treated?
  • What are the other options for treating my type of lymphoma?
  • Which treatment(s) do you recommend for me? Which ones have you had the most success with?
  • What results can I expect from treatment?
  • How long will my treatment last?
  • What are the chances that the treatment will be successful?
  • How long will the effects of treatment last?
  • Would it be appropriate for me to participate in a clinical trial for a new treatment?
  • What side effects can I expect from the treatment? How are they managed?
  • Will my ability to conduct my daily activities be affected? If so, for how long?
  • How much experience do you have in treating my type of lymphoma?