- NHL Treatment
- Hodgkin's Treatment
- Clinical Trials
- Monoclonal Antibodies
In a perfect world, every case of cancer would respond to, and be cured by, first-line therapy. Unfortunately it is not often the case. This is especially true in lymphomas.
Although we often see the term "Relapsed/Refractory Lymphoma", there is a difference between a relapsed cancer and a refractory one.
Despite the enormous amount of research that has gone into the causes, symptoms, and treatments of lymphomas, science can not currently say why any one patient will relapse or why his or her cancer will prove refractory.
At best, research has been able to identify certain prognostic indicators that help determine whether that patient's lymphoma may relapse. These indices are traditionally used to determine initial prognosis against first-line treatment, but can also be used to help determine risk of relapse.
In general, relapsed or refractory Hodgkins lymphoma has a much better prognosis, and is considered significantly more treatable and curable, than relapsed or refractory non-Hodgkins lymphomas—regardless of the treatment modality involved.
When it does happen, the treatments for relapsed or refractory disease are variable, and which one each patient receives depends on certain factors, such as:
Second-line therapies generally involve some form of more intense chemotherapy. The term 'salvage therapy' is often used to dennote therapy that follows on the heels of a prior therapy that has failed.
Salvage chemotherapy regimens for relapsed or refractory Hodgkins lymphoma include MOPP, ChlIVPP, CBVD, PCVP, CEVD, CAPE / PALE and Dexa-BEAM.
Salvage chemotherapy regimens given prior to an allogenic or autologuos bone marrow transplantation for relapsed or refractory Hodgkins lymphoma include ASHAP, Mini-BEAM, High-dose Melphalan, and CBV.
Second-line therapies for non-Hodgkins lymphomas will differ depending on the factors listed above but also on the non-Hodgkins lymphoma subtype.
Second-line therapy examples
Treating relapsed or refractory follicular lymphoma might involve:
Treating relapsed or refractory mantle cell lymphoma might involve:
In most cases, there is no consensus on a 'third-line' therapy for treating lymphomas, unless it involves trying another second-line therapy. Generally if first and second-line therapies fail, oncologists are apt to recommend a clinical trial or giving palliative care only.
The actual statistics on the chance of success on being treated for a relapsed or refreactory lymphoma vary, and can range from as high as 80% in some cases of Hodgkins lymphoma down to 2-4% in some non-Hodgkins lymphomas.