Making a Plan After Non-Hodgkin Lymphoma Relapse

Undergoing cancer treatment can increase your risk of developing several health problems, but one of the primary concerns for most patients is facing cancer again. Non-Hodgkin lymphoma is a treatable disease, but like many cancers, it can also return after successful treatment.

“When your lymphoma comes back, our goal is to treat you and cure you, or at least give you another long remission,” Dr. Catherine Diefenbach, a medical oncologist at New York University Langone Health, tells SurvivorNet. “Luckily, in this day and age, we have several approaches to achieve that goal.”

Non-Hodgkin Lymphoma Recurrence

Non-Hodgkin lymphoma is one of the most common cancers in the United States, accounting for about 4% of all cancers, according to The American Cancer Society.

While most people with Hodgkin lymphoma and high-grade non-Hodgkin lymphoma who go into remission do not relapse, certain types of high-grade disease are more likely to relapse, including:

• Mantle cell lymphoma
• Many types of T-cell lymphomas

When relapse happens, it usually occurs within the first two years after treatment. The more time passes, the less likely you are to experience a relapse.

What Happens If Non-Hodgkin Lymphoma Returns?

First, the good news: There are more treatment options available for recurring non-Hodgkin lymphoma than ever before.

“Our goal if your disease comes back is to get you into a second complete remission, and get you to a potentially curative strategy such as transplant,” Dr. Diefenbach says. To achieve that outcome, oncologists may employ a number of approaches, including:

Chemotherapy. “If you’ve had a good response to your first chemotherapy and it has been at least six months since your first chemotherapy, we consider that you have chemotherapy sensitive disease. And, the use of chemotherapy in the second line is a reasonable strategy, particularly regimens that use multiple agents,” Dr. Diefenbach says.

New drug treatments. If chemotherapy didn’t work that well the first
time, then clinical trials, which offer new drugs with novel mechanisms of action but that may not yet be FDA approved, may be a good option.

Stem cell transplant. Chemotherapy not only destroys abnormal blood cells, but healthy ones, too. The goal of a stem cell transplant is to infuse your body with a healthy crop of new stem cells to replace the ones that chemotherapy damaged. These early cells in your bone marrow grow into infection-fighting white blood cells, oxygen-carrying red blood cells, and blood-clotting platelets that can more effectively battle lymphoma — and the approach can be curative for a subset of patients.

What Happens If You Relapse Again?

Even when treatment works a first and second time, patients can relapse again. When that happens, CAR T-cell therapy may offer another option.

With CAR T-cell therapy, doctors remove immune cells called T cells from your body, re-engineer them, multiply them into the millions, and return them to your body to help fight your cancer. Once that army of cells lands inside your body, they’re better equipped to recognize and target your cancer.

“CAR T-cell therapy is FDA-approved for patients with aggressive lymphoma, and there are at least two CAR T-cell products which are approved for patients with large cell lymphoma that has relapsed at least twice,” Dr. Diefenbach says.

CAR T therapy may be an option for:

• Diffuse large B-cell lymphoma
• Primary mediastinal B-cell lymphoma
• High-grade B-cell lymphoma
• Transformed follicular lymphoma
• Mantle cell lymphoma

Selecting the Best Strategy

Deciding which treatment approach to try isn’t always clear cut. Your best bet is to consult with your medical team and work together to determine which approach makes the most sense for your unique circumstances.

Considerations include:

• Which type of lymphoma you have
• Which symptoms you’re experiencing
• Which treatments you’ve had previously
• Which clinical trials you’re eligible for
• The length of time since your last treatment
• What other medical conditions you have
• Your overall health and wellbeing

It’s possible that you’ll receive several different treatments for non-Hodgkin lymphoma to keep the disease under control. Still, most people who have this cancer will only need treatment periodically, when their symptoms worsen or their disease progresses.

The bottom line: “If you have relapsed, aggressive non-Hodgkin lymphoma, you should pursue a clinical trial,” Dr. Diefenbach says. “Clinical trials offer the best opportunity to get the newest and most exciting therapies — or you should pursue a CAR T-cell strategy in a specialized center.”

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