Our knowledge of cancer is always expanding. Researchers and healthcare professionals take the knowledge gained from research studies and use it to develop better practices that will help prevent, detect and treat non-Hodgkin lymphoma (NHL), as well as improve the quality of life of people with non-Hodgkin lymphoma.
The following information is a selection of research showing promise for non-Hodgkin lymphoma.
Risk reduction
Risk reduction strategies may reduce the chance of developing cancer.
Noteworthy research includes:
- It is unclear whether diet may play a role in reducing the risk of NHL. A study showed that eating more vegetables and fruits is associated with a reduced risk of developing NHL (International Journal of Cancer, PMID* 19685491). It remains unclear if eating more vegetables and fruits alone reduced risk or if it is a marker for some other aspect of lifestyle or environment that reduces the risk.
- A study in Japan found that women who ate soy had a lower chance of developing NHL. There was no association between consumption of soy and NHL in men (Annals of Oncology, PMID 21765045).
- Statins (drugs used to lower cholesterol) may reduce the risk of developing NHL. An American study found that people who used statins for 5 or more years had a significantly lower risk of developing NHL (Cancer Research, PMID 21343395).
Diagnosis
A key area of research activity involves developing better ways to diagnose and stage NHL.
Noteworthy research includes:
- Molecular genetic tests are proving useful in the diagnosis of NHL. However, at this time, they are not a substitute for a full lymph node biopsy or biopsies of other tissues. These tests may be used in addition to standard processing of biopsy samples when diagnosing NHL.
- Polymerase chain reaction (PCR) is a method used to create many copies of a particular gene segment so that it can be closely studied in the laboratory. PCR is a very sensitive technique that can be useful in diagnosing lymphoma in cases where only a small number of cancer cells are present. Eventually, researchers hope that gene-based diagnostic tests will help doctors identify new prognostic markers and tailor treatments for people with NHL and other types of cancer (Diagnostic Molecular Pathology, PMID 20186011; Annals of Oncology, PMID 19465421).
- Fluorescence in situ hybridization (FISH) is a molecular genetic test used to identify chromosomal abnormalities and other genetic changes in cancer cells using special DNA probes labelled with fluorescent dyes. FISH can be tested on fine needle aspiration (FNA) biopsy samples from people with NHL (Cancer Cytopathology, PMID 20862704, PMID 19711476).
- Flow cytometry is a laboratory test that is used to sort, count and examine microscopic particles, such as cells or DNA. Flow cytometry has proven useful in helping to classify NHL tumours (Histopathology, PMID 21438908; Diagnostic Cytopathology, PMID 21077168; Cancer Cytopathology, PMID 19711476).
Prognostic factors
Prognostic factors that may help determine the outcome of the disease are being studied in NHL. They can be used to predict the chances of recovery or of cancer coming back. Doctors may also use prognostic factors to help them make treatment recommendations.
Noteworthy research includes:
- An American study has found that smoking, alcohol use and obesity each has an effect on the outcome of people with NHL. Those who were smokers, drank alcohol or were obese before their diagnosis of NHL have a less favourable prognosis (Cancer, PMID 20564404).
- Researchers are studying positron emission tomography (PET) to assess early responses to chemotherapy (after 2–3 cycles) to see whether people with NHL would benefit from more intensive treatment or a change in treatment. Researchers are trying to find out if doing a PET scan after a few cycles of chemotherapy may help predict whether radiation therapy may be usefully added to chemotherapy or whether a person is likely to relapse. PET scans may also be done before and after a stem cell transplant to check for response to treatment and help predict outcome or decide about radiation therapy. Research results have been promising, but more studies are needed to fully determine the role of PET scanning, when it should be done to assess the response to treatment, exactly what prognostic information it provides and how it may be used to help tailor the treatment for NHL (Cancer, PMID 20665491; British Journal of Haematology, PMID 20507301; Hematology, PMID 20132658; International Journal of Clinical Oncology, PMID 19390947).
- American researchers have found that people with NHL who have low vitamin D levelshave a poorer prognosis. More research is needed to find out if giving extra vitamin D to these people would improve outcome (Journal of Clinical Oncology, PMID 20713849).
- Angiogenin is a protein that stimulates new blood vessels to form (angiogenesis). In solid-tumour cancers, like NHL, the tumours create new vessels to get the blood they need to grow. Research has shown that people with NHL who have high levels of angiogenin in the blood do not respond as well to treatment and have poorer survival (European Journal of Cancer, PMID 21439815).
- B symptoms are usually associated with more extensive disease and less favourable prognosis in people with NHL. A British study showed that people who experience B symptoms are more likely to suffer from bone marrow suppression if they are given chemotherapy. Giving granulocyte colony-stimulating factor (G-CSF) before chemotherapy may help to improve bone marrow recovery in these people (BMC Cancer, PMID 19450285).
Treatment
Researchers are looking for new ways to improve the treatment of NHL. Advances in cancer treatment and new ways to manage the side effects related to treatment have improved the outlook and quality of life for many people with cancer.
Noteworthy research includes:
- Bendamustine (Treanda) is a chemotherapy drug that may be a particularly useful treatment option for indolent (slow-growing) B-cell NHL. Bendamustine is showing promise alone and in combination with rituximab (Rituxan) in treating indolent lymphomas. It has recently been approved in the United States for treating people with indolent B-cell NHL whose lymphoma has progressed during or within 6 months of treatment with rituximab alone or in combination with other drugs. Results of ongoing trials will help to clarify the role of bendamustine in indolent NHL (Seminars in Hematology, PMID 21530769; Blood, PMID 20978267; Drugs, PMID 20731477; Journal of Clinical Oncology, PMID 19224851).
- Rituximab (Rituxan) is a biological therapy used to treat many different types of B-cell lymphomas. It may be added to chemotherapy or is sometimes used alone. Some studies are looking at new drug combinations that include rituximab to treat NHL. Two European studies have reported that the combination of dexamethasone (Decadron, Dexasone), cytarabine (Cytosar, Ara-C) and oxaliplatin (Eloxatin), with or without rituximab, are effective treatments for NHL that has come back after treatment (relapsed) or that does not respond to treatment (refractory) (Clinical Lymphoma, Myeloma & Leukemia, PMID 20709662; Cancer, PMID 20572029.
- Researchers are studying many other biological therapies for the treatment of NHL. However, these therapies are in early development or are being tested in phase I or II clinical trials. We will not know how effective these newer biological therapies will be until they are tested in larger groups of people and in studies that test these drugs against the current standard therapy.
- Denileukin diftitox (Ontak) is a new drug that combines the biological therapy drug interleukin 2 (Aldesleukin, Proleukin) and the diphtheria toxin. The interleukin targets cutaneous T-cell lymphoma (a type of NHL) cells and the diphtheria toxin kills them. Researchers are studying denileukin as a treatment for peripheral T-cell lymphomas and B-cell lymphomas (Expert Review of Anticancer Therapies, PMID 21417858; Blood, PMID 20978267; Expert Opinion on Biological Therapy, PMID 19817678).
- Lenalidomide (Revlimid) is a drug related to thalidomide, but that has different side effects. It appears to affect the immune system and, like thalidomide, may block or stop cancer growth. There may be other ways that it works against cancer, such as causing cells to die (apoptosis), but how it acts is not yet fully understood. Clinical studies have shown that lenalidomide given alone works against a variety of blood-related cancers. Researchers are studying lenalidomide in combination with rituximab and other monoclonal antibodies as a treatment for NHL (Blood, PMID 20978267; Leukemia & Lymphoma, PMID 20658952; Clinical Advances in Hematology & Oncology, PMID 20391648; Journal of Clinical Oncology, PMID 19805688).
- Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. Early-stage MF is usually treated with PUVA, which stands for psoralen (P) and ultraviolet A (UVA) light therapy. Although PUVA is an effective treatment for MF, the cancer usually comes back and needs to be treated again with PUVA. Researchers are seeing if giving the drug bexarotene (Targretin) with PUVA will help improve treatment for MF and prevent it from coming back (Oncology, PMID 20568590; British Journal of Dermatology, PMID 19222457).
- Early studies have provided some evidence that cancer vaccines can possibly stimulate the body’s immune system to attack lymphoma cells. Unlike other vaccines directed at preventing disease, this type of vaccine therapy is currently being studied to see if it plays a role in treating NHL and reducing the chance of it recurring. It is hoped that the outcome of this research will help determine if there is a role for vaccine therapy in NHL treatment and if it helps prolong survival and the time to relapse (Cancer Research, PMID 20884630).
- A stem cell transplant replaces a person’s blood-producing stem cells when their bone marrow has been destroyed by high doses of chemotherapy or radiation therapy. While a stem cell transplant may be an option for some people with certain types of NHL, researchers are studying new ways to do stem cell transplants. They are also studying the best timing of the procedure for different types of NHL.
- Autologous stem cell transplant with cyclophosphamide (Cytoxan, Procytox), etoposide (Vepesid) and oral busulfan (Myleran) may be used for people with relapsed or refractory NHL. An American study found that giving busulfan intravenously instead of by mouth (orally) was associated with longer survival and fewer side effects (British Journal of Haematology, PMID 19821828).
- Cord blood stem cell transplants use stem cells removed from the blood of an umbilical cord. Clinical trials are currently underway that use umbilical cord blood from multiple donors to treat an average-sized adult with NHL (Journal of Clinical Oncology, PMID 19064984).
- Stem cell mobilization causes the bone marrow to make more stem cells and release them into the bloodstream in preparation for an autologous stem cell transplant. Granulocyte colony-stimulating factor (G-CSF) is used for stem cell mobilization. Recently, 2 phase III studies found that giving plerixafor (Mozobil) in combination with G-CSF achieved better conditions for collecting stem cells than G-CSF alone (Biology of Blood and Marrow Transplantation, PMID 19896082; Journal of Clinical Oncology, PMID 19720922).
- Researchers are studying a variety of techniques to make stem cell transplants safer, easier and more effective for people with NHL. Reduced-intensity allogeneic transplants (mini-transplants) may be an option for some people with NHL. This technique uses lower doses of chemotherapy that do not completely destroy the recipient’s bone marrow. This may be very important for older adults who cannot tolerate the higher doses of chemotherapy and radiation normally associated with stem cell transplants (Leukemia & Lymphoma, PMID 20583964; Annals of Hematology, PMID 20490794).
- A randomized study in Israel found that people who were given interleukin-2 (Aldesleukin, Proleukin) and interferon alfa (Intron A, Wellferon) after an autologous stem cell transplant had a longer remission than those who did not receive these drugs. Both interleukin-2 and interferon alfa are types of biological therapies that use a person’s own immune system to fight the cancer (Journal of Immunotherapy, PMID 20445353).
- Researchers in the United Kingdom have found that using lower doses of radiation therapy to treat NHL may be just as effective as standard doses (Radiotherapy and Oncology, PMID 21664710). Another study in Canada found that low-dose radiation therapy was effective for relieving the symptoms (palliative treatment) of slow-growing (indolent) NHL (International Journal of Radiation Oncology, Biology, Physics, PMID 21167657).
Supportive care
Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects.
Noteworthy research includes:
- An American study has found that problems related to sexuality can often affect survivors of NHL. Problems included sexual dysfunction and general unhappiness with one’s sex life. It is important for survivors of NHL to be aware of the potential for sexual problems so they can seek professional help (Oncology Nursing Forum, PMID 21875831).
*PMID is the National Library of Medicine PubMed abstract identity number.
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