Developments in management of NHL
Dr Andy Haynes, Nottingham University Hospitals NHS Trust, UK
Scientists and doctors have made great improvements in the way they manage and treat non-Hodgkin's lymphoma (NHL). It is true that the indolent, slow-growing types of NHL do not normally go away completely: treatment can stop the lymphoma growing but every so often patients have a relapse that needs more treatment. Patients with indolent NHL can live for many years with the disease. These years are made up of times of relapse and times of remission. The important thing is that today’s treatments have increased the length of time that people stay in remission before needing more treatment and this is a great leap forward.
Follicular lymphoma is the most common type of indolent NHL. About one-third of people with NHL have follicular lymphoma. Often when I first see a patient with follicular NHL, they do not need treatment straight away. I watch and wait until the time that the lymphoma starts to progress.
There are a lot of new treatment options available today for follicular lymphomaIn particular, immunotherapy can make chemotherapy more effective when the treatments are used together as induction treatment. This treatment can make the length of remission longer. There is also a very interesting new way of using immunotherapy: this is known as maintenance therapy.
Maintenance therapy is used in patients whose lymphoma has responded to induction treatment so that they are in remission. It means giving an anti-CD20 monoclonal antibody at regular intervals to patients, without chemotherapy, instead of waiting for the next relapse.
In an important study, maintenance therapy was given to people with follicular lymphoma who had already relapsed. Scientists found that this maintenance therapy increased the length of time that patients stayed in remission without needing any more chemotherapy. The average length of remission after induction treatment was about 3 years longer in people who had maintenance therapy, compared with people who didn't have maintenance therapy.
Maintenance therapy has the potential to become one of the most exciting developments in the management of follicular lymphoma.