All cancer treatments for non-Hodgkin lymphoma (NHL) have to be fully researched before they can be used for everyone. This is so we can be sure that:
- they work
- they work better than the treatments already available
- they are known to be safe
In this video, Jean talks about her experience of taking part in a clinical trial for NHL. The video lasts for 2 minutes.
John: We’ve been married 43 years very happily. When they told us that she had cancer it was like the end of the world to me. I was in shock.
Jean: When I went out of the general hospital onto oncology I met with the people there and they explained that as I was fit and healthy I could go onto a trial.
When I learned that I probably would be accepted onto the trial there were lots of questions that I had to ask and they were all answered, and I was quite confident.
The treatment lasted for three months and I was linked up to an IV in the hospital. I would be there all day and John would be there with me.
They take your obs every hour on the hour, they check that you’re well, they make sure that you’re hydrated. You get CT scans very regularly, blood tests, all the rest of it.
John: We also had a 24 hour nurse that we could phone. Any worries we could talk to her about and she would ease our minds on that situation.
Jean: I’ve now been given the all clear. I just feel that life is so good. I’m so very happy and so grateful to get my life back which I took. It’s a really warm feeling knowing that what you did has helped other people.
I can fully understand if people are offered a trial and they’re scared because they’re unsure of what’s going to happen. I can fully understand that, but anyone who has any form of phone, internet, whatever, you can ask the questions anywhere.
You can actually go to your doctor. There’s support there just waiting for you to ask.
Researchers are looking at the causes of some types of lymphoma and chronic leukaemia. They are looking at blood, bone marrow and tissue samples from people with white blood cell disorders. They hope to learn more about the causes and possible treatments.
Tests to monitor treatment
In one study, researchers are collecting information about the genes in people’s lymphoma cells. This is called molecular profiling.
The trial team are also recording the treatment that people have and how well the treatments work. It's possible that changes to genes in certain types of lymphoma can encourage the lymphoma to grow. New treatments might be able to target these gene changes.
Often after treatment for NHL, the disease appears to have gone and you are said to be in remission. But there are often lymphoma cells left behind. This is called minimal residual disease (MRD).
Scientists are exploring new ways of finding out if there are lymphoma cells left behind after the disease appears to have clinically gone. These tests can help your doctors to find out how well chemotherapy has worked and whether your lymphoma is likely to come back (relapse).
Many tests are used to do this. To help doctors decide who needs further treatment and who does not, researchers are looking at:
- different scans such as PET and PET-CT scans
- substances in the body called biomarkers
Research is looking at new chemotherapy drug combinations for some types of NHL. Other trials are looking at new ways of giving standard chemotherapy drugs for different types and stages of lymphoma.
Combining with other treatment
There is research looking at combining chemotherapy with different types of targeted cancer drugs (biological therapies) and comparing it with standard treatments. For example, adding copanlisib to the drug combination R-CHOP.
Combined chemotherapy for people with diffuse large B cell lymphoma that has spread to the brain or spinal cord
A trial called the MARIETTA study, showed that MATRIX and RICE combination chemotherapy might be useful treatments for people with diffuse large B cell lymphoma that has spread to the brain and spinal cord. People who had this treatment followed by a stem cell transplant did much better than expected.
The research team concluded that this combination of treatment was promising for people with secondary CNS lymphoma. This is especially true for those who went on to have a stem cell transplant.
Chemotherapy is also used to treat some of the rare types of NHL. One trial compared 2 different chemotherapy drugs for a type of NHL called Waldenstrom's macroglobulinaemia. The team found that fludarabine chemotherapy was a better treatment than chlorambucil.
Radiotherapy is a common treatment for NHL. But it can have troublesome side effects.
Researchers have compared a lower dose of radiotherapy with standard dose radiotherapy. They found a lower dose was as good as standard dose radiotherapy and side effects were similar. But reddening and darkening of the skin was less for people who had the lower dose radiotherapy.
Leaving out radiotherapy
You usually have chemotherapy and rituximab to treat a rare type of NHL in the chest called primary mediastinal large B cell lymphoma (PMBCL). You might then have radiotherapy to your chest. But radiotherapy can increase the risk of heart problems and of getting another cancer in the future. Researchers are looking to see if it is safe to leave radiotherapy out of the treatment plan for some people with PMBCL.
Targeted drugs change the way that cells work. For example, they can block signals that tell cells to grow. Immunotherapies can boost the body’s own immune system to fight off or kill cancer cells.
There are different types of targeted cancer drugs and immunotherapies. For non-Hodgkin lymphoma, researchers are looking at:
- BI 1206
Immunotherapy uses our immune system to recognise and attack cancer cells. One type of immunotherapy is CAR T-cell therapy. Researchers are looking at this as a way to treat lymphoma, leukaemia and other types of cancer.
With this treatment doctors take a sample of a person’s T cells (a type of white blood cell). The scientists then change (genetically alter) these T cells in the laboratory. These altered T cells are called CAR T-cells.
The patient then has a drip of the CAR T-cells into their bloodstream. For people with lymphoma, these CAR T-cells are designed to recognise and target a specific protein on the lymphoma cells. They aim to attack and kill the lymphoma cells.
Half matched transplants
A transplant using donor cells is called an allogenic transplant. Usually, the donor is a very close match to the person having the transplant.
Sometimes doctors can't find a match for a person needing a transplant. So they are looking at half matched transplants, where the donor is at least 50% match with the person having the transplant.
Mini Transplants (Low intensity transplant)
In a mini transplant you have a lower dose of chemotherapy, also called low intensity treatment. So this treatment can be suitable for people who are not well enough for a standard high dose treatment.
This type of transplant has been looked at in a trial for a type of NHL called mantle cell lymphoma. The trial wanted to find out whether this is a safe treatment for mantle cell lymphoma. And whether it is better for people to have a transplant sooner in their treatment, rather than wait for their lymphoma to come back.
Donor lymphocyte donation
Researchers are looking at giving extra T cells, a type of white blood cell, after a mini transplant. Doctors think that giving specific T cells called CD4 cells may help boost immunity and reduce the risk of infection.
In this trial, people have extra CD4 cells from their donor a few months after their transplant. This is called a donor lymphocyte infusion. The trial team hope that the CD4 cells will recognise and kill any lymphoma cells left behind. This is called the graft versus lymphoma (GvL) effect.
Using umbilical cord blood
Research is looking at using stem cells collected from the umbilical cords of newborn babies. These cord blood transplants are for people who don't have a relative who can be their stem cell donor.
Older children and adults might need the stem cells from more than one umbilical cord. Researchers want to find out if it is safe to do a transplant in adults and children using cord blood from unrelated donors.
Trials are looking at the use of cord blood stem cells after intensive treatment in some people. And following reduced intensity treatment in other people.