The type and stage of a patient’s anaplastic large cell lymphoma will determine their course of treatment. All of the therapies listed below are often effective in treating the disease, however, relapse is common. Therefore, long-term follow up care is required.
Systemic Anaplastic Large Cell Lymphoma
Chemotherapy is often given to newly-diagnosed systemic anaplastic large cell lymphoma patients. Chemotherapy is treatment with drugs (as opposed to radiation, for example). Chemotherapy for anaplastic large cell lymphoma often consists of giving several drugs together (called combination chemotherapy) in a defined way, called a treatment regimen. Drug combinations are used because different medications damage or kill cancer cells in different ways making them more vulnerable to the treatment. The ALK positive type of anaplastic large cell lymphoma responds extremely well to CHOP (a combination of the chemotherapy drugs cyclo-phosphamide, doxorubicin, vincristine and prednisone), rendering over a 70 percent long-term disease-free survival. The ALK negative type of anaplastic large cell lymphoma has a poorer prognosis, with less than 50 percent achieving long-term disease-free survival. Higher doses of chemotherapy followed by a stem cell transplant may be prescribed for relapsed patients or patients with a low chance of being cured by CHOP.
In August 2011, the United States Food and Drug Administration (FDA) approved brentuximab vedotin (ADCETRIS™) for the treatment of patients systemic anaplastic large cell lymphoma after failure of at least one combination chemotherapy regimen. It is an antibody-drug conjugate that combines an antibody and cytotoxic agent, allowing the antibody to direct the drug to a target on the surface of lymphoma cells known as CD30. Brentuximab vedotin is the first FDA-approved antibody drug conjugate directed to CD30-expressing cells.
Primary Cutaneous Anaplastic Large Cell Lymphoma
Primary cutaneous anaplastic large cell lymphoma is very different than systemic anaplastic large cell lymphoma, in terms of prognosis and management. If the disease is localized to a single lesion or single area, radiation therapy will leave about half of people in long-term remission. Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation is a most often localized, which means it only affects cancer cells in the treated area.
If there are multiple lesions or relapsed disease in the skin, radiation can eradicate the skin lesions, but will not reduce the likelihood of new lesions developing in the future. Despite this tendency to relapse, as long as the relapses are confined to the skin, the long-term prognosis remains excellent. At relapse, radiation, topical treatments, mild chemotherapies, biologic therapies, or excisions for small lesions can all be used successfully.
For those with primary cutaneous anaplastic large cell lymphoma appearing in multiple sites on the body, systemic treatment is usually needed and may include:
- Mild chemotherapy (single agents or mild combinations)
- Bexarotene (Targretin) capsules
- CVP (cyclophosphamide, vincristine, prednisone) chemotherapy
- Methotrexate (Trexall), oral or injection form
For additional information on all of these therapies, as well as treatments for anaplastic large cell lymphoma that are currently under investigation, view or order your free copy of the Foundation’s Anaplastic Large Cell Lymphoma Fact Sheet.
Please note: It is critical to remember that today’s scientific research is continuously evolving. Treatment options for anaplastic large cell lymphoma may change as new treatments are discovered and current treatments are improved. Therefore, it is important that patients check with their physician for any treatment updates that may have recently emerged.
FDA approved a 90-minute infusion for rituximab (Rituxan Injection, Genentech, Inc.) starting at Cycle 2 for patients with non-Hodgkin's lymphoma (NHL) who did not experience a grade 3 or 4 infusion-related adverse reaction during Cycle 1. Patients with clinically significant cardiovascular disease and high circulating lymphocyte counts (>5000/mcL) are not recommended to receive the faster infusion. More Information. October 19, 2012