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<\/p>\nThe term chemotherapy indicates a therapy with drugs, which are used to limit the rapid growth of cancer cells and prevent their replication.
\nA number of drugs are administered together in order to achieve the best result possible and dilute the different toxicities that every drug may have.
\nTheir use usually takes place in several stages with a variable time interval between one cycle and the other in the so called “cycles of combination chemotherapy”.
\nChemotherapy is often administered through venous infusion; however there exist a number of drugs which are administered orally and, in some forms of lymphoma, also intrathecally (in the cefalo-rachidian fluid through lumbar puncture).
\nShould intravenous administration be repeated, physicians may decide to install and use a central venous route (central venous catheter, or CVC), which will remain in place, sometimes for months.
\nChemotherapy drugs however are not sufficiently selective against tumour cells and also destroy some healthy cells and, in particular, the elements of the bone marrow from which red blood cells, white blood cells and platelets develop. Among the most important side effects therefore is the possibility of inducing anaemia or a drop in white blood cells, resulting in increased frequency of infections, or even a drop in platelets with potential tendency to bleeding.
\nMucous cells (mouth, stomach, genitals) and the hair system cells may too be compromised in their replication (due to the side effects of cytostatic drugs, see the chapter “problems related to treatments”).
\nIn recent years, improvements in the results on lymphomas have been achieved thanks to both the association of monoclonal antibodies to cytostatic chemotherapy cycles, and the testing of new molecules that can either act more selectively on typical metabolic stages of lymphoma cells or can facilitate their aggression by the immune system.<\/p>\n
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Monoclonal antibodies are antibodies produced in the laboratory that selectively bind to molecules on the cell surface of the lymphocyte subtypes giving rise to lymphoma, such as the CD20 antigen which is expressed by most B-cell lymphomas or the CD30 antigen expressed by Hodgkin’s lymphoma and by a number of T-lymphomas.
\nMonoclonal antibodies used in therapy against lymphomas thus recognise the substances on the surface of lymphoma cells in a rather selective way.
\nThe bond between the antibody and the lymphoma cell can damage the latter either directly or by increasing their likelihood to be destroyed by the immune system.
\nCertain antibodies are able to damage the lymphoma cell simply with their bond, whereas others are used to convey venom or a radioactive isotope that selectively penetrate in the cell to destroy it.
\nThe antibodies can be administered alone or in combination with a chemotherapy treatment, according to the type of lymphoma. The dose is administered intravenously.
\nThey usually are well tolerated and can be administered in in-patients or outpatients.
\nThe infusion duration is variable and can be extended in case of side effects.
\nThe infusion is usually preceded by a pre-medication consisting in paracetamol, antihistamines and\/or cortisone to prevent potential reactions similar to allergic reactions.<\/p>\n
A series of new molecules is used or is coming into existence: such molecules can no longer be classified as cytostatic drugs as they do not act in a generic way on all replicating body cells, but they rather inhibit only some very specific metabolic stages on which the advantage that tumour cells have against healthy cells is based.
\nIn other words, these drugs have a higher selective action, although not yet totally exclusive against lymphoma cells of which they inhibit very specific vital functions.
\nEach of these drugs, which tend to constitute a new precision “therapy”, will be indicated for very specific subtypes of lymphoma and will find indication alone or in combination with more traditional therapy in specific situations.
\nThe potential side effects may also vary from drug to drug.<\/p>\n
This type of therapy is extremely innovative and has been developed in recent years.
\nCancer cells are very different from normal ones, so the immune system tends to recognize them as foreign bodies and attack them. However, tumor cells find ways to deceive the immune system by “masquerading” as normal cells and escaping defense mechanisms. Furthermore, tumor cells can change over time, which also causes them to evade the immune response. Natural immune defenses are therefore not sufficient to defeat the tumor.
\nOncology immunotherapy (also called immunological therapy or immuno-oncology therapy) works by activating the patient’s immune system, strengthening it and making it able to recognize and destroy cancer cells.
\nAt the moment, immunotherapy is used in some types of lymphoma, and is able to obtain appreciable results even in patients who have already received, without success, various types of previous therapies and for whom there are no further standard therapeutic options available . Numerous immunological drugs are currently in development (including drugs for some types of non-Hodgkin’s lymphoma).<\/p>\n
Among the drugs used in clinical practice are:<\/p>\n
\u2022 immunological checkpoint inhibitors<\/strong> Radiotherapy is an important therapy option in the treatment of lymphoma.
\nImmunological checkpoints are molecules placed on the membrane of cells that send inhibitory signals that reduce the activity of the immune system when, for example, the microorganisms that caused an infection have been eliminated and the destructive action of the immune system is no longer necessary. The inhibitors of these checkpoints are therefore able to promote an inverse activity, i.e. activate the immune system.
\n\u2022 cell therapies with CAR T cells<\/strong>
\nCellular therapies are among the so-called advanced therapies, capable of offering new treatment opportunities.
\nSpecifically, these therapies involve taking a certain quantity of lymphocytes from the patient, which are the white blood cells that are part of the immune system and which act against diseases. The lymphocytes are then genetically manipulated in the laboratory and transformed into “killer” lymphocytes of tumor cells through the expression of a new protein\/receptor on the surface of the lymphocyte capable of recognizing a target present on the tumor cell, this protein is defined as CAR (= chimeric antigen receptor). These “killer” lymphocytes are reinfused into the patient and act very powerfully against tumor cells. In this way, a personalized therapy is created for each patient, as it is built starting from the patient’s own cells.<\/p>\nRadiotherapy<\/h2>\n
\nDepending on the type of lymphoma and on the different presentations of the illness, this can be used as single treatment or combined with other systemic treatments (chemotherapy, chemo-immunotherapy).
\nIt is a localised and painless treatment acting on precise areas of the body where generally the largest adenopathies are located at the very beginning.
\nRadiations can be defined as rays with a particular form of energy and are generated by extremely sophisticated equipment called linear accelerators.
\nRadiations attack the cancer cells in the exact zones where the treatment is necessary, damaging them or killing them completely.
\nThanks to major technological progress, modern radiotherapy can precisely administrate the required dose thus sparing the healthy tissues.
\nOver the years, it has been witnessed that radiated areas of the body were limited as well as the administrated doses thus resulting in a significant decrease of risk of delayed toxicity which was typical of old-generation technology.<\/p>\n
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