Lymphoma

Lymphoma

Lymphoma, or cancer of the lymphatic cells of the immune system, was one of the first types of cancer to be considered curable. In the 1970s, the success of combination chemotherapy in curing patients with Hodgkin’s lymphoma helped inspire the nation's new investments in cancer research. Since then, continued advances have led to high cure rates for some forms of lymphoma, while helping to reduce side effects and improve patients' lives.

Despite these advances, lymphoma is not always curable and more than 20,000 Americans still die from the disease annually. However, researchers are gaining a deeper understanding of the biology of lymphoma, with more than 60 unique cancer subtypes now known. This information is guiding the search for new treatments and helping to determine which patients need more aggressive therapy.

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2015

Immunotherapy helps patients with treatment-resistant Hodgkin lymphoma

Immunotherapy helps patients with treatment-resistant Hodgkin lymphoma

2015-2017

A growing body of research shows that for patients with Hodgkin lymphoma that do not respond to standard treatment, including autologous stem cell transplantation, immunotherapy with PD-1 inhibitors can have significant benefits. Clinical trials suggest that treatment with the PD-1 inhibitors nivolumab (Opdivo) or pembrolizumab (Keytruda) can lead to remissions in patients who had received many previous cancer treatments, leading the FDA to grant accelerated approval to both drugs for this indication in 2016 and 2017, respectively.  

2013

Ibrutinib approved for two hard-to-treat blood cancers

Ibrutinib approved for two hard-to-treat blood cancers

The FDA approves ibrutinib (Imbruvica) for patients with mantle cell lymphoma or chronic lymphocytic leukemia that progresses despite other standard therapies.  The approvals are driven by clinical studies showing that the drug causes tumor shrinkage in a substantial majority of patients with these treatment-resistant cancers.  Ibrutinib—which is taken orally—targets a critical enzyme involved in the growth and survival of these cancers, and in many cases, offers patients a treatment option that causes fewer side effects than existing therapies.

2008

First drug approved specifically for T-cell lymphoma treatment

First drug approved specifically for T-cell lymphoma treatment

A study shows that the new targeted anticancer drug pralatrexate (Folotyn) shrank tumors in nearly one-third of patients with peripheral T-cell lymphoma that persisted or returned after conventional therapy. Tumors disappeared completely in more than 10 percent of patients in the study. In 2009, the FDA grants accelerated approval for pralatrexate for peripheral T-cell lymphoma that has relapsed or has not responded well to other forms of chemotherapy. This is the first drug to be specifically approved to treat T-cell lymphoma, and this accomplishment reflects a movement toward increased clinical research coordination among lymphoma researchers in the U.S. and worldwide to identify new therapies for this rare but often aggressive disease.

2007

PET scanning helps guide lymphoma treatment

PET scanning helps guide lymphoma treatment

Periodic PET (positron emission tomography) scanning is shown to be useful in predicting treatment outcomes for patients with advanced Hodgkin lymphoma. This new ability to accurately and non-invasively monitor a patient's cancer, and their response to therapy, leads to increased research on how to spare patients from unnecessary treatment, while maintaining effectiveness.

2005

Bortezomib shrinks tumors in mantle cell lymphoma

Bortezomib shrinks tumors in mantle cell lymphoma

Two studies show that the drug bortezomib (Velcade) shrinks tumors in nearly half of patients with mantle cell lymphoma, one of the rarest forms of non-Hodgkin lymphoma. The drug is approved the next year for patients who have relapsed after prior treatment. Bortezomib blocks the proteasome, a protein complex inside the cell that destroys proteins that are no longer needed and cleanses the cell of abnormal proteins. Researchers continue to explore other drugs that target the proteasome.

2002

Radioimmunotherapy introduced to treat lymphoma

Radioimmunotherapy introduced to treat lymphoma

This new therapeutic approach becomes available to patients with the FDA approval of the drug ibritumomab tiuxetan (Zevalin). The drug acts as a "smart bomb" against the tumor by combining a radioactive material with a protein that locates and binds to a select receptor on cancer cells called CD-20. The radioactive material kills the cells with which it comes in contact, while sparing the healthy surrounding tissue. In 2003, a similar drug called tositumomab (Bexxar) is approved for the same use.

Adding rituximab to "CHOP" chemotherapy boosts survival

Adding rituximab to "CHOP" chemotherapy boosts survival

The targeted drug rituximab (Rituxan), when added to standard CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone), is shown to boost survival for older patients with diffuse B-cell lymphoma. Subsequent trials confirm the results in patients of all ages, and the "R-CHOP" combination soon becomes standard treatment for this type of non-Hodgkin lymphoma.

2001

Scientists discover that common type of lymphoma is two distinct diseases

Scientists discover that common type of lymphoma is two distinct diseases

Research shows that diffuse large B-cell lymphoma – the most common form of non-Hodgkin lymphoma – is actually two distinct diseases, each with its own genetic profile. The finding explains why only 40 percent of patients with B-cell lymphoma are cured with current treatments, and leads to a renewed search for treatments that can be tailored to each subtype.

1998

New technique enables older patients to undergo life-saving stem cell transplants

New technique enables older patients to undergo life-saving stem cell transplants

Researchers develop a new way to perform stem cell transplants in patients with lymphoma aged 55 and older. This new technique, called a "reduced intensity transplant," enables older patients, for the first time, to receive potentially curative stem cell transplants from biologically matched donors. The approach involves lower-than-usual doses of chemotherapy and radiation therapy before the transplant, making it feasible for older patients, who may have other health issues. Following chemotherapy and radiation, the donated stem cells are transplanted into the patient's body in order to stimulate a "graft-versus-lymphoma" effect, in which the donated stem cells recognize the patient's cancer cells as diseased and destroy them.

1997

Classification system established for non-Hodgkin lymphoma

Classification system established for non-Hodgkin lymphoma

The International Lymphoma Study Group proposes a new classification system for non-Hodgkin lymphoma, called the Revised European-American Lymphoma (REAL) Classification system. This system incorporates recent discoveries about the clinical differences among the various types of non-Hodgkin lymphomas. Four years later, the World Health Organization issues another system that more specifically classifies non-Hodgkin lymphomas according to the latest science. This system is updated again in 2008. The evolution of these classification systems gives physicians and researchers a shared standard for describing, studying and treating the 23 broad categories and nearly 60 subtypes of non-Hodgkin lymphoma.

FDA approves first-ever targeted cancer drug, rituximab

FDA approves first-ever targeted cancer drug, rituximab

The FDA approves the first molecularly targeted cancer drug, rituximab (Rituxan), to treat patients with B-cell non-Hodgkin lymphoma that no longer responds to other treatments. Rituximab is in a new class of drugs called monoclonal antibodies, and targets a protein on the surface of immune cells known as B cells, interfering with the development of cancer. It is later combined with other cancer therapies to boost cure rates and increase survival.

1995

Bone marrow transplantation improves survival for relapsed non-Hodgkin lymphoma

Bone marrow transplantation improves survival for relapsed non-Hodgkin lymphoma

A pivotal clinical trial demonstrates that autologous bone marrow transplantation (transplant of the patient's own bone marrow, collected before treatment) helps improve survival for patients with diffuse large B-cell lymphoma who have a relapse after earlier treatment. The bone marrow transplant is administered after intensive chemotherapy and radiation to reverse damage to the blood and immune systems. These results establish autologous bone marrow transplantation as a standard of care for all patients who relapse with the disease.

Lymphocyte transfusions re-induce leukemia remissions

Lymphocyte transfusions re-induce leukemia remissions

Researchers discover that giving a "graft" of lymphocytes (a form of white blood cells) from a biologically matched, healthy donor to a patient with chronic myeloid leukemia (CML) can help drive the leukemia back into remission if the cancer returns after a previous stem cell or bone marrow transplant from the same donor. In these patients, the new donor lymphocytes will often recognize the cancer cells as diseased, and work to destroy them.

This phenomenon, known as the "graft-versus-leukemia" or "graft-versus-lymphoma" effect, appears to be most powerful in certain leukemias and in slow-growing lymphomas. Scientists continue to explore ways to capitalize on the graft versus leukemia/lymphoma effect to improve outcomes for patients with both diseases.

Research suggests a therapeutic vaccine for follicular lymphoma could be possible

Research suggests a therapeutic vaccine for follicular lymphoma could be possible

The concept of a therapeutic vaccine against follicular lymphoma is first proposed, based on a growing body of data suggesting this approach may be effective. Unlike a traditional vaccine, which mobilizes the immune system to prevent infection, a therapeutic cancer vaccine would trigger the immune system to fight cancer cells, while leaving healthy cells unaffected. In the late 2000s, researchers report promising data on one such experimental vaccine, though it does not prove as effective as hoped. Research in this area continues today.

1993

Mantle cell lymphoma recognized as a subtype of non-Hodgkin lymphoma

Mantle cell lymphoma recognized as a subtype of non-Hodgkin lymphoma

Investigators learn that a type of lymphoma called mantle cell lymphoma differs genetically from other types of the disease. Mantle cell tumors tend to grow more aggressively and are linked to an exchange of genetic material between chromosomes 11 and 14. This finding leads to intense and ongoing research to develop effective therapies that target these genetic abnormalities in the tumor. Over time, survival has risen from 3-5 years to 8-10 years.

1988

Benzene discovered to cause blood cancers

Benzene discovered to cause blood cancers

Scientists find that occupational exposure to benzene, a chemical commonly used as a solvent and in oil-related products, is associated with increased risk of developing non-lymphocytic leukemia, non-Hodgkin lymphoma, and other diseases. Following this discovery, workers begin taking steps to protect themselves from benzene exposure and reduce their cancer risk.

1980

Imaging tests begin replacing surgery for Hodgkin lymphoma staging

Imaging tests begin replacing surgery for Hodgkin lymphoma staging

Computed tomography (CT) is shown to be an accurate, non-invasive alternative to surgery for assessing Hodgkin lymphoma and determining a patient's prognosis (a process known as staging). Later, positron emission tomography (PET) is introduced as an additional staging tool and eliminates the need for routine laparotomy (open abdominal surgery) to assess the cancer's spread.

1976

CHOP regimen boosts cure rates for non-Hodgkin lymphoma

CHOP regimen boosts cure rates for non-Hodgkin lymphoma

A combination of cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone (CHOP) is shown to cure some patients with aggressive non-Hodgkin lymphoma. The introduction of CHOP chemotherapy boosts cure rates to 40 to 50 percent for this otherwise very aggressive and fatal form of lymphoma. In more recent years, cure rates have climbed to approximately 90 percent for some types of lymphoma, with the addition of the targeted drug rituximab (Rituxan) to the regimen – a combination called R-CHOP.

1975

Era of bone marrow transplantation begins – extending lives of many patients with leukemia and lymphoma

Era of bone marrow transplantation begins – extending lives of many patients with leukemia and lymphoma

The world's first transplant of bone marrow from a sibling donor is successfully performed in Minnesota in an infant with a severe immunodeficiency syndrome. Ten years later, bone marrow transplantation is successfully used to cure lymphoma. These discoveries usher in a new era in which bone marrow transplantation becomes a viable option for treating – and sometimes curing – leukemias, lymphomas and other blood diseases. Much of this progress can be attributed to the research of E. Donnall Thomas, who received the 1990 Nobel Prize in Physiology or Medicine for his pioneering work in the field. Subsequent refinements have enabled doctors to treat leukemias, lymphomas, and myelomas using patients' own marrow (autologous transplants) or with donations of stem cells obtained from umbilical cord blood.

New chemotherapy regimen boosts Hodgkin lymphoma cure rates to 70 percent

New chemotherapy regimen boosts Hodgkin lymphoma cure rates to 70 percent

Researchers led by Gianni Bonnadonna find that a new chemotherapy combination of doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban, Velsar) and dacarbazine (known as ABVD) is more effective than the older MOPP combination regimen, and causes fewer side effects. Originally developed for use as a treatment when MOPP no longer worked, ABVD quickly becomes the standard of care when it's found to cure approximately 70 percent of patients with advanced stage Hodgkin lymphoma.

1974

FDA approves doxorubicin, a vital part of combination chemotherapy

FDA approves doxorubicin, a vital part of combination chemotherapy

Doxorubicin (Adriamycin), an anticancer antibiotic, is widely used to treat many cancers, including Hodgkin lymphoma and some leukemias. It is also routinely used to treat cancers of the bladder, breast, stomach, lung, ovaries, thyroid and other organs. Doxorubicin and similar drugs (anthracyclines) are now considered the backbone of chemotherapy to cure diffuse large B-cell lymphoma, the most common type of aggressive lymphoma.

1967

Chemotherapy found to increase remissions in Hodgkin lymphoma

1966

Greater understanding of lymphoma growth leads to more tailored treatment

Greater understanding of lymphoma growth leads to more tailored treatment

Careful observations by researchers Saul Rosenberg and Henry Kaplan lead to the determination that Hodgkin lymphoma spreads through the body in an orderly and somewhat predictable way – implying that prognosis and appropriate treatment can be determined based on the extent of its spread. This new understanding leads to more tailored radiation therapy and greater use of surgery to precisely determine the stage of a patient's cancer.

1952

Researchers discover ways to protect the body from radiation damage

Researchers discover ways to protect the body from radiation damage

Early studies explore ways to protect healthy tissue in the body from the side effects of intense cancer treatment. Leon Jacobson and others discover that shielding a mouse's spleen from radiation can protect the mouse from otherwise lethal radiation. Eventually, scientists learn that the body recruits stem cells, which are found in the spleen and bone marrow, to protect and heal itself from radiation damage. This finding paves the way for the development and widespread use of stem cell transplantation in patients with lymphoma and leukemia, who often receive intensive radiation therapy and chemotherapy to treat their disease.

1949

First chemotherapy drug approved for cancer

First chemotherapy drug approved for cancer

Following results of clinical trials conducted in 1946 and 1947, nitrogen mustard is approved by the Food and Drug Administration (FDA) for the treatment of Hodgkin lymphoma. Nitrogen mustard – also known as mustard gas and stockpiled as a weapon in World War II – kills cancer cells by modifying their DNA through a process called alkylation. Its discovery spurs rapid advancements in chemotherapy, and the drug still receives some use today in combination chemotherapy for Hodgkin lymphoma.

1945

Radiation cures some patients with Hodgkin lymphoma

Radiation cures some patients with Hodgkin lymphoma

Early in the 20th century, doctors find that use of radiation therapy can cure some patients with Hodgkin lymphoma, one of two major classes of lymphomas. When studies show that radiating larger parts of the body improves cure rates, physicians begin increasing the size of the radiation fields during therapy. In later decades, however, the long-term effects of radiation to the chest (including cardiovascular disease and second cancers) are recognized, and efforts are taken to reduce radiation exposure to healthy tissue.