Treatment Basics

This piece was written by Guide Contributors

Living with cutaneous lymphoma and understanding the diversity of the treatment options available can be challenging.

The good news is that there are many treatment options available today. Armed with knowledge and information, you can be prepared for discussions with your healthcare provider about the best treatment options for you.
 

Treatment Decision
How are treatment options determined?

Treatments for cutaneous lymphomas vary based on several factors. These include whether it is a CTCL or CBCL, an early or advanced cancer, and any prior treatments for the lymphoma. As a result, treatments are personalized and tailored to each patient’s particular situation. 

Goals of Treatment

  • Clear up all patches, plaques, or tumors
  • Eliminate or reduce the number of cancerous lymphocytes in the skin and blood 
  • Prevent migration of malignant cells from skin to other organs 
  • Block the growth of tumor cells 
  • Restore immune balance and competence
  • Improve the patient’s quality of life by relieving symptoms such as pain, itching, burning, and redness
Does everyone respond the same to treatment?

Your treatment plan is based on your personal situation.

While there may be common themes in treatment approaches, a particular patient’s treatment plan may vary based on the specifics of their lymphoma, previous treatments and experiences, the patient’s health and particular situation, and overall needs. There have been very few studies done to compare the effectiveness of one therapy for cutaneous lymphoma with another, so it is often a matter of trial and error until your healthcare team finds the right treatment or combination of treatments that work for you. It is necessary to discuss the benefits and disadvantages of treatment options with your healthcare team before making a decision on your individual treatment course. For less common forms of cutaneous lymphomas, physicians may select a treatment that has been used successfully in other, more common types of cutaneous lymphoma.

Your response to treatment may change over time.

It is important to understand that some cutaneous lymphomas will respond to a treatment temporarily, but the patient may not maintain a permanent remission. Constant monitoring and maintenance may be required, but maintenance therapy may also be sufficient to prevent progression. For patients whose lymphoma has recurred, the treatment used previously may still be effective at controlling the disease. For others, the previous treatment may not be effective and a new treatment approach is needed.

Treatment Types
What are the different types of treatment?

Local/Skin-Directed Therapies 

Generally, early, localized disease is treated with skin-directed therapies that are administered directly to the affected area. Localized therapy or skin-directed treatment includes topical therapies like topical steroids, phototherapy, radiation, intralesional therapy, and surgical removal (excision) of lesions. These kinds of treatments are applied to limited areas of the skin with little or no effect on other regions of the body. This approach can limit the side effects of treatments. 

Systemic Therapies

Systemic therapies, given orally, intravenously, or subcutaneously (injected under the skin), are distributed across the entire body, reaching and affecting cells all over the body to kill cancer cells wherever they are located, including the skin, blood, and organs. These are typically administered for more advanced disease. There are several different types of systemic therapies.

Targeted Therapies 

Targeted therapies are agents that act directly and specifically against particular molecules needed for cancer growth. Targeted therapies usually affect fewer normal cells and therefore may result in fewer side effects. However, not all cutaneous lymphomas develop in the same way and patients’ disease may develop along different pathways. If a particular patient’s disease does not have the specific target exploited by the drug (for example, a specific marker on the surface of the cancer cell) due to the pathway along which it developed, then the drug will not be effective. Targeted therapies represent a new area of interest in cutaneous lymphoma treatments and are leading to increasingly individualized treatments where each patient can receive therapy that is specific for their individual disease. 

Biologic Therapies 

Biologic therapy is a kind of systemic targeted therapy that works with the body’s normal cell functions to fight cancer. These drugs repair, stimulate, or enhance the action of the patient’s healthy immune cells. Specific biologic agents target specific characteristics of cancer cells. 

Stem Cell Transplantation

Bone marrow or stem cell transplantation is considered in cases for patients with advanced disease. Allogeneic stem cell transplantation is the recommended transplantation method for advanced cutaneous lymphoma patients. However, most cutaneous lymphoma patients will never need to evaluate this option. Stem cell transplantation refers to a procedure where healthy stem cells are transplanted from one individual to another. Sources of stem cells include bone marrow, peripheral blood or umbilical cord blood. Hematopoietic stem cells can grow into any of the cells found within the bloodstream. They make blood cells and the components that your immune system needs to function. During a transplant, your body is infused with healthy stem cells which then grow and produce all of the different parts of the blood that both your body and your immune system need.

What and when are combination therapies used?
Occasionally skin-directed therapies may be used in combination or with a systemic therapy when one therapy alone isn't fully effective.

EXPERT PRESENTERS

Steven Horwitz, MD, Medical Oncologist, Memorial-Sloan Kettering Cancer Center

Lauren Pinter-Brown, MD, FACP, Hematologist/Oncologist, UCLA Medical Center

Learn More

Which Type of Doctor Should I See and When?

Being diagnosed with cutaneous lymphoma can be a difficult time. Determining which physician (dermatologist, oncologist or hematologist) to work with can be confusing. Dr. Laura McGirt provides guidelines for choosing.

OBTAINING A PROPER CUTANEOUS LYMPHOMA DIAGNOSIS

Uncommon diseases pose a number of challenges, one of which is the difficulty patients and physicians face in reaching a proper diagnosis. A definitive diagnosis will help inform treatment decisions and potentially yield better patient-related outcomes over time.

Staging Cutaneous T-cell Lymphoma

Staging describes how much of the body is affected by cutaneous lymphoma and where. Identifying your stage is important in determining appropriate treatment.
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