Small Lymphocytic Lymphoma

Treatments for small lymphocytic lymphoma may include a “watch and wait” approach, targeted therapy, chemotherapy, immunotherapy and radiation therapy. Other treatment options may include bone marrow transplant, also known as bone marrow stem cell transplant, CAR-T cell therapy and clinical trials. Which treatment is right for you depends on whether you have symptoms and the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.

Watch and wait

If your small lymphocytic lymphoma doesn’t cause symptoms, you may not need treatment right away. Instead, you may have checkups every few months. The checkups help your healthcare team watch your condition to see if your cancer progresses.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Targeted therapy is often the first treatment for small lymphocytic lymphoma. You may take a combination of targeted therapy medicines. Targeted therapy also may be combined with immunotherapy. Targeted therapy also may be used when other treatments haven’t worked, known as refractory small lymphocytic lymphoma, or for cancer that comes back after treatment, called relapsed small lymphocytic lymphoma.

Side effects of targeted therapy may include diarrhea, liver issues, high blood pressure, and issues with blood clotting and wound healing. Side effects also may include fatigue, mouth sores and nail changes. Most side effects go away after treatment is done.

Chemotherapy

Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

Chemotherapy may be a treatment for small lymphocytic lymphoma. You may take several chemotherapy medicines at one time. Chemotherapy also may be combined with immunotherapy. Chemotherapy may be the first line treatment for older adults or others who can’t tolerate targeted therapy. Chemotherapy also may be used for small lymphocytic lymphoma that has transformed into a more aggressive cancer.

Side effects of chemotherapy depend on the medicines you’re given. Common side effects are nausea and hair loss. Serious long-term complications can happen, such as heart disease, lung damage, infertility and developing another kind of cancer, called a secondary cancer.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body’s immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn’t be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may be combined with targeted therapy or chemotherapy to treat small lymphocytic lymphoma. Immunotherapy also may be used for small lymphocytic lymphoma that has transformed into a more aggressive cancer.

Side effects of immunotherapy may include constipation, cough, fatigue, diarrhea, headache, muscle spasms and nausea.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body. Radiation therapy is sometimes used to treat early-stage small lymphocytic lymphoma.

Radiation therapy side effects include fatigue and skin irritation at the site where the radiation is aimed. Other side effects depend on where the radiation is aimed. Radiation to the neck can cause dry mouth and damage the thyroid. Radiation to the chest can damage the heart and lungs.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. Stem cells can come from your own body, called an autologous transplant. Stem cells also can come from a donor, called an allogeneic transplant.

A bone marrow transplant may be done for relapsed or refractory small lymphocytic lymphoma. A bone marrow transplant also may be an option for small lymphocytic lymphoma that has transformed into a more aggressive cancer. Chemotherapy is typically done before the transplant to suppress the immune system and bone marrow.

Short-term side effects of a bone marrow transplant may include upset stomach, vomiting and not feeling hungry. They also may include fatigue, mouth sores, hair loss and skin reactions. Long-term side effects may include infertility, secondary cancers, organ damage, weakness in the bones or muscles, and cataracts.

CAR-T cell therapy

Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight lymphoma. This treatment begins with removing some white blood cells, including T cells, from the blood.

The cells are sent to a lab. In the lab, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the lymphoma cells. Then the cells go back into the body. They find and destroy lymphoma cells.

CAR-T cell therapy may be an option for some people with refractory or relapsed small lymphocytic lymphoma. CAR-T cell therapy also may be an option for small lymphocytic lymphoma that has transformed into a more aggressive cancer. CAR-T cell therapy is typically used after at least two other treatments have been tried.

Side effects of CAR-T cell therapy may include fever, upset stomach, headache and confusion. They also may include dizziness, rash, rapid heartbeat, trouble breathing and low blood pressure.

Clinical trials

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you can be in a clinical trial.

Monitoring after treatment

After treatment is complete, you may have frequent follow-up appointments to see if the cancer has come back, known as a relapse. You may have repeat blood tests to check for a relapse.

Treatment complications

Treatments for small lymphocytic lymphoma may have complications, including:

• Bone marrow suppression. When the bone marrow is suppressed, it can’t produce enough blood cells, including white blood cells. White blood cells help fight infections. With a lower amount of white blood cells, you are at a higher risk of infections.
• Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, a type of white blood cell that helps fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn’t have enough neutrophils.
• Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you receive. There are many different medicine options. Your healthcare team can work with you to find the best medicines for you.
• Reactivating viruses. If you have had a viral infection in the past, such as hepatitis B or hepatitis C, some treatments can cause the virus to become active again. This can lead to liver inflammation, liver damage and other complications.
• Tumor lysis syndrome. Tumor lysis syndrome is a serious condition that can happen when cancer cells break down quickly after treatment or randomly. When these cells die, they release substances into the bloodstream that can overwhelm the body. This can lead to issues with the kidneys and other organs. You may take medicines to treat or prevent harmful side effects.