Lymphoma

Lymphoma treatment is not one-size-fits-all. With more than 90 subtypes and a wide range of staging possibilities, your treatment plan needs to be built around your specific diagnosis. That’s why it matters that your oncologist specializes in lymphoma, not just cancer broadly. 

WashU Medicine oncologists at Siteman Cancer Center give each patient a treatment plan tailored to their exact lymphoma type, stage, and health profile. For some patients, chemotherapy is the right answer. Others benefit from a combination of immunotherapy, targeted therapy, and CAR T-cell therapy. Our team has the subspecialty expertise to make that call — and the clinical trial access to offer options that aren’t available anywhere else in the region. 

Your Siteman care team will walk through every option with you and answer every question. You will never have to navigate this alone. 

Matching the Treatment to the Diagnosis 

The type of lymphoma you have determines which treatments are most likely to work. Hodgkin lymphoma and non-Hodgkin lymphoma are treated differently, and the subtype within each category matters too. 

Treatments used for Hodgkin lymphoma 

Hodgkin lymphoma is one of the most treatable cancers when caught and managed by the right team. Treatment often depends on your stage. 

• Stages 1 and 2: Chemotherapy, sometimes combined with radiation therapy 
• Stages 3 and 4: A combination of chemotherapy and immunotherapy 
• Relapsed or refractory cases: Stem cell transplant or CAR T-cell therapy 

Treatments used for non-Hodgkin lymphoma 

Non-Hodgkin lymphoma covers a broad range of subtypes, each with different behavior and different responses to treatment. Your oncologist will use your specific subtype and stage to determine the right combination. 

• Chemotherapy 
• Targeted therapy 
• Immunotherapy 
• CAR T-cell therapy 
• Radiation therapy 
• Stem cell transplant 

Drug Therapy  

Chemotherapy for lymphoma  

Chemotherapy is often the first line of treatment for lymphoma. These drugs work by targeting and killing rapidly dividing cancer cells. Patients may receive them as oral medications or as IV infusions. The treatment plan usually revolves in cycles, with treatment days followed by recovery days. 

Side effects like fatigue and nausea are common, and your Siteman care team will help you manage them from the start. If something is making you uncomfortable, tell us. There are real ways to reduce your side effects and protect your quality of life throughout treatment. 

Targeted therapy  

Targeted therapies block the specific pathways that cancer cells use to grow and multiply. Unlike chemotherapy, they are designed to act only on cancer cells, meaning there are fewer side effects on healthy tissue. Physicians administer targeted therapy by IV or as a daily pill, depending on the drug. 

Targeted therapy drugs are available for several lymphoma subtypes, and your oncologist will determine whether this approach fits your diagnosis. 

Immunotherapy  

Cancer cells are skilled at hiding from the immune system. Immunotherapy helps the immune system identify lymphoma cells as the threat they are, so the body can fight back. Several types of immunotherapies are used to treat lymphoma. 

Bispecific antibodies 

Bispecific antibodies are engineered to attach to two different types of cells: a lymphoma cell and one of the patient’s own T-cells. By binding them together, the antibody essentially introduces the lymphoma cell to the immune system, allowing the body to destroy it. 

Chemoimmunotherapy 

Chemoimmunotherapy combines antibodies with chemotherapy agents, using the antibody to deliver the chemotherapy directly to lymphoma cells. Physicians may use this as a standalone treatment or alongside traditional chemotherapy. 

Researchers at Siteman are also developing a vaccine for patients with follicular lymphoma. This development is an example of the next-generation immunotherapy work happening at WashU Medicine every day. 

CAR T-cell therapy: Siteman’s landmark contribution to lymphoma treatment 

CAR T-cell therapy is one of the most significant advances in lymphoma treatment in decades, and researchers at Siteman Cancer Center were there when it began (WashU Medicine’s Dr. Ghobadi was the clinical trial site principal investigator). This therapy reprograms a patient’s own immune cells to recognize and destroy lymphoma cells. It was developed through clinical trials, and Siteman was one of the centers that led that work. 

Today, CAR T-cell therapy is FDA-approved for patients with certain types of lymphoma. In a Siteman-led clinical trial, approximately 80% of patients with aggressive lymphoma achieved remission after CAR-T therapy, including patients who had already failed other treatments.  

Researchers at Siteman are now advancing next-generation CAR-T therapies through a phase 1 trial aimed at improving accessibility and reducing toxicity for patients with B-cell lymphoma. 

Read more about CAR T-cell therapy at Siteman.

Radiation Therapy  

Some patients with lymphoma receive radiation therapy as part of their treatment plan. Radiation uses focused energy beams to shrink tumors and destroy cancer cells. Radiation oncologists at Siteman are experts at delivering radiation precisely to reach the lymphoma cells while protecting the surrounding tissue. 

MR-guided adaptive radiation therapy 

Siteman Cancer Center was the first center in the world to use MR-guided adaptive radiation therapy (ART) for lymphoma. During treatment, the radiation oncologist uses MR imaging to watch the radiation in real time, making adjustments moment by moment as the tumor responds. This level of precision is not available at most centers. 

Proton beam therapy 

The S. Lee Kling Proton Therapy Center at Siteman was the first proton therapy center in Missouri and the surrounding region, and the first in the world to use a compact, single-room proton beam accelerator, the Mevion S250. Proton beams are different from traditional radiation — they stop directly on their target without passing through the body. This makes proton therapy ideal for tumors located near sensitive structures like the heart, brain, or spinal cord. 

Stem Cell Transplants  

Some patients with lymphoma need a stem cell transplant to achieve or sustain remission. Siteman Cancer Center has one of the largest stem cell transplant programs in the United States. As of 2024, our physicians have performed more than 10,000 transplants, giving us refined protocols and better outcomes than centers with less experience. 

Before high-dose chemotherapy, your team may collect and preserve your own stem cells to protect them from the treatment. After chemotherapy, those cells are returned to restore your body’s ability to produce healthy blood cells. 

Our care team knows that time outside the hospital matters to patients. Siteman’s Blood and Marrow Transplant Program and our Outpatient Cellular Therapy Center allow patients to receive this specialized care with fewer hospital stays.  

Exploring Clinical Trials as Part of Your Lymphoma Care 

Clinical trials give lymphoma patients access to treatments that aren’t yet available everywhere. Your Siteman physician may recommend a clinical trial as part of your treatment plan. You can also ask about them at any time. 

Siteman has more clinical trials available than any other cancer center in the region. That means our patients have options that patients elsewhere simply don’t have. Ask your care team what trials might be right for you. 

Thanks to clinical trials, lymphoma patients have three CAR T-cell therapies that are FDA approved. And clinical trials made several new FDA-approved bispecific antibody treatments available to patients, too.