Systemic treatments, which enter the bloodstream and go throughout the body, are most useful for more advanced or aggressive disease. Systemic treatments include:
Photoimmune therapy (photopheresis)
Phtopheresis may be used for T cell lymphomas, especially Sezary syndrome. In this procedure your blood is pushed through a machine that separates and treats your lymphocytes with a drug and UV light. This method may kill some lymphoma cells and boost your immune system to kill other lymphoma cells. Photopheresis is typically well tolerated with relatively few side effects. The main side effect is sensitivity to sunlight for about one day after your treatment.
Interferons are substances that are produced by the immune system to help fight infections and a variety of cancers. They are administered by injection, typically into the abdomen or thigh, and can be combined with other therapies including photopheresis and retinoids. Potential side effects include flu-like symptoms, low blood counts, and auto-immune conditions, like thyroid problems.
These newer drugs that are designed to target specific parts of cancer cells or to boost your immune system to attack cancer cells. Targeted therapies used in treating cutaneous lymphomas include: vorinostat (Zolinza), romidepsin (Istodax), bortezomib (Velcade), denileukin diftitox (Ontak), rituximab (Rituxan), alemtuzumab (Campath). The side effects of these drugs are typically different, and often milder, than chemotherapy.
Used to treat a variety of skin diseases, retinoids may be given as a topical treatment or as a pill for more extensive lymphomas. Potential side effects depend on the type and dose of treatment and may include elevated blood sugar and/or fat levels, mood changes, thyroid problems, and eye problems. Retinoids may cause serious birth defects and should never be used by a woman who is pregnant or may become pregnant.
Not often used for cutaneous lymphoma, chemotherapy may be used when the disease is advanced or when other treatments are no longer working. It may also be useful when the disease has spread to the lymph nodes or other organs and tissues. It may be given alone or in combination with other chemotherapy or targeted drugs. Chemotherapies that may be used include: high dose methotrexate, pentostatin (Nipent), fludarabine (Fludara), liposomal doxorubicin (Doxil), gemcitabine (Gemzar), cyclophosphamide (Cytoxan), and a combination chemotherapy regimen known as CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone).
There are a number of side effects associated with chemotherapy. The side effects vary greatly from person to person and depend on the type and dose of drug(s) given, how they are given, and the length of time they are taken. Some people experience few, if any, side effects. Your doctor may give you medicines to help protect your body’s normal cells and lessen the severity of side effects or prevent them before they happen. The time it takes to get over some side effects and regain energy depends on many factors, including your overall health and the drugs you were given. See our Symptom Management section for more information.
High-dose chemotherapy with bone marrow transplant (BMT)
BMT may be used to treat cutaneous lymphoma on rare occasions. It is typically used only when other treatments are no longer working. This therapy uses high doses of chemotherapy and/or radiation to destroy both the healthy and cancerous blood cells in the bone marrow. Stem cells are then transplanted to travel to the marrow and begin making new blood cells. A bone marrow transplant is a complex treatment, with a number of potential complications and side effects.