Lymphoma of the Skin

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Treating Lymphoma of the Skin TOPICS

What if the lymphoma keeps growing or comes back after treatment?

Some lymphomas may not respond well to treatment. Most often, other types of treatment can then be tried. But as more treatments are tried, they may be less likely to work or more likely to cause side effects.

When a cancer comes back after treatment it is called recurrent or relapsed. In general, if a skin lymphoma comes back it tends to be in the skin. If this is the case, skin-directed therapies that haven’t been used yet may be effective.

Some skin lymphomas eventually spread to lymph nodes and internal organs as well. Often, lymph nodes are the first site of relapse. After that, it may spread to internal organs such as the liver, spleen, and bone marrow. Chemotherapy is often used in this situation, especially if the patient has not yet received chemotherapy. Other drugs, such as romidepsin (Istodax), bortezomib (Velcade), alemtuzumab (Campath), and denileukin diftitox (Ontak), may also be options at the time of relapse. A stem cell transplant may be another option at some point.

Advanced skin lymphomas are very hard to cure. Different systemic treatments may be effective for some time. But in general, with each type of treatment that is tried, the next treatment has a smaller chance of being helpful. If the lymphoma improves with later treatments, it often comes back sooner than it did before. Over time, treatments tend to provide less benefit, but they can still cause side effects.

At some point, a person may want to consider trying to relieve the symptoms of the lymphoma, rather than trying to get rid of it with more aggressive treatments that have a very small chance of success. This approach is called palliative care.

For example, when lymph nodes become enlarged, they may press on nerves and cause pain. Radiation therapy to these areas may help relieve the pain and can be used if radiation has not previously been given to this area of the body. Treatment with appropriate pain medicines is also important. Help with pain treatment from a palliative care team may be required.

Some symptoms from lymphoma may result from low blood counts. Fatigue may be caused by low red blood cell counts (anemia). Sometimes blood transfusions may be used to increase the number of red blood cells and help a person feel better. Low white blood cell counts (from chemotherapy or from the lymphoma itself) may lead to infections. Certain drugs such as G-CSF (Neupogen) or GM-CSF (Leukine) may be used to increase the white blood cell count.

Nausea and loss of appetite can occur because of the disease or its treatment. These symptoms can also be treated effectively with drugs, as well as high-calorie food supplements. If the lymphoma involves the lungs, patients may get short of breath. Oxygen may be used to help treat this symptom. See the “Physical Side Effects” section of our Web site for more information on side effects from cancer and cancer treatment.

Some people may become depressed. Counseling and medication may be helpful. If depression is a problem, it is important to discuss your feelings with your doctor or nurse, so that appropriate treatment can be started. See the “Emotional Side Effects” section of our Web site for information on coping with cancer.

For more information on dealing with lymphoma that is no longer responding to treatment, see the section, “If treatment of lymphoma of the skin is no longer working.”

Last Medical Review: 03/14/2013
Last Revised: 02/11/2014