Non-Hodgkin lymphoma treatment

How is non-Hodgkin lymphoma treated?

Treatment varies depending on the exact type of B or T-cell lymphoma you have, where it has spread in your body and how fast it is likely to grow. Your age and your general health are also taken into account. When deciding how to treat your lymphoma it is important to know how fast it is likely to grow and cause problems in your body. This is called the grade of your lymphoma.

Some types of lymphoma grow slowly, cause few symptoms and may not need to be treated urgently. These are known as indolent lymphomas (also called low-grade lymphomas). Others grow more quickly, cause more severe symptoms and generally need to be treated soon after they are diagnosed. These are known as aggressive lymphomas (also called intermediate-grade and high-grade lymphomas).

Low-grade lymphomas (indolent)

Many low-grade lymphomas take years to grow, cause few if any symptoms and do not necessarily need to be treated initially. In these cases the doctor may recommend regular checkups to carefully monitor your health. If the disease is limited to a small group of lymph nodes, radiotherapy alone may be able to cure some low-grade lymphomas, or control them for a long time.

If the low-grade lymphoma is more widespread in the body, the decision to treat the disease or not depends on where the lymphoma has spread to, how large the spots of lymphoma are, and your general condition. In some situations chemotherapy is given, either in tablet form or intravenously. This is usually very effective and puts many patients into a remission that lasts a variable length of time. In some cases, low-grade lymphomas develop over time into more aggressive or high grade lymphomas requiring more aggressive treatment.

Intermediate and high-grade lymphomas

Intermediate-grade and high-grade lymphomas grow quickly and treatment is needed when they are diagnosed. If these diseases respond well to chemotherapy, they can sometimes be cured. Chemotherapy is usually combined with rituximab in B-cell lymphomas to give the best results.

Relapsed disease

Finding out that your disease has come back (relapsed) or is resistant to standard treatment can be devastating. If your disease does relapse there are usually ways of getting it back under control. These might involve using more combination chemotherapy, or using more intensive or high dose chemotherapy followed by a bone marrow or peripheral blood stem cell transplant.

Palliative care

If a decision is made not to continue with anti-cancer treatment (chemotherapy and radiotherapy) for your lymphoma there are still many things that can be done to help you to stay as healthy and comfortable as possible for some time. Palliative care is aimed at relieving any symptoms or pain you might be experiencing as a result of your disease or its treatment, rather than trying to cure or control it.

Types of treatment

Treatment for lymphomas usually involves chemotherapy or radiotherapy and surgery. Peripheral blood stem cell transplantation, steroid therapy and biotherapies may also be used.

Radiotherapy
Radiotherapy uses high energy x-rays to kill cancer cells and shrink cancers. Radiotherapy is usually given in small doses (also known as fractions) each weekday (Monday to Friday) over a few weeks in the radiotherapy department of a hospital.  You do not see or feel anything during the actual radiotherapy treatment. You will, however, need to stay perfectly still for a few minutes while the treatment is taking place.

Before you start radiotherapy, the radiotherapist (doctor who specialises in treating people with radiotherapy) will carefully calculate the correct dose of radiation therapy for you. The areas of your body that need to be treated will be marked with tiny ink dots on your skin using a special pen. Radiotherapy is usually given in small doses (also known as fractions) each week day (Monday to Friday) over a few weeks in the radiotherapy department of the hospital.

When you are having radiotherapy you usually lie on a table underneath the radiotherapy machine which delivers the planned dose of radiation. Important structures like your heart and lungs are shielded as much as possible to ensure that they are not affected by the treatment given. Radiotherapy is painless. In fact you do not see or feel anything during the actual treatment. You will however need to stay perfectly still for a few minutes while the treatment is taking place. You might like to bring along some music to help you relax.

Chemotherapy
Chemotherapy literally means therapy with chemicals. Many chemotherapy drugs are also called cytotoxics (cell toxic) because they kill cells, especially ones that multiply quickly like cancer cells. Chemotherapy is usually given as a combination of drugs, in several cycles (or courses) of treatment with a rest period of a few weeks in between each cycle. Chemotherapy may be given in either tablet form or intravenously, into a vein in your hand or arm, or through a special line called a central venous catheter inserted before you start treatment.

A typical chemotherapy regime for lymphoma might involve around six cycles of a combination of drugs, given over a period of several months. Improved results have been achieved by combining chemotherapy with monoclonal antibody therapy which is specifically engineered to target lymphoma cells. Once antibodies bind to these cells, a patient’s own immune system is then able to recognise these cancer cells as foreign and kill them.

Stem cell transplant
Occasionally, a stem cell transplant is given for non-Hodgkin lymphoma, providing some people with a better chance of cure or long-term control of their disease. It is generally only suitable in some situations where the lymphoma has come back (relapsed) or is at a high risk of relapse, and where it doesn’t respond well to standard (conventional) treatment.