What is the standard treatment for non-Hodgkins lymphoma?

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.

Índice Show

Types of treatment
Treatment for limited high grade NHL
Treatment for advanced high grade NHL
Treatment to prevent spread to the brain
Stem cell transplants or bone marrow transplant
When you have it
Clinical trials

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.

Last updated on July 2nd, 2020

Developed by the Leukaemia Foundation in consultation with people living with a blood cancer, Leukaemia Foundation support staff, haematology nursing staff and/or Australian clinical haematologists. This content is provided for information purposes only and we urge you to always seek advice from a registered health care professional for diagnosis, treatment and answers to your medical questions, including the suitability of a particular therapy, service, product or treatment in your circumstances. The Leukaemia Foundation shall not bear any liability for any person relying on the materials contained on this website.

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The treatment you have for high grade NHL depends on the type of lymphoma you have. Diffuse large B cell lymphoma is the most common type of high grade NHL.

It might also depend on the stage of your lymphoma when it is diagnosed (limited or advanced stage).

Treatment for limited high grade NHL

Limited disease generally means you have stage 1 or stage 2 NHL.

Treatment

You might have a short course of chemotherapy and a targeted drug, followed by radiotherapy to the affected lymph nodes. A short course of treatment usually takes about 6 to 12 weeks.

Or you might have a longer course of chemotherapy and a targeted drug, without radiotherapy. Whether you have radiotherapy depends on factors such as where the lymphoma is in the body and how fit you are.

For diffuse large B cell lymphoma, you are most likely to have CHOP chemotherapy. You have it with a targeted immunotherapy drug called rituximab. This treatment is known as R-CHOP.

Treatment for advanced high grade NHL

Advanced disease means you have stage 3 or stage 4 lymphoma. Some people with stage 2 bulky lymphoma might have advanced disease, depending on their circumstances.

Treatment

In practice, most people with high grade NHL have treatment as if it is an advanced cancer. This usually means quite intensive chemotherapy treatment with 3 or 4 different drugs, over 6 to 8 months.

You have some or all of these drugs into your bloodsteam. You will probably have a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in the whole time you are having treatment.

The exact choice of treatment depends on which type of high grade NHL you have. Most of the chemotherapy combinations contain a drug called doxorubicin. This works well for many types of high grade NHL.

For advanced diffuse large B cell lymphoma, you have a combination treatment called R-CHOP. This is CHOP chemotherapy together with a targeted immunotherapy drug called rituximab.

Treatment to prevent spread to the brain

You might have chemotherapy into the fluid around your spinal cord:

for some types of NHL
if the lymphoma is affecting the space behind your nose (the paranasal sinuses)
if the lymphoma is affecting your testicles

This is because there is a chance of lymphoma cells spreading to the brain in these situations. The treatment is to prevent that happening. You might hear it called prophylactic treatment. Usually, you have a chemotherapy drug called methotrexate.

Doctors call this intrathecal chemotherapy. It is similar to having a lumbar puncture.

Some doctors prefer to use radiotherapy to the brain instead of chemotherapy into the fluid around your spinal cord. Or you might have high dose methotrexate injections into the bloodstream instead.

Stem cell transplants or bone marrow transplant

Some people with faster growing types of high grade NHL have intensive high dose chemotherapy. This gives the best chance of curing the lymphoma. But it also increases the risk of complications such as infection. The treatment is followed with a stem cell or bone marrow transplant.

When you have it

It isn't easy for doctors to decide who will do best with high dose chemotherapy treatment. You have to be fit enough to make a good recovery from the treatment.

You might be offered this type of treatment if:

your lymphoma has come back after other treatments
you have a type of NHL that is faster growing and likely to come back quickly after standard chemotherapy
you have lots of affected lymph nodes
the NHL is in your bone marrow or other body organs as well as in the lymph nodes
you have large tumours (called bulky disease)
you have sweats, fevers and weight loss (B symptoms)

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

For support and information, you can call the Cancer Research UK information nurses. They can give advice about who can help you and what kind of support is available. Freephone: 0808 800 4040 - Monday to Friday, 9am to 5pm.

18 Dec 2020

19 Dec 2023