Non-Hodgkin Lymphoma

General Information | Treatment Options | Additional Resources

Treatment
  • Overview
  • Standard Treatment
  • Clinical Trials
  • Treatment By Stage

There are different types of treatment for patients with non-Hodgkin lymphoma.

Different types of treatment are available for patients with non-Hodgkin lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

For pregnant women with non-Hodgkin lymphoma, treatment is carefully chosen to protect the fetus. Treatment decisions are based on the mother's wishes, the stage of the non-Hodgkin lymphoma, and the age of the fetus. The treatment plan may change as the symptoms, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Four types of standard treatment are used:

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells and keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

For pregnant women with non-Hodgkin lymphoma, radiation therapy should be postponed until after delivery, if possible, to avoid any risk to the fetus. If immediate treatment is needed, pregnant women may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the fetus may not protect it from scattered radiation that could possibly cause cancer in the future.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). To treat certain types of adult non-Hodgkin lymphoma that spread to the brain, CNS prophylaxis (chemotherapy given to kill cancer cells in the brain or spinal cord) may be used. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Combination chemotherapy is treatment using two or more anticancer drugs. Steroid drugs may be added, to relieve swelling and inflammation.

In pregnant women, the fetus is exposed to chemotherapy when the mother is treated, and some anticancer drugs cause birth defects. Because anticancer drugs are passed to the fetus through the mother, both must be watched closely when chemotherapy is given.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Monoclonal antibody therapy is a type of biologic therapy used to treat adult non-Hodgkin lymphoma. This is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies that have been joined to radioactive material are called radiolabeled monoclonal antibodies.

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment until symptoms appear or change.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Vaccine therapy

Vaccine therapy is a type of biologic therapy that uses a substance or group of substances meant to cause the immune system to respond to a tumor and kill it.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Indolent, Stage I and Contiguous Stage II Adult Non-Hodgkin Lymphoma

Treatment of indolent, stage I and contiguous stage II adult non-Hodgkin lymphoma may include the following:

  • Radiation therapy directed at the area where cancer is found.
  • Watchful waiting.
  • Radiation therapy directed at the area where cancer is found and nearby lymph nodes.
  • Chemotherapy with radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with indolent, stage I adult non-Hodgkin lymphoma and indolent, contiguous stage II adult non-Hodgkin lymphoma.

Aggressive, Stage I and Contiguous Stage II Adult Non-Hodgkin Lymphoma

Treatment of aggressive, stage I and contiguous stage II adult non-Hodgkin lymphoma may include the following:

  • Combination chemotherapy with or without radiation therapy to areas where cancer is found.
  • A clinical trial of monoclonal antibody therapy and combination chemotherapy with steroids. Radiation therapy may also be given.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with aggressive, stage I adult non-Hodgkin lymphoma and aggressive, contiguous stage II adult non-Hodgkin lymphoma.

Indolent, Noncontiguous Stage II/III/IV Adult Non-Hodgkin Lymphoma

Treatment of indolent, noncontiguous stage II/III/IV adult non-Hodgkin lymphoma may include the following:

  • Watchful waiting for patients who do not have symptoms.
  • Chemotherapy with or without steroids.
  • Combination chemotherapy with steroids.
  • Monoclonal antibody therapy with or without combination chemotherapy.
  • Radiolabeled monoclonal antibody therapy.
  • Radiation therapy directed at the area where cancer is found and nearby lymph nodes, for patients who have stage III disease.
  • A clinical trial of chemotherapy with or without total-body irradiation (radiation therapy to the entire body) or radiolabeled monoclonal antibody therapy, followed by autologous or allogeneic stem cell transplant.
  • A clinical trial of chemotherapy with or without vaccine therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with indolent, noncontiguous stage II adult non-Hodgkin lymphoma, indolent, stage III adult non-Hodgkin lymphoma and indolent, stage IV adult non-Hodgkin lymphoma.

Aggressive, Noncontiguous Stage II/III/IV Adult Non-Hodgkin Lymphoma

Treatment of aggressive, noncontiguous stage II/III/IV adult non-Hodgkin lymphoma may include the following:

  • Combination chemotherapy alone.
  • Combination chemotherapy with radiation therapy or monoclonal antibody therapy.
  • Combination chemotherapy with CNS prophylaxis.
  • A clinical trial of autologous or allogeneic stem cell transplant for patients who are likely to relapse.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with aggressive, noncontiguous stage II adult non-Hodgkin lymphoma, aggressive, stage III adult non-Hodgkin lymphoma and aggressive, stage IV adult non-Hodgkin lymphoma.

Adult Lymphoblastic Lymphoma

Treatment of adult lymphoblastic lymphoma may include the following:

  • Combination chemotherapy and CNS prophylaxis.
  • A clinical trial of autologous or allogeneic stem cell transplant.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult lymphoblastic lymphoma.

Diffuse Small Noncleaved Cell/Burkitt Lymphoma

Treatment of adult diffuse small noncleaved cell/Burkitt lymphoma may include the following:

  • Combination chemotherapy and CNS prophylaxis.
  • A clinical trial of combination chemotherapy.
  • A clinical trial of autologous or allogeneic stem cell transplant.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult Burkitt lymphoma.

Non-Hodgkin Lymphoma During Pregnancy

Aggressive Non-Hodgkin Lymphoma During the First Trimester of Pregnancy

When aggressive non-Hodgkin lymphoma is diagnosed in the first trimester of pregnancy, medical oncologists may advise the patient to end her pregnancy so that treatment may begin. Treatment is usually chemotherapy with or without radiation therapy.

Aggressive Non-Hodgkin Lymphoma During the Second and Third Trimester of Pregnancy

When possible, treatment should be postponed until after an early delivery, so that the fetus will not be exposed to anticancer drugs or radiation therapy. However, sometimes the cancer will need to be treated immediately in order to increase the mother's chance of survival.

Indolent Non-Hodgkin Lymphoma During Pregnancy

Women who have indolent (slow-growing) non-Hodgkin lymphoma can usually delay treatment with watchful waiting.

Recurrent Adult Non-Hodgkin Lymphoma

Indolent, Recurrent Adult Non-Hodgkin Lymphoma

Treatment of indolent, recurrent adult non-Hodgkin lymphoma may include the following:

  • Chemotherapy with one or more drugs.
  • Radiation therapy.
  • Radiation therapy and/or chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
  • Monoclonal antibody therapy.
  • A clinical trial of radiolabeled monoclonal antibody therapy.
  • A clinical trial of monoclonal antibody therapy as palliative therapy to relieve symptoms and improve quality of life.
  • A clinical trial of autologous or allogeneic stem cell transplant.

Treatment of indolent lymphoma that comes back as aggressive lymphoma may include the following:

  • A clinical trial of autologous or allogeneic stem cell transplant.
  • A clinical trial of combination chemotherapy followed by radiation therapy or stem cell transplant and radiation therapy.
  • A clinical trial of monoclonal antibody therapy.
  • A clinical trial of radiolabeled monoclonal antibody therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with indolent, recurrent adult non-Hodgkin lymphoma.

Aggressive, Recurrent Adult Non-Hodgkin Lymphoma

Treatment of aggressive, recurrent adult non-Hodgkin lymphoma may include the following:

  • Stem cell transplant.
  • Monoclonal antibody therapy.
  • A clinical trial of autologous or allogeneic stem cell transplant.
  • A clinical trial of combination chemotherapy followed by radiation therapy or stem cell transplant and radiation therapy.
  • A clinical trial of radiolabeled monoclonal antibody therapy.

Treatment of aggressive lymphoma that comes back as indolent lymphoma may include the following:

  • Chemotherapy.
  • Palliative therapy to relieve symptoms and improve quality of life.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with aggressive, recurrent adult non-Hodgkin lymphoma.

Cancer information from the NCI PDQ service