Doctors use several types of approaches and treatment combinations for NHL, some at different stages:
- â€˜Watch and waitâ€™
- Chemotherapy and monoclonal drug therapy
- Radiation therapy, usually combined with chemotherapy
- Stem cell transplantation
- Your doctor may suggest that you participate in a clinical trial. Clinical trials can involve therapy with new drugs and new drug combinations.
There can also be significant differences between treatment for aggressive NHL and treatment for indolent NHL.
Watch and wait
Some people with indolent (low grade) non-Hodgkin lymphoma (NHL) can be observed for years using a watch and wait approach. By using the watch and wait method, your doctor can monitor your condition with regular assessments. The watch and wait approach lets you avoid the side effects of therapy until you need treatment. For some patients treating NHL during this early stage has not proved to be helpful. You wonâ€™t take any drugs or during this period.
When to Begin Treatment
Your doctor may advise you to begin treatment if you have:
- Lymph nodes that are getting larger
- Newly affected lymph nodes
- Bone or other organs that have become affected by NHL
- A decrease in the number of blood cells
Chemotherapy, a combination of anti-cancer drugs, is the main form of treatment for non-Hodgkin lymphoma. These drugs need to be taken in a precise sequence, called a protocol, to have the best effect. Patients may be given different protocols according to the type and stage of their lymphoma. Each drug type works in a different way to kill the cancerous cells. Combining drug types can strengthen their effectiveness. It is most commonly given several weeks apart as an outpatient treatment.
Monoclonal drug therapy
Monoclonal antibodies are a relatively non-toxic form of treatment that targets the cancer cells directly. They work by attaching to and â€˜labellingâ€™ cancer cells so that they are recognised and destroyed by the patientâ€™s own immune system. Most patients with B-cell non-Hodgkin lymphoma are treated with a drug combination plus a monoclonal antibody called rituximab. Rituximab binds to a target which is only found on B cells so it cannot be used for other types of lymphoma.
Few NHL cases are treated solely with radiation therapy because lymphoma cells are likely to be widespread throughout the body. Radiotherapy is sometimes used on its own, or with chemotherapy, to treat patients with early stage non-Hodgkin lymphoma. Radiotherapy is an intensive form of treatment that uses high-energy rays to kill cancer cells. It can also be used when large lymph nodes are pressing on or invading organs or structures and chemotherapy alone canâ€™t control the problem.
Stem cell transplant
Stem cell transplant is an intensive form of treatment and is only feasible for patients who are in good general health and whose lymphoma is difficult to treat with chemotherapy alone. This includes some patients with indolent lymphoma and those whose disease has come back after treatment.
In most cases patients have transplants using their own stem cells and this is called an autologous transplant. This is possible because the bone marrow where the blood stem cells are found is generally unaffected in patients with non-Hodgkin lymphoma.