Non-Hodgkin's Lymphoma - Treatment Overview

Treatment Overview

Different types of treatment are used for different types of non-Hodgkin's lymphoma (NHL). Treatment of NHL depends on:

• The stage of the disease.
• The grade of the disease.
  • Aggressive (intermediate- and high-grade) lymphomas tend to grow and spread quickly and cause severe symptoms. They are also easier to cure.
  • Less aggressive (indolent or low-grade) lymphomas tend to grow slowly and cause fewer symptoms. They often come back after long periods of remission.
• Your age.
• Your general health.
• Whether you have had lymphoma in the past (recurrent disease). Although lymphoma that has come back (recurred) may be controlled, it usually is not curable.

Initial treatment

Treatment recommendations that may be appropriate when you are first diagnosed with non-Hodgkin's lymphoma include:

• Watchful waiting (surveillance), an interval after the diagnosis of some types of NHL when little or no other treatment is used. Watchful waiting gives as good or better results than more aggressive treatment for some types of NHL. Your health professional may discuss watchful waiting with you if you have an advanced, low-grade (indolent) lymphoma.^{3, 4} Watchful waiting is not appropriate for aggressive lymphoma or less aggressive lymphoma that has gotten larger or is causing symptoms.
• Radiation therapy, which is often the treatment of choice for early-stage, indolent NHL. Radiation therapy may be used alone or combined with other treatment options for more advanced NHL.
• Medications, such as chemotherapy or monoclonal antibody therapy, which often cure NHL. Even when cure is not possible, treatment with medications may allow you to live a long time without symptoms.

If you have recently been diagnosed with non-Hodgkin's lymphoma, you may experience a wide variety of emotions. Most people experience some denial, anger, and grief. Other people may have fewer emotions. There is no "normal" or "right" way to react to a diagnosis of lymphoma. There are many steps you can take to help with your emotional reactions. You may find that talking with family and friends helps you with your emotions. Some people may find that spending time alone is what they need.

If your reaction is interfering with your ability to make decisions about your health, it is important to talk with your health professional. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.

You may use home treatment to help you manage the side effects that may accompany NHL or its treatment.

Ongoing treatment

Schedule regular follow-up examinations with your health professional after you have been treated for non-Hodgkin's lymphoma. Follow-up care is an important part of the overall treatment plan. During regular follow-up care:

• You will be seen every 3 to 4 months for the first 2 years and then every 6 months until it has been 5 years since your diagnosis. After that you will have annual checkups.
• Changes in health can be discussed with your health professional. To monitor your health, your health professional may obtain lab tests, such as a chemistry screen and CBC, and imaging tests, such as a chest X-ray or CT scan.

Report any problems you might have to your health professional as soon as they appear. If you are having a problem, you may need additional appointments.

Treatment if the condition gets worse

You may be offered the following treatment options if your disease progresses:

• Radiation therapy may be used alone or in combination with other treatments if non-Hodgkin's lymphoma (NHL) recurs. Targeted radiation therapy uses monoclonal antibodies to deliver radiation directly to lymphoma cells.
• Chemotherapy often effectively treats recurrent NHL. Sometimes a person may take one type of chemotherapy for several cycles and later be switched to different medications if the first medications are no longer working.
• Stem cell transplant (bone marrow transplant) is often used to treat recurrent lymphoma. Stem cell transplant may be offered as part of standard treatment or in a clinical trial. Talk with your health professional to see if a clinical trial may be available for your type of recurrent disease.
• Biological therapy may be used to treat recurrent lymphoma.

What to think about

Survival rates have improved as a result of clinical trials. Check with your doctor to determine whether clinical trials are available in your area.

Your health professional may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people with non-Hodgkin's lymphoma are successfully treated, the term remission is used because cancer can return. It is important to discuss the possibility of recurrence with your health professional.

Even after effective treatment for NHL, you may be at higher risk for other types of cancer, especially melanoma, lung, brain, kidney, and bladder cancers. Be watchful for any symptoms of cancer.

For more information about specific treatments, see the following topics:

• Non-Hodgkin's lymphoma – Health Professional Information [NCI PDQ]
• Non-Hodgkin's lymphoma - Patient Information [NCI PDQ]