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Non-Hodgkin's Lymphoma: Treatment

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There are many differing treatments for patients with Non- Hodgkin's Lymphoma. The main types of treatment are:
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors)
  • Chemotherapy (using drugs to kill cancer cells and shrink tumors).
Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for NHL usually comes from a machine outside the body (external-beam radiation therapy). Radiation therapy given to the neck, chest, and lymph nodes under the arms is called radiation therapy to a mantle field. Radiation therapy given to the mantle field and to the lymph nodes in the upper abdomen, the 

spleen, and the lymph nodes in the pelvis is called total nodal irradiation. Radiation therapy may be used alone or in addition to chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. An in-depth discussion of chemotherapy can now be found on the Adult Non-Hodgkin's Lymphoma Chemotherapy Page.

Immunotherapy tries to help your body to fight cancer or infections. It uses materials made by your body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Immunotherapy is sometimes called biological response modifier (BRM) therapy. Recent advances have been made in the use of Monoclonal Antibody therapy and vaccines.  In Non-Hodgkin's, T-Cell Immunotherapy is now coming out of the labs into trials which uses a patient's own immune cells (modified to kill tumors).

Bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) are the use of high doses of chemotherapy with a rescue of the immune system afterwards.  More on the Transplantation Information Page.

Watch and wait is used in some low grade/indolent (slow growing) NHL cases. Since it is difficult to treat low grade the doctor will wait until symptoms become troublesome or nodes flare up. It is difficult to see why the doctor refuses a more direct approach. Newer treatments for low grade NHL may allow this method of treatment to be used less often. Monoclonal antibodies are a new form of chemotherapy that may bring this about.

Clinical trials are often used for people who are not responsive to conventional treatment or who wish to help researchers test new therapies.

The treatment chosen will depend on the exact type of lymphoma (there are many subtypes), how much it has spread through the body, the health & age of the patient, and other factors determined by your doctor.

Depending on the choice made by your doctor, some cutting edge / recent advance treatments may be chosen including immunotherapy which includes vaccines and monoclonal antibody therapy.  New drugs in this area are rituxan, bexxar, and zevalin.  These drugs are not for all types of NHL though.

Several types of therapy may be combined - for example immunotherapy is being studied in conjunction with traditional chemotherapy drugs to make them work better.  Likewise, depending on disease presentation, radiotherapy may be added to chemotherapy.

A list of questions you can use to discuss treatment options.

For specific types of treatment see the pages for individual types of NHL or the National Cancer Institute (NCI) data sheets listed under the Non-Hodgkin's Lymphoma: Resources Page.

Further Reading / In-Depth

  • Non-Hodgkin's Lymphomas, Peter M. Mauch (Editor), James O. Armitage (Editor), et al., 2004.
    • Section III: Treatment Principles and Techniques
      • Chapter 11: Principles in Radiation Therapy
      • Chapter 12: Principles of Chemotherapy and Combined Modality Therapy
      • Chapter 13: Biologic Therapy of Lymphoma

       

  • For Patients & loved ones:  Living With Lymphoma, 
    Elizabeth Adler, Oct. 2005
    • Part 2: Treating Lymphoma, pp 59-230

Other Books on Lymphoma Treatment

Multimedia Resources (Updated)

Pretreatment Testing

Radiotherapy

Chemotherapy

Watch and Wait / Watchful Waiting

  • A new page on Watch and Wait (watchful waiting) as a form of treatment

Blood Work

Supportive Care

Nutrition

  • NCI information on Nutrition  (updated link)
  • Lymphoma patients taking procarbazine should avoid the supplement Melatonin - the Melatonin FAQ concurs with this. (updated link)
  • Procarbazine Food Restrictions from Li's Pages

Bone Marrow and Peripheral Blood Cell Information

  • Bone Marrow / Peripheral Blood Stem Cell Transplant Information Page
  • Abstract - Benefit of Autologous Bone Marrow Transplantation Over Sequential Chemotherapy in Poor-Risk Aggressive Non-Hodgkin's Lymphoma: Updated Results of the Prospective Study LNH87-2, Haioun et al, 1997.  (abstract not on Net anymore)

Immunotherapy / Biological Therapies

Clinical Trials

For more information on Adult Non-Hodgkin's Lymphoma, please see the following pages: :

Other pages you may want to visit:

This page is a work in progress - if you have more complete information, references, or other information please contact the author. The author is not in the medical field and does not warrant the correctness of the material on this page or the sites linked - please take online information and consult with your own medical team to make informed decisions.

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Updated November 18, 2005