Treatments for Non-Hodgkin Lymphoma
Several treatments are available for non-Hodgkin lymphoma. What's best for you depends on the type and stage of non-Hodgkin lymphoma you have, as well as your personal preferences. The stage indicates where the cancer started, whether it has spread, and where it has spread.
The four main treatments for non-Hodgkin lymphoma are chemotherapy, radiation, immunotherapy, and targeted therapy. Different types of cancer specialists give these treatments. It's common to need more than one type of treatment. That means you will work with a team of healthcare providers.
Chemotherapy is the main treatment for all types and stages of non-Hodgkin lymphoma. Chemotherapy involves using a drug to kill cancer cells or keep them from growing. You take some chemotherapy drugs by mouth. Others you get through a tube placed in one of your veins (intravenous infusion). If you have a fast-growing (aggressive) type of non-Hodgkin lymphoma, your chemotherapy might be a combination of four drugs.
Chemotherapy kills cancer cells and some normal cells. This can cause side effects, some of which last a short while and go away once treatment stops. Other chemotherapy side effects can be long-term. Your treatment team will work with you to avoid or manage any side effects.
Short-term side effects may include:
Long-term side effects and ones that start after treatment can include:
A second cancer
Radiation therapy is high-energy X-rays or other types of radiation. These treatments kill cancer cells or keep them from growing. All types and stages of non-Hodgkin lymphoma may benefit from radiation therapy. Most people with cancer get radiation therapy along with chemotherapy or right after chemotherapy.
Like chemotherapy, radiation can damage normal cells along with cancer cells. Long-term side effects also are similar to chemotherapy. Short-term side effects include fatigue, nausea, diarrhea, and skin reactions.
Immunotherapy is a treatment that helps your body’s immune system fight cancer. The most common immunotherapy for non-Hodgkin lymphoma involves the use of man-made versions of immune system proteins (monoclonal antibodies). Rituximab (Rituxan) is one example. The antibodies attach to a cancer cell and kill it or make it easier for other treatments to find and kill the cell. Monoclonal antibodies can treat all types and stages of non-Hodgkin lymphoma. Your doctor may recommend immunotherapy alone or combine it with chemotherapy.
You get this treatment through an injection into a vein (IV infusion) or under your skin.
Side effects during or after the infusion can include fever, chills, headache, fatigue, itching and rash. Immunotherapy also can put you at risk for developing serious infections. It's also possible to have allergic reactions, such as swelling of the face or tongue or trouble breathing. You will get medication to block this reaction before treatment.
Targeted therapy attacks only cancer cells. It does not affect normal cells. That means it also has fewer side effects than chemotherapy or radiation.
One type of drug doctors prescribe is a proteasome inhibitor. The drug bortezomib (brand name Velcade) targets certain proteins (proteasomes) in cancer cells that the cells need to grow and divide. You receive this drug as an IV infusion or an injection under your skin. This type of targeted therapy may work on types of non-Hodgkin lymphoma not responding to other treatments. Side effects can include nausea and nerve damage.
Another type of targeted therapy involves kinase inhibitors. Kinase inhibitor drugs block specific protein (kinases) that cancer cells need to grow. Ibrutinib (Imbruvica) and idelalisib (Zydelig) are two different kinase inhibitors. This targeted therapy may help people with stage 2, 3 or 4 slow-growing (indolent) non-Hodgkin lymphoma. You take these drugs by mouth Side effects can include fatigue, constipation, diarrhea, nausea, rash, stomachache, cough, chills and fever.
Besides the four main ones, other treatments include:
Stem cell transplant. This treatment is for people with non-Hodgkin lymphoma that is aggressive or has come back after other treatments. First, your treatment team removes very young blood cells (stem cells) from your blood or bone marrow. You then have whole-body radiation or very high doses of chemotherapy to kill cancer cells. After treatment, the stem cells are put back in your body. The stem cells will grow into healthy white blood cells. Another option is to get stem cells from a donor instead of using your own stem cells.
Surgery. Surgery is a rare treatment for non-Hodgkin lymphoma. It may be done to treat lymphoma that forms tumors in the stomach, spleen or intestine.
Another option is called "watchful waiting." This might be suggested if you have indolent non-Hodgkin lymphoma and no symptoms. Watchful waiting is not actually a treatment. Instead, your treatment team will monitor your cancer and your health very closely. But, you won't start treatment unless your condition changes and your doctors think treatment is necessary.