Non-Hodgkin lymphoma - Treatment

Treatment-Non-Hodgkin lymphoma




Non-Hodgkin lymphoma is usually treated with chemotherapy or radiotherapy, although some people may not need treatment straight away.
In a few cases, if the initial cancer is very small and can be removed during a biopsy, no further treatment may be needed.

Your treatment plan

The recommended treatment plan will depend on your general health and age, as many of the treatments can put a tremendous strain on the body.
Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma.
This is known as a multidisciplinary team (MDT). Your MDT will recommend the best treatment options for you.
But you shouldn't be rushed into making a decision about your treatment plan.
Before deciding, you may wish to talk to friends, family and your partner.
You'll be invited back to see your care team for a full discussion about the risks and benefits of any treatments planned before treatment begins.
You can ask your care team if a clinical trial is available to take part in.

Wait-and-see approach

If the disease is low grade (slow developing) and you're well, a period of "watch and wait" is often recommended.
This is because some people take many years to develop troublesome symptoms and starting treatment immediately is often felt to be unnecessary.
If watch and wait is recommended, you'll be seen regularly for reviews and invited to come back at any stage if you feel your symptoms are getting worse.

Chemotherapy

Chemotherapy is a widely used treatment for non-Hodgkin lymphoma that involves using medicine to kill cancer cells.
It may be used on its own, combined with biological therapy, or combined with radiotherapy.
The medication can be given in a number of different ways, depending on the stage of your cancer.
You'll normally get chemotherapy through a drip directly into a vein (intravenous chemotherapy), as tablets taken by mouth, or a combination of both.
If there's a risk of the cancer spreading to your brain, you may have chemotherapy injections directly into the cerebrospinal fluid around your spine.
Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you get treatment during the day and shouldn't have to stay in hospital overnight.
But there may be times when your symptoms or the side effects of treatment become particularly troublesome and a longer hospital stay may be needed.
If you're taking chemotherapy as tablets, you might be able to take these at home.
Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow.
This can interfere with the production of healthy blood cells and cause the following problems:
  • feeling very tired (fatigue)
  • breathlessness
  • increased vulnerability to infection
  • bleeding and bruising more easily
If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells.
Growth factor medicines can also stimulate the production of blood cells.
Other possible side effects of chemotherapy include:
Most side effects should pass once your treatment has finished.
Tell your care team if side effects become particularly troublesome, as there are treatments that can help.
Read more about the side effects of chemotherapy.

High-dose chemotherapy

If non-Hodgkin lymphoma doesn't get better with initial treatment (known as refractory lymphoma), you may have a course of chemotherapy at a stronger dose.
But this intensive chemotherapy destroys your bone marrow, leading to the side effects mentioned.
You'll need a stem cell or bone marrow transplant to replace the damaged bone marrow.

Radiotherapy

Radiotherapy is most often used to treat early-stage non-Hodgkin lymphoma, where the cancer is only in 1 part of the body.
Treatment is normally given in short daily sessions, Monday to Friday, usually for no more than 3 weeks.
You shouldn't have to stay in hospital between appointments.
Radiotherapy itself is painless, but it can have some significant side effects. These can vary, depending on which part of your body is being treated.
For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss.
Other common side effects include:
  • sore and red skin in the treatment area
  • tiredness
  • nausea and vomiting
  • dry mouth
  • loss of appetite
Most side effects are temporary, but there's a risk of long-term problems, including infertility and permanently darkened skin in the treatment area.
Read more about:

Monoclonal antibody therapy

For some types of non-Hodgkin lymphoma, you may have a type of medication called a monoclonal antibody.
These medications attach themselves to both healthy and cancerous cells, and signal to the immune system to attack and kill the cells.
Once the treatment is over the level of healthy cells goes back to normal over time.
You may be given monoclonal antibody therapy as your only treatment, or they're sometimes given in combination with chemotherapy to make the treatment more effective.
For some types of non-Hodgkin lymphoma, you may continue having monoclonal antibody treatment regularly for up to 2 years after initial treatment, in combination with chemotherapy.
This can reduce the chances of the cancer coming back in the future.
One of the main monoclonal antibody medications used to treat non-Hodgkin lymphoma is called rituximab. 
This medication is given directly into your vein over the course of a few hours.
Side effects of rituximab can include:
  • tiredness
  • feeling sick (nausea)
  • night sweats
  • an itchy rash
  • tummy pain
  • hair loss
You may be given additional medication to prevent or lessen these side effects. Side effects should improve over time as your body gets used to rituximab.

Steroid medication

Steroid medication is commonly used in combination with chemotherapy to treat non-Hodgkin lymphoma.
This is because research has shown that using steroids makes the chemotherapy more effective.
The steroid medication is normally given as tablets or injections, usually at the same time as your chemotherapy.
You'll usually take the steroids for a few days or 1 week during each cycle of chemotherapy, and take breaks in between. This helps to reduce the side effects.
Common side effects of short-term steroid use include:
  • increased appetite, which can lead to weight gain
  • indigestion
  • problems sleeping
  • feeling agitated
On rare occasions, you may have to take steroids on a long-term basis.
Side effects of long-term steroid use include high blood pressure, weight gain, and swelling in your hands, feet and eyelids.
The side effects of steroid medication usually start to improve once treatment finishes.

Follow-up

After your course of treatment ends, you may have a repeat scan to see how well the treatment has worked.
Following this, you'll need regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning (known as a relapse).
These appointments will start off being every few weeks or months, but become less frequent over time.
For more information, see:

Your multidisciplinary team

During your treatment for non-Hodgkin lymphoma, you may see any of the following professionals:
  • specialist cancer nurse or key worker – the first point of contact between you and the members of the care team
  • haematologist – a specialist in drug treatments
  • clinical oncologist – a specialist in radiotherapy
  • pathologist – a specialist in looking at biopsies
  • radiologist – a specialist in X rays and scans
  • social worker
  • transplant specialist
  • psychologist
  • counsellor
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