The treatment options your doctor will recommend will be based on the stage of your NHL, your overall health and your preferences about treatment. In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique. 

If your disease is diagnosed early, you have no symptoms, and it is categorized as an indolent (slow growing) lymphoma, your doctor may recommend a watch and wait approach to your care. This means your doctor may not recommend any treatment at the time of diagnosis. 

Creating a treatment plan is a way to deal with both the short and long-term goals of managing your cancer. It can be helpful to seek second opinions and to talk through all of your options with your doctors in order to develop a treatment plan that best fits your needs. 

Ask questions if you do not understand any aspect of treatment or the medical terms your doctors are using. One of the best ways to improve communication with your health care team is to prepare questions before your visits. It is also helpful to write down notes so you can remember what your doctor has said when you return home, or have someone join and take notes for you.

Questions to Ask Your Doctor:

  • What stage is my NHL?
  • What type of treatment do you recommend at this time?
  • Will the treatment occur primarily as an inpatient or as an outpatient?
  • What are the goals of my treatment?
  • What are the side effects of treatment?
  • Will I need a caregiver at any point during this treatment?
  • Do you recommend a clinical trial at this time?
  • How will my cancer affect my quality of life?
  • What will my treatment cost and how much will my insurance cover?

Treatment Options

The following are common therapies used for the treatment of individuals with a diagnosis of NHL. All of the treatments listed will not necessarily be required or prescribed in your case, as they are individualized to disease stage, presentation and other factors related to your health. Consult with your providers and your health care team to discuss the best option for your disease.

Chemotherapy is treatment of disease with the use of drugs to destroy cancer cells. More than half of all people treated for cancer receive chemotherapy and many different types are available. Each person has a unique response to chemotherapy. Side effects will vary depending on which chemotherapy drug or drug combination you receive, as well as the dose of your drugs, and how often you receive your chemotherapy treatments. 

Chemotherapy can destroy cancer cells almost anywhere in your body, but it can also destroy normal cells. Some chemotherapy is given through your vein, while others may be given in pill form. Chemotherapy is usually given in cycles, which means you may receive treatment for several weeks and take a break for your body to recover. A common chemotherapy drug regimen for NHL is called CHOP, which includes:
  • cyclophosphamide (Cytoxan®)
  • doxorubicin (hydroxydoxorubicin)
  • vincristine (Oncovin®)
  • prednisone
  • Rituximab (Rituxan®), – although it is classified as a monoclonal antibody (a type of immunotherapy) it is often added to this chemotherapy regimen

Stem Cell Transplant: Some people with NHL receive a stem cell transplant as treatment, but it is usually not recommended for those who are newly diagnosed. The stem cells are removed from a patient’s blood or bone marrow, frozen, and stored. Then very high doses of chemotherapy (with or without radiation therapy) are given to the patient in order to kill the cancer prior to re-infusing the previously collected stem cells. These high doses destroy bone marrow, too. When this happens, the body is no longer able to make new blood cells. So, after the treatment ends, the stored stem cells are thawed and put back into the patient's bloodstream through a vein. Over time, the stem cells return to the bone, replacing the marrow and making new, normal blood cells. This type of transplant is referred to as an autologous stem cell transplant, as the cells being re-infused into the body are the patient’s own.

Although used more commonly in NHL, an allogenic transplant (which uses donor stem cells) is not prescribed for every case. However, allogenic transplants may be an option for a person with relapsed or recurring disease that is not responding to initial treatments such as chemotherapy. 

Immunotherapy is a category consisting of any treatment that boosts the patient’s own immune system to fight cancer. These treatments work to kill lymphoma cells or to slow the growth of lymphoma cells. Common categories of immunotherapy agents include monoclonal antibodies (drugs that target the CD20 antigen), antibodies that target the CD52 and CD30 antigens, interferon, and immunomodulating agents. Many of these immunotherapy treatments can only be accessed through clinical trials . Rituximab (Rituxan®) is currently the only immunotherapy approved by Food and Drug Administration (FDA) for the treatment of NHL. 

What is radioimmunotherapy? 
Radioimmunotherapy combines radiation therapy and immunotherapy. A monoclonal antibody is used to deliver radiation directly to the cancer cell. Today, there is one FDA approved radioimmunotherapy treatment—ibritumomab tiuxetan (Zevalin®). Radioimmunotherapy is not an option for every person with NHL. It may be an option for NHL patients with specific types of B-cell lymphomas, and is used more commonly in those with relapsed or refractory disease.

Targeted Therapy uses a drug to identify and target specific types of cancer cells, causing less harm to normal cells. Some targeted therapies work by interfering with a tumor’s ability to grow its own blood supply; others interrupt the signaling system within the cancer cell to prevent it from growing and dividing.

Targeted therapy is given by mouth, through a vein, or as an injection. Targeted therapy may be given in combination with other treatments, such as chemotherapy. Brentuximab vedotin (Adcetris®) is a targeted drug that is approved for NHL after a stem cell transplant.

Most people with NHL are cured with chemotherapy and radiation therapy. However, for people whose cancer returns after treatment or who no longer respond to treatment, several targeted drugs are being tested in clinical trials

Drugs categorized as targeted therapy work differently from standard chemotherapy drugs, and often have different side effects. As scientists have learned more about cancer, they have begun to develop novel drugs that specifically target changes in cells that cause cancer. These targeted therapies include proteasome inhibitors, histone deacetylase (HDAC) inhibitors, and kinase inhibitors.

Radiation Therapy is the use of high-energy rays (ionizing radiation) to kill cancer cells. Radiation works by damaging the genetic material in cells. After radiation treatment ends, cancer cells will keep dying for days or even months. 

For some people with cancer, radiation therapy is the only treatment needed. For others, radiation is given before, during or after other treatments. The goal of radiation is to damage as many cancer cells as possible without harming healthy tissue. To minimize damage to healthy cells, radiation doses are calculated very precisely. Treatment areas are carefully defined and treatment is spread out over time. You will be referred to a radiation oncologist who will deliver your radiation care during this time.

When radiation therapy is used to treat NHL, it is commonly done with a focused beam of radiation, delivered from a machine outside of the body. External beam radiation is a painless procedure, and can be equated to getting an x-ray in terms of how it feels. Radiation may be the main treatment for some types of lymphoma (usually lymphomas found early, stage I or II). For more advanced lymphomas, radiation is often used with chemotherapy for treatment. People receiving stem cell transplant as treatment may get whole-body radiation along with chemotherapy in an effort to kill lymphoma cells throughout the entire body. Radiation therapy is also used to alleviate symptoms caused by lymphoma in some cases. Radiation can also be given as a drug in some cases, such as administration of the drug Zevalin®.

Updated 2/24/15