Treatment Options and Side Effects Management for NHL
Chemotherapy uses drugs to destroy cancer cells. Most people treated for cancer receive some kind of chemotherapy. Side effects will vary depending on the type, dose and frequency of the drug or drug combination you receive.
Chemotherapy can destroy cancer cells, but it can also destroy normal cells. It is given through a vein, as a shot , or taken in pill form. Chemotherapy is usually given in cycles, which means you may receive treatment for several weeks then 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®) and prednisone.
Treatment for B-cell lymphomas usually also includes a targeted medication called rituximab (Rituxan®). This drug binds to a marker on the outside of the B-cells. Since this medication was approved, patient outcomes have significantly improved in B-cell lymphomas. When rituximab– is added to CHOP, it is called R-CHOP. Sometimes, other targeted medications similar to Rixutan are used, such as obinutuzumab (Gazyva), or ofatumumab (Arzerra).
Stem Cell Transplant
Stem cell transplants are sometimes used to treat NHL. This treatment is rarely recommended for newly diagnosed lymphomas. Learn more information on stem cell transplants.
Immunotherapy is any treatment that boosts the patient’s own immune system to fight cancer or uses man-made versions of the normal parts of the immune system to kill lymphoma cells or slow their growth.
Common categories of immunotherapy include:
- Monoclonal antibodies (manmade versions of antibodies) that target the CD20 antigen (a protein on the surface of B lymphocytes). Rituxan targets CD 20. It is the most commonly used immunotherapy approved by the Food and Drug Administration (FDA) for the treatment of NHL.
- Antibodies that target the CD52 and CD30 antigens
- Immune checkpoint inhibitors. These drugs block immune system cells that have substances that act as checkpoints to keep them from attacking other healthy cells in the body. Blocking these checkpoints can boost the immune response against cancer cells.
- Immunomodulating drugs. These drugs stimulate or suppress the immune system to help the body fight cancer.
- Radioimmunotherapy. This treatment combines radiation therapy and immunotherapy. A monoclonal antibody is used to deliver radiation directly to the cancer cell. Radioimmunotherapy may be an option for NHL patients with specific types of B-cell lymphomas. It is used more commonly in relapsed or refractory disease, when cancer comes back or remains in the bone marrow after treatment.
Many of these immunotherapy treatments are available only through clinical trials.
CAR T-cell (Chimeric antigen receptor T-cell) therapy is a new type of immunotherapy. White blood cells called T-cells are removed from the blood, and are re-programmed to attack the cancer. The patient is treated with chemotherapy to suppress the immune system and allow the CAR T-cells to work, and then receives these reprogrammed cells back into their blood. This treatment poses some serious risks. It can only be given at a few approved centers, with very close monitoring. Often it must be given in the hospital for the first several days. It is not used as a first-line treatment. CAR T-cell therapy is reserved for cases where a patient has suffered a relapse of their NHL after two prior lines of treatment.
Targeted therapy uses new kinds of drugs to identify and target cancer cells, causing less harm to normal cells. There are several types of targeted therapy in use today, including: proteasome inhibitors, histone deacetylase (HDAC) inhibitors, kinase inhibitors, and antibody drug conjugates. Some work by interfering with a tumor’s ability to grow its own blood supply. Others interrupt the signaling system within the cancer cell to stop it from growing and dividing.
Targeted therapy is given either by mouth in pill form, through a vein, or as an injection. In the past, targeted therapies were used mostly for lymphomas that had returned after initial treatment. Today these new therapies are more often being used as part of initial treatment. Sometimes targeted therapy is used in combination with other treatments. Other targeted therapies may be available through clinical trials.
Radiation therapy uses high-energy rays or ionizing radiation to kill cancer cells. The goal is to damage cancer cells without harming healthy tissue. After radiation treatment ends, cancer cells continue to die for days or even months. Some people with cancer only need radiation therapy. Others receive radiation before, during or after other treatments.
Radiation therapy for NHL uses a focused beam of radiation from a machine outside of the body. External beam radiation is a painless procedure. Radiation may be the main treatment for some stage I and II lymphomas. It may be used with chemotherapy for more advanced lymphomas. People receiving stem cell transplants may get whole-body radiation along with chemotherapy to kill lymphoma cells throughout the body, and to help prepare the body to receive the stem cells . Radiation therapy is also sometimes used to treat symptoms of lymphoma. Some radiation is available in drug form.
Side Effect Management
It helps to learn more about the side effects of treatment before you begin so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.
There are many medications available to address side effects from cancer treatment. Everyone reacts differently to treatment and experiences side effects differently. Talk to your health care team about your side effects so they can help you feel better. Your doctor may be able to discuss options such as lowering the dose of your treatment if side effects persist and are not easily managed. You may want to consult a palliative and supportive care specialist, who can help manage symptoms from cancer treatment.
The following are common side effects:
- Hair loss
- Mouth sores or dry mouth
- Loss of appetite
- Nausea and vomiting
- Skin changes
- Increased chance of infections (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
You may also experience side effects of treatment well after your treatment has ended. It is important to talk to your doctor about long-term effects of treatment as part of your post-treatment plan.