Treatment Option Overview

There are different types of treatment for patients with non-Hodgkin lymphoma.

Treatment for adult non-Hodgkin lymphoma may cause side effects.

Nine types of standard treatment are used:

Radiation therapy
Chemotherapy
Immunotherapy
Targeted therapy
Plasmapheresis
Watchful waiting
Antibiotic therapy
Surgery
Stem cell transplant

New types of treatment are being tested in clinical trials.

Vaccine therapy
CAR-T Cell therapy

Patients may want to think about taking part in a clinical trial.

Side Effects of Treatment for adult non-Hodgkin lymphoma

Early Effects of cancer treatment may include the following:

Appetite Loss
Low White Cell Count (Leucopenia/Neutropenia)
Bleeding and Bruising (Thrombocytopenia)
Constipation/Diarrhea
Nausea and Vomiting
Edema (Swelling)
Fatigue
Flu-Like Symptoms
Hair Loss (Alopecia)
Infections
Memory or Concentration Problems
Mouth and Throat Problems
Nerve Problems (Peripheral Neuropathy)
Skin and Nail Changes
Sleep Problems and Insomnia
Urinary and Bladder Problems
Fertility and Sexual Health Issues

Late effects of cancer treatment may include the following:

Heart problems.
Infertility (inability to have children).
Loss of bone density.
Neuropathy (nerve damage that causes numbness or trouble walking).
A second cancer

Some late effects may be treated or controlled. It is important to talk with your doctor about the effects cancer treatment can have on you. Regular follow-up to check for late effects is important.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).
When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Combination chemotherapy is treatment using two or more anticancer drugs. Steroid drugs may be added, to lessen inflammation and lower the body's immune response.
Systemic combination chemotherapy is used for the treatment of adult non-Hodgkin lymphoma.
Intrathecal chemotherapy may also be used in the treatment of lymphoma that first forms in the testicles or sinuses (hollow areas) around the nose, diffuse large B-cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma, and some aggressive T-cell lymphomas. It is given to lessen the chance that lymphoma cells will spread to the brain and spinal cord. This is called CNS prophylaxis.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. Immunomodulators and CAR T-cell therapy are types of immunotherapy.
Immunomodulators: Lenalidomide is an immunomodulator used to treat adult non-Hodgkin lymphoma.
CAR T-cell therapy: The patient's T cells (a type of immune system cell) are changed so they will attack certain proteins on the surface of cancer cells.
T cells are taken from the patient and special receptors are added to their surface in the laboratory.
The changed cells are called chimeric antigen receptor (CAR) T cells.
The CAR T cells are grown in the laboratory and given to the patient by infusion.
The CAR T cells multiply in the patient's blood and attack cancer cells.
CAR T-cell therapy (such as axicabtagene ciloleucel or tisagenlecleucel) is used to treat large B-cell lymphoma that has not responded to treatment.
CAR T-cell therapy is being studied in several other lymphomas.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapy may cause less harm to normal cells than chemotherapy or radiation therapy do.

Monoclonal antibody therapy, proteasome inhibitor therapy, and kinase inhibitor therapy are types of targeted therapy used to treat adult non-Hodgkin lymphoma.

Monoclonal antibody therapy: This treatment uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading.

Monoclonal antibodies are given by infusion.

Types of monoclonal antibodies include:

Rituximab, used to treat many types of non-Hodgkin lymphoma.
Obinutuzumab, used to treat follicular lymphoma.
Mogamulizumab, used to treat certain types of relapsed or refractory T-cell lymphoma.
Polatuzumab vedotin, combined with bendamustine and rituximab to treat relapsed or refractory diffuse large B-cell lymphoma.
Brentuximab vedotin, which contains a monoclonal antibody that binds to a protein called CD30 that is found on some lymphoma cells. It also contains an anticancer drug that may help kill cancer cells.

Proteasome inhibitor therapy: This treatment blocks the action of proteasomes in cancer cells. Proteasomes remove proteins no longer needed by the cell. These proteins build up in the cell and may cause the cancer cell to die. Bortezomib is used for treatment for lymphoplasmacytic lymphoma. It is also being studied to treat relapsed mantle cell lymphoma.

Kinase inhibitor therapy: This treatment blocks certain proteins, which may help keep lymphoma cells from growing and may kill them. Kinase inhibitor therapies include:

Copanlisib, idelalisib, and duvelisib, which block P13K proteins and are used to treat follicular non-Hodgkin lymphomas that have not responded well to treatment.
Ibrutinib and acalabrutinib, types of Bruton tyrosine kinase inhibitor therapy. They are used to treat lymphoplasmacytic lymphoma and mantle cell lymphoma.
Venetoclax may also be used to treat mantle cell lymphoma. It blocks the action of a protein called B-cell lymphoma-2 (BCL-2) and may help kill cancer cells.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Sometimes total-body irradiation is given before a stem cell transplant.
External radiation therapy is used to treat adult non-Hodgkin lymphoma, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Surgery

Surgery may be used to remove the lymphoma in certain patients with indolent or aggressive non-Hodgkin lymphoma.

The type of surgery used depends on where the lymphoma formed in the body:

Local excision for certain patients with mucosa-associated lymphoid tissue (MALT) lymphoma, PTLD, and small bowel T-cell lymphoma.
Splenectomy for patients with marginal zone lymphoma of the spleen.

Stem cell transplant

Stem cell transplant is a method of giving high doses of chemotherapy and/or total-body irradiation and then replacing blood-forming cells destroyed by the cancer treatment.
Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient (autologous transplant) or a donor (allogeneic transplant) and are frozen and stored.
After the chemotherapy and/or radiation therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion.
These reinfused stem cells grow into (and restore) the body’s blood cells.