Your Treatment Options for Non-Hodgkin's Lymphoma

If you've been diagnosed with non-Hodgkin's lymphoma, your next step is to figure out what kind of treatment you need. There are lots of choices. You and your doctor will talk over which one is best for you. Some things that come into play as you wrestle with a decision are the type and stage of the cancer, your symptoms, how old you are, and any other long-term medical problems you have.

You also need to think about any risks or side effects from the treatment. It's OK to talk to another doctor to get a second opinion.  

If you have a slow-growing type of non-Hodgkin's lymphoma, your doctor may suggest you hold off on treatment, a strategy called "watch and wait." He'll keep tabs on your condition, and he won't begin treating you unless the disease gets active.

Chemotherapy

It fights your disease with anti-cancer drugs, and it's a common way to treat non-Hodgkin's lymphoma. The disease affects immune cells that are spread around your body, and chemotherapy lets you reach these areas.

Sometimes doctors inject the medicine into your vein, and sometimes you take it in a pill form. Chemo can also be combined with other treatments, including radiation therapy or immunotherapy. 

Most chemotherapy for lymphoma, whether you take one drug or a few at once, can be done in a clinic, so you won't have to stay overnight in a hospital. You might need a short hospital stay if your treatment plan calls for frequent infusions of drugs into your blood.

A common course of chemotherapy for non-Hodgkin's Lymphoma is called CHOP. It includes a combo of four drugs:

  • Cyclophosphamide (Cytoxan)
  • Hydroxydoxorubicin (Doxorubicin)
  • Vincristine (Oncovin)
  • Prednisone

 Also, many other drugs are effective when used or combined.

Radiation

For this therapy, your doctor will use high-energy rays, like X-rays, to kill your cancer cells. You may also get radiation along with other treatments, like chemotherapy

Radiation therapy is painless and only takes a few minutes. When you're getting the treatment, you most often have the procedure done 5 days a week for a few weeks.

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Immunotherapy

It's a type of treatment that uses your immune system -- the body's defense against germs -- to fight your non-Hodgkin's lymphoma. You'll take drugs that boost your immune system's activity or are man-made versions of your immune system, called monoclonal antibodies. Most of the time, you'll take these medicines through an IV injection.

Some immunotherapy drugs you might get are:

  • Ibritumomab tiuxetan (Zevalin), obinutuzumab (Gazyva), ofatumumab (Arzerra), and rituximab (Rituxan) are all monoclonal antibodies that target CD20, a protein found on some white blood cells.
  • Alemtuzumab (Campath) is an antibody directed at CD52, a different protein.
  • Brentuximab vedotin (Adcetris) is an antibody against CD30, which is found on some lymphoma cells.
  • Interferon is a hormone-like protein that helps your immune system beat infections and can help fight cancer as well.

 

Targeted Therapy

In recent years, researchers have learned more about what causes non-Hodgkin's lymphoma, helping them design drugs that go directly after the cancer-causing changes in cells. These targeted therapies include medications you take as pills, IV infusions, and injections.

Some that your doctor may suggest are:

Proteasome inhibitors. They keep your cells from breaking down certain important proteins. Bortezomib (Velcade) is one of these drugs that your doctor may suggest.

Histone deacetylase (HDAC) inhibitors. They affect how the DNA in your body interacts with proteins and what genes are turned on and off. Belinostat (Beleodaq) and romidepsin (Istodax) are examples.

Kinase inhibitors. These drugs block a type of protein called a kinase, which in some cases is linked to cancer. The medicines include ibrutinib (Imbruvica) and idelalisib (Zydelig).

Stem Cell Transplants

In some rare cases, stem cell transplants are used to treat people with non-Hodgkin's lymphoma who are in remission or have a relapse.

These transplants give you new stem cells for your bone marrow -- the place inside bones that makes blood cells. The procedure lets your doctors give you higher doses of chemotherapy, which normally destroys the stem cells found in bone marrow.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on November 07, 2016

Sources

SOURCES:

Medscape: "Non-Hodgkin Lymphoma Treatment & Management."

American Cancer Society: "How is non-Hodgkin lymphoma treated?" "Chemotherapy for non-Hodgkin lymphoma," "Radiation therapy for non-Hodgkin lymphoma," "Immunotherapy for non-Hodgkin lymphoma," "Targeted therapy drugs for non-Hodgkin lymphoma," "High-dose chemotherapy and stem cell transplant for non-Hodgkin lymphoma."

Leukemia & Lymphoma Society: "Chemotherapy and Drug Therapy," "Radiation Therapy."

Lymphoma Association: "Watch and wait for lymphoma."

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