Understanding Non-Hodgkin Lymphoma -- the Basics
Basic information about non-Hodgkin lymphoma from the experts at WebMD.
Understanding Non-Hodgkin Lymphoma -- Diagnosis & Treatment
Learn more about the diagnosis and treatment of non-Hodgkin lymphoma from the experts at WebMD.
Radiation Therapy for Lymphoma and Leukemia
Radiation therapy is the use of high - dose X - rays to treat cancer cells that may remain after surgery, especially if all of the cancer cannot be removed. Radiation therapy is often used for the treatment of cancer, such as non - Hodgkin's lymphoma (NHL), Hodgkin's lymphoma, and all types of leukemias. Radiation therapy may be used alone or in combination with other treatment options, such as ..
Watchful Waiting (Surveillance) for Non-Hodgkin's Lymphoma
Watchful waiting (surveillance) is a period in the treatment of non - Hodgkin's lymphoma (NHL) in which little or no treatment is done. It does not mean that your health professionals are giving up or refusing to give you treatment. ...
Treatment for Indolent, Noncontiguous Stage II / III / IV Adult NHL
Optimal treatment of advanced stages of low-grade non-Hodgkin lymphoma is controversial because of low cure rates with the current therapeutic options. Numerous clinical trials are in progress to settle treatment issues, and patients should be urged to participate. The rate of relapse is fairly constant over time, even in patients who have achieved complete response to treatment. Indeed, relapse may occur many years after treatment. Currently, no randomized trials guide clinicians about the initial choice of watchful waiting, rituximab, nucleoside analogs, alkylating agents, combination chemotherapy, radiolabeled monoclonal antibodies, or combinations of these options.; [Level of evidence: 1iiDiii]For patients with indolent, noncontiguous stage II and stage III non-Hodgkin lymphoma, central lymphatic radiation therapy has been proposed but is not usually recommended as a form of treatment.[3,4]Numerous prospective clinical trials of interferon-alpha,
Treatment Option Overview for Adult NHL
Treatment of non-Hodgkin lymphoma (NHL) depends on the histologic type and stage. Many of the improvements in survival have been made using clinical trials (experimental therapy) that have attempted to improve on the best available accepted therapy (conventional or standard therapy). In asymptomatic patients with indolent forms of advanced NHL, treatment may be deferred until the patient becomes symptomatic as the disease progresses. When treatment is deferred, the clinical course of patients with indolent NHL varies; frequent and careful observation is required so that effective treatment can be initiated when the clinical course of the disease accelerates. Some patients have a prolonged indolent course, but others have disease that rapidly evolves into more aggressive types of NHL that require immediate treatment.Radiation techniques differ somewhat from those used in the treatment of Hodgkin lymphoma. The dose of radiation therapy usually varies from 25 Gy to 50 Gy and is
Changes to This Summary (04 / 04 / 2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.Cellular Classification of Childhood NHLAdded Godot et al. as reference 42 and Louissaint et al. as reference 48.Revised text to state that mucosa-associated lymphoid tissue (MALT) lymphomas observed in pediatric patients usually present as low-stage disease, and pediatric gastric MALT lymphomas are associated with Helicobacter pylori and require no more than local therapy involving curative surgery and/or radiation therapy. Also added text to state that conjunctival MALT lymphomas are often associated with chlamydial psittaci infections (cited Stefanovic et al. as reference 54).Added text to state that an oral retinoid (bexarotene) has been reported to be active against subcutaneous panniculitis-like T-cell lymphomas and cutaneous gamma-delta T-cell lymphomas in a series of 15 patients from
Recurrent Childhood NHL Treatment
Outcome for recurrent non-Hodgkin lymphoma (NHL) in children and adolescents depends on histologic subtype. A Children's Cancer Group study (CCG-5912) was able to achieve complete remission (CR) in 40% of NHL patients. A Pediatric Oncology Group study showed a 70% response rate and 40% CR rate. Radiation therapy may have a role in treating patients who have not had a complete response to chemotherapy. All patients with primary refractory or relapsed NHL should be considered for clinical trials. For recurrent or refractory B-lineage NHL, survival is generally 10% to 20%.[3,4,5,6,7] Chemoresistance is a major problem, making remission difficult to achieve. There is no standard treatment option for patients with recurrent or progressive disease. The use of single-agent rituximab, as well as rituximab combined with standard cytotoxic chemotherapy, has shown activity in the treatment of B-cell lymphoma patients.[Level of evidence: 3iiiDii] A Children's Oncology Group (COG)
Treatment for Indolent, Recurrent Adult NHL
In general, treatment with standard agents rarely produces a cure in patients whose disease has relapsed. Sustained remissions after relapse can often be obtained in patients with indolent lymphomas, but relapse will usually ensue. Favorable survival after relapse has been associated with an age younger than 60 years, complete remission rather than partial remission, and duration of response longer than 1 year. Even the most favorable subset, however, has a tenfold greater mortality compared with age-adjusted U.S. population rates. Patients who experience a relapse with indolent lymphoma can often have their disease controlled with single agent or combination chemotherapy, rituximab (an anti-CD20 monoclonal antibody), lenalidomide, radiolabeled anti-CD20 monoclonal antibodies, or palliative radiation therapy.[2,3] Long-term freedom from second relapse, however, is uncommon and multiple relapses will usually occur. Patients with indolent lymphoma may experience a relapse with a
Treatment for Aggressive, Stage I and Contiguous Stage II Adult NHL
Patients with stage I or contiguous stage II diffuse large B-cell lymphoma are candidates for combination chemotherapy with or without involved-field radiation therapy (IF-XRT).The following drug combinations are referred to in this section:R-CHOP: rituximab, an anti-CD20 monoclonal antibody, + cyclophosphamide + doxorubicin + vincristine + prednisone.Standard Treatment Options for Aggressive, Stage I and Contiguous Stage II Adult NHLStandard treatment options for aggressive, stage I and contiguous stage II adult NHL include the following:R-CHOP with or without IF-XRT.R-CHOP with or without IF-XRTFour prospective randomized trials have evaluated the comparison of CHOP or more intensive CHOP-based chemotherapy alone versus combined–modality therapy with CHOP and IF-XRT.[1,2,3,4,5]Evidence (CHOP vs. CHOP with IF-XRT): In a randomized trial with 7 years' median follow-up, 576 patients older than 60 years with early-stage disease received four cycles of CHOP with or without IF-XRT;