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Non-Hodgkin's Lymphoma

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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 dependent on factors that include the histologic type of lymphoma, the patient's stage and overall condition, the goal of treatment (curative or palliative), the proximity of sensitive surrounding organs, and whether the patient is being treated with radiation therapy alone or in combination with chemotherapy. Given the patterns of disease presentations and relapse, treatment may need to include unusual sites such as Waldeyer ring, epitrochlear, or mesenteric nodes. The associated morbidity of the treatment must be considered carefully. The majority of patients who receive radiation are usually treated on only one side of the diaphragm. Localized presentations of extranodal NHL may be treated with involved-field techniques with significant (>50%) success.

    Table 4. Standard Treatment Options for NHL

    StageStandard Treatment Options
    CNS = central nervous system; CHOP = cyclophosphamide plus doxorubicin plus vincristine plus prednisone; IF-XRT = involved-field radiation therapy; NHL = non-Hodgkin lymphoma; R-CHOP = rituximab, an anti-CD20 monoclonal antibody, plus cyclophosphamide plus doxorubicin plus vincristine plus prednisone.
    Indolent, Stage I and Contiguous Stage II Adult NHL Radiation therapy
    Rituximab with or without chemotherapy
    Watchful waiting
    Other therapies as designated for patients with advanced-stage disease
    Indolent, Noncontiguous Stage II/III/IV Adult NHLWatchful waiting for asymptomatic patients
    Rituximab
    Purine nucleoside analogs
    Alkylating agents (with or without steroids)
    Combination chemotherapy
    Yttrium-90 labeled ibritumomab tiuxetan and iodine-131-labeled tositumomab
    Maintenance rituximab
    Indolent, Recurrent Adult NHLChemotherapy (single agent or combination)
    Rituximab
    Lenalidomide
    Radiolabeled anti-CD20 monoclonal antibodies
    Palliative radiation therapy
    Aggressive, Stage I and Contiguous Stage II Adult NHLR-CHOP with or without IF-XRT
    Aggressive, Noncontiguous Stage II/III/IV Adult NHLR-CHOP
    Other combination chemotherapy
    Adult Lymphoblastic LymphomaIntensive therapy
    Radiation therapy
    Diffuse Small Noncleaved-Cell/Burkitt LymphomaAggressive multidrug regimens
    Central nervous system (CNS) prophylaxis
    Aggressive, Recurrent Adult NHLBone marrow or stem cell transplantation
    Re-treatment with standard agents
    Palliative radiation therapy
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