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.
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, targeted 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)
- Vincristine (Oncovin)
Also, many other drugs are effective when used or combined.
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.
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.
Here are some immunotherapy drugs you might get:
- 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.
- CAR T-cell therapy, or chimeric antigen receptor T-cell therapy, is used when at least two other kinds of treatment have failed. It’s made from your own white blood cells, which are altered to recognize and attack your lymphoma cells.
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), acalabrutinib (Calquence), idelalisib (Zydelig), and copanlisib (Aliqopa).
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.