Non-Hodgkin Lymphoma Treatment

Non-Hodgkin lymphoma (NHL) is a type of cancer that develops from lymphocytes. These are a type of white blood cell.^1,2

Blood travels through the blood and lymphatic vessels, and the bone marrow is the factory for all the blood cells. Lymphomas and leukemias are both types of blood cancer. However, the term leukemia describes diseases that are mostly in the blood and bone marrow. The term lymphoma describes cancers that are mostly in the lymph nodes and have a greater tendency to form solid masses.²

Treatment for NHL is based on several factors, including:³

• NHL subtype
• The extent of the disease
• The person's age and overall health

B-cell lymphoma is the most common subtype of NHL in the United States. It impacts the B lymphocytes. T-cell lymphoma is rarer and affects the T lymphocytes. In choosing the right treatment options for NHL, doctors also consider possible long-term side effects.^1,2

Types of treatment for non-Hodgkin lymphoma

Different types of treatment may be used for NHL in adults, including:²

• Radiation therapy
• Chemotherapy
• Immunotherapy
• Targeted therapy
• Watchful waiting
• Surgery
• Stem cell transplant
• Steroids
• Phototherapy

Radiation therapy

Radiation uses a focused beam of high-energy radiation to kill cancer cells. Radiation may be given for early- or late-stage NHL cancer. Radiation also may be given before a stem cell transplant along with chemotherapy. It may also be given like a drug.^2,4

Another reason for radiation is to ease symptoms like pain. This may help when NHL has spread to the brain or spinal cord, or when tumors are pressing on nerves. Treatment given to ease symptoms is called palliative care.^2,4

Chemotherapy

Chemotherapy is a broad group of drugs that slow or stop the growth of cancer cells. Chemotherapy works by targeting fast-growing cells, such as the type of cells cancer makes. However, chemotherapy also attacks other fast-growing cells in the body, including ones in the gut and hair.²

Chemotherapy drugs may be used by themselves. Or they may be combined with other drugs, surgery, or radiation. Chemotherapy drugs may be taken by mouth or injected into a vein, muscle, or area around the spinal cord.²

Immunotherapy

Immunotherapy is a treatment that works in one of 2 ways. It either boosts the body’s own immune system or uses human-made substances to kill or slow the growth of lymphoma cells. Immunotherapy is a type of biologic therapy.^2,5

Types of immunotherapy used to treat NHL include:^2,5

• Immune checkpoint inhibitors
• Immunomodulators
• Chimeric antigen receptor (CAR) T-cell therapy

In CAR T-cell therapy, the person's own T-cells are removed from the body. They are then altered in a lab. These altered T-cells are designed to target specific cancer cells. These new T-cells are then put back into the person's bloodstream to fight cancer.^2,5

Targeted therapy

Targeted therapies are treatments targeted to attack specific cancer cells. Targeted therapies may take the form of drugs or other substances. They work by blocking or slowing the growth of cancer cells. Targeted therapies usually cause less damage to healthy cells than chemotherapy or radiation.²

Types of targeted therapy used to treat NHL include:^2-5

• Monoclonal antibodies – These antibodies are created in a lab to identify and block cancer growth or kill cancer cells. They may also be used to deliver chemotherapy drugs or radioactive particles to cancer cells.
• Proteasome inhibitors – These drugs block the action of proteasomes, which remove proteins inside cancer cells. By blocking this action of proteasomes, these treatments increase proteins in cancer cells, which can cause them to die.
• Kinase inhibitors – These drugs block specific proteins. This can keep certain lymphoma cells from growing and may kill them.
• Histone deacetylase inhibitors – This therapy can help treat cancer cells by affecting proteins known as histones.
• Nuclear export inhibitors – These drugs work by impacting the XPO1 protein to disrupt the normal distribution of other proteins within cancer cells. This can cause cancer cells to die.
• EZH2 inhibitors – This therapy helps block the methyltransferase protein, which can play a key role in cancer cell growth.

Watchful waiting

Depending upon your specific type of NHL, your doctor may recommend watchful waiting if you are not having symptoms of the disease. During watchful waiting, you do not receive treatment for blood cancer. However, other problems like infections are treated.²

Your health is monitored closely during watchful waiting. Your doctor will watch for any changes in your condition and the potential appearance of symptoms like fatigue, weight loss, or an enlarged spleen.²

Surgery

Surgery may be used to treat certain cases of NHL in adults. For example, the spleen may be removed (splenectomy). Surgery also may be used in some people with mucosa-associated lymphoid tissue (MALT) lymphoma or small bowel T-cell lymphoma.²

Stem cell transplants

Stem cell transplants may be a treatment option for some people with NHL in combination with chemotherapy. High doses of chemotherapy destroy cancer cells. However, they also damage healthy blood cells. Stem cells (immature cells that can become new blood cells) can be removed before the chemotherapy and replaced afterward to help restore healthy bone marrow.^2,6

The stem cells may be gathered from the person with NHL before chemotherapy. This is called an autologous transplant. Or they may be donated by another person. This is called an allogeneic transplant.^2,6

Not everyone is a candidate for stem cell transplants. High doses of chemotherapy can be very taxing on a person’s body, so stem cell transplants may not be tolerated by older adults or those with other health problems.^2,6

Steroids

Steroids are often used to increase the effectiveness of chemotherapy to treat NHL. Steroids come in tablet form or are given as an injection when you receive chemotherapy.⁶

Phototherapy

Phototherapy uses a combination of a drug and laser light to kill cancer cells. After the drug is injected into a vein, it is activated when the laser light is shined on the skin. Phototherapy may be used to treat some people with a type of NHL called cutaneous T-cell lymphoma.⁷

Clinical trials

Clinical trials are an important way that researchers find new treatments. In this type of research, new treatments are studied to determine whether they are safe and effective for certain conditions. Visit ClinicalTrials.gov to learn more about clinical trials. Your doctor also can help you decide if a clinical trial may be right for you.⁸