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
Lymphomas are a different form of blood cancer than leukemias. Blood travels through the blood and lymphatic vessels, and the bone marrow is the factory for all the blood cells. However, the term leukemia describes diseases that are mostly in the blood and bone marrow, and lymphoma describes blood cancers that are mostly in the lymph nodes and have more of a tendency to form solid masses.
Treatment for NHL is based on several factors, including:
- NHL subtype
- The extent of the disease
- The person's age and overall health
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
- Targeted therapy
- Watchful waiting
- Stem cell transplant
Radiation therapy uses high-energy radiation. In NHL, radiation may be given in early-stage or late-stage cancers. Radiation may also be given before a stem cell transplant. Radiation can be used as a palliative treatment (to ease symptoms like pain) when NHL has spread to certain parts of the body.2,3
Chemotherapy is the use of drugs to stop cancer cells. Chemotherapy works by targeting fast-growing cells, such as cancer cells. However, there are other fast-growing cells in the body that can also be affected, such as those in the gastrointestinal tract and hair.2
Chemotherapy drugs may be used along with other drugs or alone. They may be taken by mouth or injected into a vein or muscle. Chemotherapy may also be delivered directly into the space around the spinal cord. This is called intrathecal chemotherapy.2
Immunotherapy is a type of treatment that boosts the body’s immune system to fight cancer.2,4
Types of immunotherapy used to treat NHL include:2,4
- Immune checkpoint inhibitors
- 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 to specifically target cancer cells and given back into the person's bloodstream to fight cancer cells.
Targeted therapies are cancer treatments that block or slow the growth and spread of cancer. They do this by interfering with specific areas of cancer cells involved in cell growth or by focusing on specific features that are unique to cancer cells. While chemotherapy drugs often kill cancer cells, targeted therapy usually blocks the growth of cancer cells.2
Types of targeted therapy used to treat NHL include:2,5,6,8
- 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 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.
Depending upon the specific type of NHL, watchful waiting may be recommended if you are not experiencing symptoms from the disease. During watchful waiting, you do not receive treatment for blood cancer. However, problems like infections are treated. Your health is closely 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 may be used in the treatment of certain cases of NHL in adults, such as removal of the spleen (splenectomy). Surgery may also be used in some people with mucosa-associated lymphoma tissue (MALT) lymphoma or small bowel T-cell lymphoma.2
Stem cell transplants
Stem cell transplants are used along with high doses of chemotherapy and may be a treatment option for some people with NHL. High doses of chemotherapy destroy cancer cells. However, they also damage healthy blood cells. The transplant of stem cells (immature cells that can become new blood cells) is given to restore the bone marrow.2,3
The stem cells may be gathered from the person with NHL before chemotherapy. This is called an autologous transplant. Or, they may be given by a donor. This is called an allogeneic transplant. Not everyone is a candidate for stem cell transplants. The 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.2,3
Phototherapy uses a drug and a type of laser light to kill cancer cells. The drug is injected into a vein and becomes active 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.4
Clinical trials are a type of research where new treatments are studied. Clinical trials are an important part of the scientific process to find and prove the safety and effectiveness of new treatments. They offer people a chance to receive the latest treatments and be closely monitored by doctors. You can learn more about clinical trials by talking to your doctor or visiting the ClinicalTrials.gov website. Your doctor can help you decide if a clinical trial may be right for you.2,7,8