Non-Hodgkin Lymphoma Treatment

Non-Hodgkin lymphoma (NHL)  is a type of cancer that develops from lymphocytes, a type of white blood cells. Lymphomas and leukemias are both types of blood cancer. Lymphoma refers to cancers that usually occur in the lymph nodes.1,2

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

• NHL subtype
• Extent of the disease
• Age and overall health of the person
• Possible long-term treatment side effects

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.^1,2

Types of treatment for non-Hodgkin lymphoma

Several types of treatment may be used in adults with NHL, including:²

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

Radiation therapy

Radiation uses a 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 in medication form in certain situations.2,4

Another reason for radiation treatment is to ease symptoms. This may help when NHL has spread to the brain or spinal cord, or when tumors are pressing on nerves, resulting in pain. 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 cancer cells. However, chemotherapy also attacks other fast-growing healthy cells in the body, like ones in the gut and hair.2

There are many types of chemotherapy drugs. They may be used by themselves or combined with other drugs, surgery, or radiation. Chemotherapy drugs may be taken by mouth or injected.2

Immunotherapy

Immunotherapy is a treatment that works in 1 of 2 ways. It may boost the body’s own immune system to attack lymphoma cells. Or it may use human-made substances to kill or slow the growth of lymphoma cells.2,5

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

• Immune checkpoint inhibitors – Drugs that prevent lymphoma cells from avoiding your immune system. Examples include Keytruda^® (pembrolizumab).
• Immunomodulators – Drugs that modify the immune system to work against lymphoma. Examples include Thalomid^® (thalidomide) and Revlimid^® (lenalidomide).
• Chimeric antigen receptor (CAR) T-cell therapy – Treatment that changes your T cells in the lab to attack lymphoma cells. Examples include Yescarta^® (axicabtagene ciloleucel) and Kymriah^® (tisagenlecleucel).
• Bispecific T-cell engager (BiTE) therapy– Drugs that link T cells and lymphoma cells to help the immune system attack them. Examples include Lunsumio™ (mosunetuzumab), Epkinly™ (epcoritamab), and Columvi™ (glofitamab).

Targeted therapy

Targeted therapies are treatments that interfere with specific areas of cancer cells that are involved in cancer cell growth or focus on features that are unique to cancer cells. They block or slow the growth of cancer cells. Targeted therapies aim to cause less damage to healthy cells than treatments such as chemotherapy.2

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

• Monoclonal antibodies – Antibodies created in a lab that are designed to attack a specific target to block cancer growth or kill cancer cells. Examples include Rituxan® (rituximab) and Monjuvi® (tafasitamab).
• Antibody-drug conjugates – Treatment that uses a monoclonal antibody to bring a chemotherapy drug directly to cancer cells. Examples include Zynlonta® (loncastuximab tesirine).
• Proteasome inhibitors – Drugs that block protein removal inside cancer cells, which causes them to die. Examples include Velcade® (bortezomib).
• Kinase inhibitors – Drugs that block specific proteins that help lymphoma cells grow. Examples include Imbruvica® (ibrutinib) and Calquence® (acalabrutinib).
• Histone deacetylase (HDAC) inhibitors – Drugs that affect how certain genes interact with proteins called histones. Examples include Beleodaq® (belinostat).
• Nuclear export inhibitors – Drugs that disrupt the normal distribution of other proteins within cancer cells, causing them to die. Examples include Xpovio® (selinexor).
• EZH2 inhibitors – Drugs that block a protein called methyltransferase, which plays a role in cancer cell growth. Examples include Tazverik® (tazemetostat).

Watchful waiting

If you do not have symptoms, your doctor may recommend watchful waiting. During watchful waiting, you do not receive treatment. But your doctor will treat other problems, like infections.2

Your doctor will closely monitor your health during watchful waiting. They will watch for any changes in your condition and symptoms like fatigue, weight loss, or an enlarged spleen.2

Surgery

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

Stem cell transplants

Stem cell transplants combined with chemotherapy may be a treatment option for some people with NHL. High doses of chemotherapy destroy cancer cells. But they also damage healthy blood cells. Stem cells (immature cells that can become new blood cells) can be replaced after chemotherapy to help restore healthy bone marrow.2,10

When stem cells are gathered from the person with NHL before chemotherapy, it is called an autologous transplant. Or stem cells may be donated by another person. This is called an allogeneic transplant.2,10

Not everyone is a candidate for stem cell transplants. Older adults or other people with other health problems may not tolerate stem cell transplants.2,10

Steroids

Steroids can increase the effectiveness of chemotherapy to treat NHL. Steroids come in tablet form or as an injection when you receive chemotherapy.10

Phototherapy

Light therapy, or phototherapy, uses a combination of a drug and UV light to kill cancer cells. The drug is typically activated by shining UV light on the skin. Phototherapy may be used to treat some people with lymphoma in the skin.11

Clinical trials for non-Hodgkin lymphoma

Clinical trials are an important way for researchers to find new treatments. In this type of research, experts study new treatments to determine whether they are safe and effective for certain conditions.12

Visit ClinicalTrials.gov to learn more about clinical trials for non-Hodgkin lymphoma. Your doctor can help you decide whether a clinical trial may be right for you.