If non-Hodgkin lymphoma comes back

Even if this is not possible, treatment can be given to shrink the lymph nodes and control the disease to keep you well, often for long periods. Such treatment might be chemotherapy|, radiotherapy|, a combination of both, or a stem cell transplant.

High-dose treatment with stem cell support Back to top

Some people may be offered treatment with very high doses of chemotherapy,| sometimes combined with radiotherapy.

Your doctor will discuss with you whether this treatment is appropriate and possible in your case. High-dose chemotherapy is a very intensive treatment that needs to be given by doctors with experience of managing the side effects.

Before high-dose treatment can be considered, stem cells (the basic blood cells from which other cells develop) must be collected from your body at a time when you are well. This is called a stem cell harvest. The stem cells are then frozen and kept in storage until you have high-dose treatment.

Harvesting the stem cells involves giving you several injections of growth factors to increase the number of stem cells in your blood. The stem cells are then collected by a process in which blood is removed through a needle in your arm. The blood is then passed through a machine called a cell separator.

The cells are separated out as the rest of your blood flows back into you through another needle. Alternatively, stem cells can be collected from your bone marrow. For this, you will need to have a general anaesthetic.

High doses of chemotherapy destroy the bone marrow, where our blood cells are usually made. After the high-dose chemotherapy has been given, the stem cells are thawed and given back into your blood through a drip. The stem cells make their way to your bone marrow where they start to produce blood cells. This can take a few weeks. You will be very prone to infection at this time so you are likely to need to stay in hospital.

In most cases, your own stem cells are collected and then given back to you after the high-dose chemotherapy. This is called an autologous transplant.

Some people may be given stem cells from another person (a donor) as part of a trial rather than using their own cells. This is called an allogeneic transplant.

We have separate information about high dose treatment with stem cell support|, and allogeneic stem cell transplants|, which explain these treatments in more detail.

Stem cell and bone marrow transplants are complicated treatments and carry some risk. Because of this they are generally carried out in specialist cancer treatment hospitals. This means you may have to be treated in a hospital some distance from your home.

Anyone with NHL who has had high-dose treatment should be given blood or platelet transfusions that have been irradiated. This lowers the risk of the donated blood cells reacting against the patient’s own blood cells. People who have had this treatment should carry a card or wear a Medicalert (bracelet or necklace containing medical information) so that hospital staff are aware of this in case of an emergency.

Transforming from low-grade to high-grade Back to top

Over time, some low-grade| (indolent) lymphomas can become more aggressive (high-grade). This happens in about a third of all low-grade NHL and depends upon the type|. It can take many years before an indolent lymphoma becomes high-grade. If indolent lymphoma transforms, it will need to be treated as a high-grade lymphoma.

Sometimes it’s possible for both low-grade and high-grade NHL to be diagnosed in the same person, at the same time. If this happens the NHL is usually treated as high-grade.