Treatment for non-Hodgkin lymphoma
A team of specialists will work together to plan your treatment. There are several types of treatment for NHL, including chemotherapy, radiotherapy and monoclonal antibody therapy.
You may need just one type of treatment or a combination of different types. Your doctors will take into account several things when deciding which treatment is best for you, including:
the type of lymphoma you have
which parts of your body are affected
your general health
Watch and wait
Some types of NHL grow very slowly and may not cause troublesome symptoms for a long time. Because of this, some people don’t need to start treatment straight away. Instead, they see their specialist for regular check-ups and only begin treatment if they develop symptoms. This approach is called ‘watch and wait‘
or active surveillance.
is the most common treatment for NHL.
may be given with chemotherapy to help the treatment work more effectively.
Monoclonal antibody therapy
Monoclonal antibody therapy is often given alongside chemotherapy. Sometimes it’s used after chemotherapy treatment has finished. Monoclonal antibodies used to treat NHL target lymphocytes while having little effect on other cells.
This is sometimes used after chemotherapy to treat enlarged lymph nodes or an enlarged spleen. If you have indolent NHL affecting just one group of lymph nodes
may be the only treatment that’s needed.
Stem cell transplant
A stem cell transplant
is less commonly used. It’s sometimes used to treat people who have NHL that has come back (recurrence). It may also be used to treat some types of NHL that don’t respond well to standard chemotherapy treatments. It’s an intensive treatment, so it’s usually only suitable for people who are fit enough to cope with the side effects.
This is rarely used to treat NHL as most people need a treatment that can work in several areas of their body at once, such as chemotherapy. If the lymphoma is in just one part of the body, it may be treated with an operation. For example, people who have a rare type of lymphoma called splenic marginal zone lymphoma may have an operation to remove their spleen.
Antibiotics are sometimes used to treat a type of indolent NHL called MALT lymphoma
How treatment is planned
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In most hospitals, a team of specialists will talk to you about the treatment they feel is best for your situation. This multidisciplinary team (MDT) will include the following:
A cancer specialist with experience in treating lymphoma. This person will be either a haematologist (a doctor who specialises in treating blood cell disorders) or an oncologist (a doctor who specialises in treating cancer).
A radiologist (a doctor who analyses scans and x-rays).
A pathologist (a doctor who specialises in diagnosing lymphoma by testing lymphoma cells in the laboratory).
A stem cell transplant specialist (a doctor who specialises in treating NHL with stem cell transplants).
It may also include other healthcare professionals, such as a nurse specialist, dietitian, physiotherapist, occupational therapist, psychologist or counsellor.
Indolent or aggressive lymphoma
One of the most important things your doctors will take into account when planning your treatment is whether you have an indolent or aggressive lymphoma.
If you’re unsure about what type of lymphoma you have, ask your doctor. If you know the name of the type of lymphoma you have, you can talk to our cancer support specialists.
A type of lymphoma called mantle cell lymphoma sits between indolent and aggressive lymphoma and is most often treated as an aggressive lymphoma.
Treating indolent lymphomas
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Early-stage indolent lymphoma
Up to 1 in 5 people with indolent NHL have early-stage or localised disease (stage 1-2) when they are diagnosed. The most common treatment is radiotherapy to the affected lymph nodes. This usually makes the lymphoma disappear completely and many people are cured. If the lymphoma comes back, it can be treated with chemotherapy and can often be controlled for many years.
Advanced-stage indolent lymphoma
Most people with indolent NHL have advanced stage lymphoma (stage 3 or 4) when they are diagnosed.
Because indolent lymphoma is often very slow-growing, some people don’t need to start treatment straight away. If you’re not having problems with symptoms, your specialist may decide to keep a close eye on you with regular check-ups instead of starting treatment. This is called ‘watch and wait’ or active surveillance. It means you can avoid the inconvenience and side effects of treatment until you really need it. It also means your doctors can keep effective treatments in reserve for you until the disease is starting to cause you problems.
If your doctor feels you need treatment for the lymphoma, this is most likely to be with chemotherapy, either on its own or with a monoclonal antibody. This is often very successful at shrinking the lymphoma so you feel well and don’t have any symptoms (known as remission). After the lymphoma has gone into remission, some people have a further course of treatment with a monoclonal antibody. This is called maintenance treatment.
After a period of remission, which may last for years, lymphoma eventually comes back. But, with more treatment, it often shrinks back down again, giving another period of remission. In this way, lymphoma may be controlled for years, even decades, and most people have a good quality of life.
Transforming from indolent to aggressive lymphoma
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Over time, some indolent lymphomas become more aggressive. This happens in about a third of people (1 in 3) who have indolent NHL. It can be many years before indolent lymphoma becomes aggressive. If this happens, the transformed lymphoma is treated in the same way as an aggressive lymphoma.
Sometimes it’s possible for both indolent and aggressive NHL to be diagnosed in the same person, at the same time. If this happens, the NHL is treated as an aggressive lymphoma.
Treating aggressive lymphomas
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Aggressive lymphomas are usually fast-growing and need treatment soon after they’re diagnosed. The aim is to make the lymphoma disappear completely (complete remission) and many people are cured.
The most common treatment is chemotherapy given into a vein. This is often given in combination with a monoclonal antibody. Most people have their treatment as outpatients.
Chemotherapy can often shrink aggressive lymphoma very quickly. If there’s a high risk of the lymphoma coming back after treatment, your specialist may recommend more intensive chemotherapy.
Sometimes, radiotherapy is used after chemotherapy, especially if the lymphoma is in just one area of the body, or if the lymph nodes were very enlarged (bulky) before chemotherapy was given.
Some types of aggressive lymphoma may spread to the brain. If there is lymphoma in your brain or a high risk of it spreading there, you may be given additional treatments. These may include having chemotherapy directly into the fluid in the spine (intrathecal chemotherapy) or having chemotherapy to treat the lymphoma in the brain.
Many people with aggressive NHL are cured. But in some people, the lymphoma comes back. If this happens, the lymphoma can sometimes be put back into remission with further treatment.
Some people are offered a more intensive treatment than they had for their first treatment. This may involve high-dose chemotherapy with either stem cell support (autologous) or a donor (allogeneic) stem cell transplant.
Children and treatment
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Children with NHL nearly always have aggressive tumours. The main form of treatment is with high-dose (intensive) chemotherapy. Radiotherapy may also be needed.
When children are having intensive chemotherapy, they probably won’t be able to go to school. They may worry about missing school and getting behind with their work. It’s important to reassure them that they’ll be able to catch up.
It may help to talk to your child’s headteacher to see if the school can arrange to send work home for your child. There’s also a teacher attached to the hospital ward, who will help with your child’s education if they have to be in hospital for extended periods. The teacher will also keep in touch with your child’s school.
We have more information about non-Hodgkin lymphoma in children.
If you are offered treatment that has a good chance of curing your lymphoma or putting it into remission, deciding whether or not to accept the treatment may not be difficult. However, if the treatment has a lower chance of working, it may be more difficult to decide whether or not to go ahead.
You may need to discuss your treatment options in detail with your doctor. If you choose not to have treatment, you can still be given supportive (palliative) care to help control any symptoms.
Because some lymphomas grow very slowly, doctors sometimes recommend putting off treatment until the lymphoma begins to cause noticeable symptoms.
Clinical trials have shown that waiting in this way doesn’t cause any bad effects or put you at a disadvantage. Many people are happy to delay treatment, but for others, not starting treatment immediately causes anxiety. If you feel worried about any aspect of your treatment plan it’s important to discuss this with your doctors. This will help them take your preferences into account.
If more than one treatment is equally effective for the type and stage of your lymphoma, your doctors may offer you a choice of treatments. Sometimes people find it hard to choose which treatment to have. If you’re asked to make a decision, make sure you have enough information about the different options, what’s involved, and the side effects you might get, so you can choose the treatment that’s right for you.
Remember to ask questions about anything you don’t understand or feel worried about. You may find it helpful to discuss the advantages and disadvantages of each option with your doctor or specialist nurse.
The advantages and disadvantages of treatment
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Treatment can be given for different reasons, and the potential benefits will vary for each person. The side effects of most treatments can be controlled well and treatment is usually effective.
Indolent NHL is generally very responsive to chemotherapy and radiotherapy. Many people with indolent lymphoma can have it controlled for many years with a good quality of life.
Without treatment, aggressive NHL would usually get bigger and spread quickly, and most people would not live for much longer. But many people with aggressive NHL can be cured.
If the lymphoma doesn’t respond to treatment or comes back, another type of treatment may be effective. This may cure the lymphoma or control it, leading to an improvement in symptoms and better quality of life. However, for some people in this situation, treatment has no effect on the cancer and they get the side effects of treatment with little benefit.
The multidisciplinary team uses national and international treatment guidelines to decide on the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion.
Sometimes people worry that they may upset their doctor by asking to see another specialist but this isn’t likely to happen. Doctors often check with their colleagues about cases that have various treatment options.
Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
You might find it helpful to watch our video of a GP explaining the pros and cons of getting a second opinion.
Before you have any treatment, your doctor will explain its aims and possible side effects to you.
They will ask you to sign a form saying you give your permission (consent) for the hospital staff to give you the treatment.
Before you are asked to sign the consent form, you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you have been told, let the staff know straight away so they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need repeated explanations.
It’s often a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when it’s first explained to you.
You’re also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.