If the lymphoma is not causing symptoms, you may not need treatment immediately. Delaying treatment allows you to avoid side effects for as long as possible and doesn’t have any effect on how well treatment works.
You will be seen regularly by your cancer specialist and you will be advised to have treatment if you develop symptoms.
After treatment, many people have a period of time with no signs of active disease known as remission. If the lymphoma comes back, it can be treated again. This can give another period of remission and the lymphoma can often be controlled in this way for many years.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is an important treatment for nodal MZL and can often get the lymphoma into remission.
Chemotherapy may be given with a drug called rituximab (Mabthera ®), which is a monoclonal antibody that targets B-cells.
Chemotherapy can be given as tablets or into a vein (intravenously). You may be given just one type of chemotherapy drug or you may be given two or more together (combination chemotherapy).
Chemotherapy treatments for nodal MZL include:
Chlorambucil is a commonly used treatment. It comes as tablets.
CVP is a combination of the chemotherapy drugs cyclophosphamide and vincristine, and the steroid prednisolone. It's given as a drip into a vein, usually once every three weeks. Rituximab (Mabthera ®) is often given with CVP. This combination is called R-CVP.
Bendamustine is given into a vein, usually for 2 days every month. It is often given with rituximab.
There are other chemotherapy drugs and combinations that can be used to treat nodal MZL. Your specialist will be able to tell you which treatment is the most appropriate for you.
Monoclonal antibody therapy
Monoclonal antibodies are drugs that recognise, target and stick to specific proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy these cells.
Rituximab (Mabthera ®)
Rituximab is a monoclonal antibody that targets B-cells. It may be used to treat nodal MZL. It is given as a drip into a vein (intravenous infusion).
Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to nearby healthy cells. It is usually given if the lymphoma cells are contained in one or two areas of lymph nodes in the same part of the body (stage 1 or 2).
Steroids are drugs that are often given with chemotherapy to treat lymphomas. They also help you feel better and can reduce feelings of sickness.
Stem cell treatment (transplants)
Some people with lymphoma may have treatments using their own stem cells or stem cells from a donor. Stem cells are early blood cells that develop into all the other types of blood cell. This treatment is not suitable for everyone and is not done routinely. Doctors take into account a person's general health and age before recommending them.
Some people have some of their own stem cells collected and stored. This allows them to have higher doses of chemotherapy to destroy the lymphoma cells. After the chemotherapy, their stem cells are returned by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This is called high-dose chemotherapy with stem cell support.
Some people may have treatment using stem cells from another person (a donor). This is called a donor (allogeneic) stem cell transplant.