Treatment for non-Hodgkin lymphoma

What treatment you have depends on the type and stage of the non-Hodgkin lymphoma (NHL) you have. There are four stages – stage 1 is early stage and stage 4 is advanced. 

The main treatment for NHL is chemotherapy (anti-cancer drugs). It is usually given into a vein (intravenously). You may have side effects from the chemotherapy, such as feeling tired or sick. These usually slowly go away after treatment stops.

Monoclonal antibodies are a type of targeted therapy that can also be used to treat NHL. They lock onto a protein on the cancer cell so it is destroyed. A monoclonal antibody called rituximab is usually used. When the treatment is given, you might feel some mild pain in the areas of your body being treated. You can have painkillers to help with this.

Radiotherapy (high-energy x-rays) is sometimes given after chemotherapy. You have CT scans to plan the treatment, so the radiotherapy is aimed at the part of the body where the lymphoma is. You may have some side effects from the radiotherapy, such as tiredness or red and sore skin around the area being treated. Talk to your healthcare team about things that can help.

Treatment for NHL

Before you start treatment, your lymphoma doctor or nurse will talk to you about your treatment plan. Your lymphoma doctor may be:

  • a haematologist (a doctor who treats blood disorders)
  • an oncologist (a doctor who treats cancer).

The main treatment for NHL is chemotherapy. It uses anti-cancer drugs to kill the lymphoma cells. You may also have a targeted therapy drug with the chemotherapy, such as rituximab. Some people have radiotherapy after chemotherapy treatment ends. Radiotherapy uses high-energy x-rays to kill cancer cells.

The treatment you have depends on:

  • the type of NHL you have
  • which parts of your body are affected
  • how much lymphoma there is in your body (the stage of the lymphoma).

Your doctor or nurse may talk to you about the stage of the lymphoma. This is a way of describing how many areas of your body are affected by lymphoma and where these areas are. We have more information about stages of non-Hodgkin lymphoma. It is written for people of all ages, not just teenagers and young adults.

Treatment for NHL has a very good success rate. Many teenagers and young adults are cured. But some treatments can cause long-term or late effects. This can include changes to your fertility (being able to father a child or get pregnant). Your lymphoma doctor or nurse should talk to you about this before you start treatment. If your fertility could be affected, you may be able to have treatment to preserve your fertility. We have more information about fertility and having fertility preservation.


Clinical trials

Doctors are working all the time to:

  • improve cancer treatments
  • reduce the side effects of treatment.

They do this through research called clinical trials. Your lymphoma doctor may talk to you about having your treatment as part of a clinical trial. We have more information about clinical trials. It is written for people of all ages, not just teenagers and young adults.


Chemotherapy

Chemotherapy is a treatment that uses anti-cancer drugs to destroy cancer cells. It is the main treatment for lymphoma. Chemotherapy is often given with a targeted therapy drug called rituximab. There is more information about this further down the page.

You may have chemotherapy as an outpatient or during a short stay in hospital. Chemotherapy drugs are usually given into a vein (intravenously) or as tablets.

Some people have a small amount of chemotherapy given into the cerebro-spinal fluid (CSF). This is fluid that surrounds the spinal cord and brain. It may be done during a lumbar puncture. You may have this if lymphoma has spread to your brain or there is a risk that it might. Your doctor will explain this treatment to you if you need it.

You usually have a combination of two or more chemotherapy drugs. We have more information about different chemotherapy drugs, which is written for people of all ages.

You usually also have a steroid drug with chemotherapy. The most common one is a tablet called prednisolone. Steroids are an important part of the treatment.

Your course of chemotherapy may last several months. During this time, you have regular check-ups at the hospital.

Side effects of chemotherapy

Different chemotherapy drugs cause different side effects. Some people only have a few side effects and others have more. Everyone is different.

Most side effects are short-term (temporary) and slowly go away after treatment stops.

The most common short-term side effects are:

  • risk of getting an infection
  • losing your hair
  • feeling sick (nausea)
  • tiredness (fatigue).

We have more information about these side effects.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Targeted therapy

The targeted therapy drug that is most often used to treat NHL is called rituximab.

It can be used to treat some types of B-cell NHL. 

Rituximab is a type of targeted therapy called a monoclonal antibody. These drugs work by ‘targeting’ specific proteins on the surface of cells. Rituximab locks on to a protein called CD20. This is on the surface of some lymphoma cells. This protein is also on normal white blood cells called B-lymphocytes or B-cells. 

Rituximab locks on to B-cells and triggers the body’s immune system to attack and destroy them. This means rituximab kills both the lymphoma cells and normal B-cells. But your body can replace the normal B-cells when the treatment has finished. 

Rituximab is given as a drip into a vein. You can have it as an outpatient. You usually have it with chemotherapy. When you are having rituximab, you might feel some soreness in the parts of your body where the lymphoma is. If this happens, tell your nurses. They can give you painkillers. 

You have the first rituximab treatment slowly, over a few hours. This is because some people have a reaction to rituximab. Giving it slowly reduces the chance of a reaction. You are also given medicines before each treatment to help prevent a reaction. The nurses will check you while you have the treatment. 

Signs of a reaction can include:

  • a headache
  • feeling itchy
  • feeling shaky and shivery
  • feeling breathless.

If you don’t feel well when you are having rituximab, tell the nurses straightaway. They can stop the drip and start it again when you feel better.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


Radiotherapy

Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells. It only treats the area of the body that the beams are aimed at. A doctor who specialises in radiotherapy plans your treatment. They are called a clinical oncologist. A person who gives radiotherapy is called a radiographer.

Radiotherapy can be used on its own or after chemotherapy.

Before your first radiotherapy treatment, you have your treatment planned. This happens in the radiotherapy department. You have a CT scan or x-rays. The radiographer may also make some small marks on your skin. These help them make sure you are in the right position for each treatment. They usually use permanent marks (like tattoos). The marks are very small, and they will only do them with your permission. It may be a little uncomfortable while they are making them marks.

If you are having radiotherapy to your neck, you may need to wear a mask during each treatment. The mask is made for you before you have treatment. We have more information about radiotherapy masks. It is written for people of all ages, not just teenagers and young adults.

You go to the hospital radiotherapy department to have treatment. You usually have radiotherapy every day from Monday to Friday, with a rest at the weekend. Your course of radiotherapy may last for a few weeks, but each daily treatment only takes a few minutes.

During treatment, you need to lie still. You are left on your own in the room, but only for a few minutes. You can talk to the radiographer, who watches you from the next room.

Side effects of radiotherapy

Radiotherapy is not painful, and you cannot see or feel the treatment when it is being given. You may start feeling tired after having a few treatments. Your skin may also get red and sore in the areas being treated. Other side effects depend on the area of your body being treated. For example, radiotherapy near your neck might give you a sore throat. Your doctor or nurse can tell you more about the side effects you might have.

Always tell your doctor, nurse or radiographer about any side effects. They will do their best to help make things easier.

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Stem cell transplant (sometimes called a bone marrow transplant)

Most people who have NHL do not need a stem cell transplant. But it may be used if NHL:

  • does not respond well to treatment
  • comes back (relapses) after treatment.

Stem cells are a type of blood cell. They make all the different types of blood cells you need. 

Bone marrow blood cells
Bone marrow blood cells

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There are two types of stem cell transplant. One uses your own stem cells. The other uses stem cells from someone else (a donor).

Having a stem cell transplant

A stem cell transplant works best if you are in remission when you have it. Remission is when there are no signs of lymphoma. So you have chemotherapy to put the lymphoma into remission before having a stem cell transplant.

Stem cells for a transplant can come from:

  • you 
  • a person (donor) who is a tissue match for you – this could be either a family member or a donor who is not related to you. 

Once you are in remission, the stem cells are collected from either your blood or the donor’s blood and stored. This is done as an outpatient. 

The first part of collecting stem cells from the blood is making them move from the bone marrow into the blood. To do this, you (or the donor) have daily injections under the skin. The injections are of a drug called a growth factor. This stimulates the bone marrow to make lots of stem cells. These travel from the bone marrow into the blood. 

When there are enough stem cells in the blood, they can be collected. This takes about 3 to 4 hours. A nurse puts a short, thin tube (cannula) into a vein in each arm. Each cannula is connected by tubing to a machine called a cell separator. Some of the blood goes from one arm through the tubing into the cell separator. Then it is returned through the cannula in the other arm. 

The cell separator spins as the blood goes through it. This is to separate out the stem cells, which are collected in a bag. When it has collected enough stem cells, they are carefully frozen and stored until you need them. 

A few weeks later, you go into hospital to have high-dose chemotherapy. This is sometimes called conditioning treatment. Sometimes people also have radiotherapy as part of conditioning treatment. This is done to:

  • remove any remaining lymphoma cells
  • prepare your bone marrow for the transplant. 

A few days later, you are given the stem cells into your blood through a drip (infusion). The stem cells travel to your bone marrow. After a few weeks, your bone marrow starts to make blood cells again. This helps you recover from the side effects of the high doses of chemotherapy.

You usually stay in hospital to have a stem cell transplant. The treatment may only last from one to a few days, but you will probably be in hospital for a few weeks. This is because it can take 2 to 3 weeks for your body to start to start making new blood cells again. Until your bone marrow recovers, you are at a high risk of getting an infection, so you need to stay in hospital.

We have more information about stem cell transplants. This is written for people of all ages, not just teenagers and young adults.


After treatment

After treatment, you have regular check-ups with your lymphoma team at the outpatient clinic. This is a good time to ask any questions or talk about anything that is worrying you.

Your team will explain:

  • how often you will have these check-ups
  • possible signs of the lymphoma returning that you should be aware of
  • any possible late effects of treatment.

They may give you and your GP a letter with this information and a list of the treatments you have had. This is called a treatment summary.

Your lymphoma doctor or nurse will also tell you about things you can do to help your recovery. These include:

  • not smoking
  • having a healthy diet
  • doing regular exercise.

This will also help to prevent late effects of treatment and keep your body healthy.

If you notice any new symptoms between appointments, contact your doctor or nurse for advice.

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