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Non-Hodgkin lymphoma

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Treatment of advanced stage aggressive non-Hodgkin lymphoma

The following are treatment options for advanced stage aggressive non-Hodgkin lymphoma (NHL). The types of treatments given are based on the unique needs of the person with lymphoma.


Chemotherapy is the main treatment for advanced stage aggressive NHL. The combination of chemotherapy drugs used can vary with the type of aggressive NHL being treated.

  • CHOP is the most widely used combination of chemotherapy drugs. CHOP is:
    • cyclophosphamide (Cytoxan, Procytox)
    • doxorubicin (Adriamycin)
    • vincristine (Oncovin)
    • prednisone (Deltasone)
  • Some highly aggressive lymphomas, like Burkitt lymphoma or lymphoblastic lymphomas, are often treated with different, more intensive chemotherapy drug combinations.

Chemotherapy is often given in combination with biological therapy.

Chemotherapy often shrinks an aggressive NHL very quickly.

CNS prophylaxis

Chemotherapy may also be given as a preventative (prophylactic) treatment if there is a risk that the lymphoma may spread to the brain and spinal cord (central nervous system or CNS). Lymphomas that tend to spread to the CNS include:

  • lymphoma that involves the spaces behind the nose (paranasal sinuses) or the testicles
  • very aggressive lymphomas, such as Burkitt lymphoma or lymphoblastic lymphomas

Chemotherapy is also used to treat lymphoma that starts in the brain or spinal cord (primary CNS lymphoma). In these cases, chemotherapy is given directly into the cerebrospinal fluid (CSF) (called intrathecal chemotherapy) or may be given into a vein (intravenously). The drugs used most often to prevent the spread of lymphoma to the CNS or to treat lymphoma in the CNS are methotrexate and cytarabine (Cytosar, Ara-C).

CNS prophylaxis is often given with combination chemotherapy and biological therapy.

Biological therapy

Biological therapy is another treatment used for most types of aggressive B-cell lymphomas. Rituximab (Rituxan) is the biological therapy used most often. It is only used for B-cell type lymphomas, and is given in combination with chemotherapy.

Radiation therapy

External beam radiation therapy may be offered in some cases for advanced stage aggressive NHL. It is given after chemotherapy if the lymphoma is localized in an area of the body and can be included in the radiation field.

Stem cell transplant

Depending on the specific type of aggressive lymphoma, there is a risk that some people may not respond to standard chemotherapy or are at a very high risk for relapse. They may be considered for an increased dose of chemotherapy followed by a stem cell transplant. However, researchers are still studying the effectiveness of this treatment as part of initial treatment.

Clinical trials

People with advanced stage aggressive NHL may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.


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