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Non-Hodgkin lymphoma

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Treatments for indolent non-Hodgkin lymphoma

The following are treatment options for indolent (slow-growing) types of non-Hodgkin lymphoma (NHL). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The treatments offered depend on if the indolent NHL is limited stage (stage I or stage II) or advanced stage (stage III or stage IV). Doctors will also consider the type of NHL, your age and your overall health when planning treatments.

Some indolent NHLs grow slowly and may cause only a few symptoms as they develop. As a result, they have often spread to different parts of the body and are at an advanced stage when they are first diagnosed.

Indolent NHL usually responds well to treatment and can often be controlled for many years. Some people with indolent NHL never require treatment. Indolent NHL tends to come back (recur) after treatment. It can also become resistant to treatment over time. Some indolent NHLs can also change into a more aggressive type of NHL and will be treated as that type of NHL.

Treatments for limited-stage indolent NHL

The following are treatment options for limited-stage indolent (slow-growing) NHL.

Radiation therapy

External beam radiation therapy is used most often when only 1 or a few groups of lymph nodes have lymphoma cells in them. It is also called involved field radiation therapy (IFRT) because it is given to the affected areas. It may also be given to nearby lymph nodes.

Watchful waiting

An indolent NHL may not need to be treated right away because it is growing slowly. There may be long periods of time when there is no change. Watchful waiting (also called active surveillance) may be offered to some people who do not have symptoms. Your healthcare team watches your NHL closely and uses tests and exams to check if the NHL is progressing or your condition is getting worse. They start treatment when the NHL progresses and causes symptoms.

Chemotherapy

Doctors may offer chemotherapy to some people with limited-stage indolent NHL. It may be a treatment option if someone cannot have radiation therapy because all of the NHL cannot be included in the radiation field and it is causing symptoms. Single drugs may be used, but a combination of chemotherapy drugs is usually given. Sometimes biological therapy is given along with chemotherapy drugs.

Single drugs that may be given include:

  • fludarabine (Fludara)
  • bendamustine (Treanda)
  • chlorambucil (Leukeran)

The combinations of chemotherapy drugs most often used to treat limited-stage indolent NHL are:

  • CHOP – cyclophosphamide (Cytoxan, Procytox), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone
  • R-CHOP – CHOP with rituximab (Rituxan)
  • CVP – cyclophosphamide, vincristine and prednisone
  • R-CVP – CVP with rituximab

Targeted therapy

Targeted therapy may be offered along with chemotherapy for some limited-stage indolent NHLs. Rituximab (Rituxan) is the targeted therapy used most often and is used only for B-cell lymphomas.

Treatments for advanced-stage indolent NHL

The following are treatment options for advanced-stage indolent (slow-growing) NHL.

Watchful waiting

Watchful waiting may be offered to some people who do not have symptoms. As with limited-stage indolent NHL, treatment is given when the NHL changes and causes symptoms.

Chemotherapy

Chemotherapy is given for advanced-stage indolent NHL that causes symptoms or seems to be progressing. Drugs may be given alone, but a combination of drugs is usually given.

The chemotherapy drugs that may be given alone to treat NHL include:

  • fludarabine
  • bendamustine
  • chlorambucil
  • cyclophosphamide

The combinations of chemotherapy drugs most often used to treat advanced-stage indolent NHL are:

  • CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone
  • R-CHOP – CHOP with rituximab
  • CVP – cyclophosphamide, vincristine and prednisone
  • R-CVP – CVP with rituximab
  • BR – bendamustine and rituximab

Radiation therapy

External beam radiation therapy may also be given to specific areas to control symptoms of advanced-stage indolent NHL.

Targeted therapy

Targeted therapy may be offered for some advanced-stage indolent B-cell lymphomas. Rituximab is the targeted therapy used most often. It may be given alone, but it is usually given with chemotherapy.

Treatments for relapsed or refractory indolent NHL

Indolent (slow-growing) NHLs can come back (recur) many times. They can also become refractory over time, which means that treatments stop working. Some indolent NHLs can change into or relapse as a more aggressive (fast-growing) type of NHL. The disease is then treated as an aggressive NHL.

The following are treatment options for relapsed or refractory indolent NHL.

Chemotherapy

Doctors may give the same chemotherapy drugs that were first used to treat the NHL if it responded well to these drugs the first time. Sometimes different or stronger doses of drugs may be used than were given at first.

Doctors may offer the following chemotherapy drugs alone to treat relapsed or refractory indolent NHL:

  • fludarabine
  • bendamustine
  • chlorambucil
  • cyclophosphamide

The combinations of chemotherapy drugs most often used include:

  • CHOP
  • R-CHOP
  • CVP
  • R-CVP
  • BR
  • FND – fludarabine, mitoxantrone (Novantrone) and dexamethasone (Decadron, Dexasone)

Targeted therapy

Targeted therapy may be offered for relapsed or refractory indolent B-cell lymphomas. Rituximab is used most often and can be given alone or as part of combination chemotherapy. Other drugs, such as ibritumomab (Zevalin), may be given if chemotherapy and rituximab no longer seem to be working.

Stem cell transplant

A stem cell transplant may be offered to some people with relapsed or refractory indolent NHL if other treatments don’t work.

Radiation therapy

External beam radiation therapy may be given for relapsed NHL. Doctors may use radiation therapy to shrink a tumour or larger than normal lymph nodes that are pressing on nerves and causing pain. Radiation therapy to these areas may help shrink large tumours and relieve pain.

Clinical trials

You may be asked if you want to join a clinical trial for NHL. Find out more about clinical trials.

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