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Non-Hodgkin lymphoma

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Treatment of recurrent indolent non-Hodgkin lymphoma

The following are treatment options for recurrent indolent non-Hodgkin lymphoma (NHL). This is also called a relapse. Usually, when lymphomas recur, they tend to come back in the same part of the body they started in. NHL may also recur in another part of the body.

Indolent lymphomas can recur many times and can become less responsive to treatment over time. It is rare for an indolent NHL to be cured with standard treatment when it recurs, but it can still be controlled.

The types of treatments given are based on the unique needs of the person with lymphoma. Treatment options depend on such factors as:

  • the previous treatment a person received
  • the person’s age
  • the person’s overall health
  • how the lymphoma presents at the time of recurrence

Transformed indolent lymphoma

Some indolent NHLs can change (transform) into or recur as a more aggressive lymphoma. The disease is then treated as an aggressive lymphoma. Often more aggressive chemotherapy regimens are used for people with transformed lymphomas. Ibritumomab (Zevalin) or a stem cell transplant may be considered in some cases of transformed B-cell lymphomas.

Treatment options

Treatment options for recurrent indolent lymphomas include the following.


Chemotherapy may be offered for recurrent or relapsed indolent NHL. The same chemotherapy treatment that was used initially to treat the lymphoma may be tried again if the person had a good response the first time. Often the lymphoma will respond to new kinds of chemotherapy. This may involve single chemotherapy drugs or a combination of drugs.

  • Fludarabine (Fludara) may be used on its own or in combination with other chemotherapy drugs. It can be effective in relapsed indolent lymphomas.
  • If the person was treated with a single chemotherapy drug before, then combinations of drugs may be used. Combinations that may be used include:
    • CHOP – cyclophosphamide (Cytoxan, Procytox), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone
    • CVP – cyclophosphamide, vincristine and prednisone
    • FND – fludarabine, mitoxantrone (Novantrone) and dexamethasone (Decadron, Dexasone)
  • Sometimes more intensive treatment may be used than was given initially. The person may be offered salvage chemotherapy regimens.
  • Bendamustine (Treanda) may also be used to treat people with certain types of indolent NHL. It is given if the disease doesn’t respond to treatment, progresses during treatment or comes back after treatment (relapses).

Radiation therapy

External beam radiation therapy may be given to relieve pain or to control the symptoms of recurrent NHL (palliative radiation therapy) when lymph nodes or organs become enlarged. Radiation therapy to these areas may help reduce the size of bulky tumours and relieve pain.

Biological therapy

Biological therapy may be offered for recurrent or relapsed indolent NHL. Rituximab (Rituxan) is used most often for recurrent or relapsed B-cell lymphomas. It can be given alone or as part of combination chemotherapy.

Other biological therapy drugs, like ibritumomab (Zevalin), are usually only used for B-cell lymphomas if chemotherapy and rituximab no longer seem to be working.

Stem cell transplant

A stem cell transplant may be tried in selected people with recurrent or relapsed indolent NHL. A stem cell transplant may be an option for some people when chemotherapy and biological therapy combinations don’t work. The best time to do a stem cell transplant in people with recurrent indolent lymphoma is really not known.

Clinical trials

People with recurrent or transformed NHL may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.


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