CIENCIASMEDICASNEWS: Adult Non-Hodgkin Lymphoma Treatment (PDQ®) 3/3 —Patient Version

Adult Non-Hodgkin Lymphoma Treatment (PDQ®)—Patient Version - National Cancer Institute

Stem cell transplant

Stem cell transplant is a method of giving high doses of chemotherapy and/or total-body irradiation and then replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient (autologous transplant) or a donor (allogeneic transplant) and are frozen and stored. After the chemotherapy and/or radiation therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Vaccine therapy

Vaccine therapy is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Indolent Non-Hodgkin Lymphoma

For information about the treatments listed below, see the Treatment Option Overviewsection.

Treatment of indolent stage I and indolent, contiguous stage II adult non-Hodgkin lymphoma may include the following:

Radiation therapy.
Monoclonal antibody therapy and/or chemotherapy.
Watchful waiting.

If the tumor is too large to be treated with radiation therapy, the treatment options for indolent, noncontiguous stage II, III, or IV adult non-Hodgkin lymphoma will be used.

Treatment of indolent, noncontiguous stage II, III, or IV adult non-Hodgkin lymphoma may include the following:

Watchful waiting for patients who do not have signs or symptoms.
Monoclonal antibody therapy with or without chemotherapy.
Chemotherapy with or without steroids.
Combination chemotherapy.
Radiolabeled monoclonal antibody therapy.
Monoclonal antibody therapy after treatment with combination chemotherapy.
A clinical trial of high-dose chemotherapy with or without total-body irradiation or radiolabeled monoclonal antibody therapy, followed by autologous or allogeneic stem cell transplant.
A clinical trial of chemotherapy with or without vaccine therapy.
A clinical trial of new types of monoclonal antibodies.
A clinical trial of radiation therapy that includes nearby lymph nodes, for patients who have stage III disease.
A clinical trial of low-dose radiation therapy, to relieve symptoms and improve quality of life.

After initial treatment with the monoclonal antibody rituximab with or without chemotherapy, more treatment with rituximab may be given.

Other treatments for indolent non-Hodgkin lymphoma depend on the type of non-Hodgkin lymphoma. Treatment may include the following:

For follicular lymphoma, treatment may be within a clinical trial of new monoclonal antibody therapy, new chemotherapy regimen, or a stem cell transplant.
For lymphoplasmacytic lymphoma, Bruton's tyrosine kinase inhibitor therapy and/or plasmapheresis or proteasome inhibitor therapy (if needed to make the blood thinner) is used. Other treatments that are like those used for follicular lymphoma may also be given.
For gastric mucosa-associated lymphoid tissue (MALT) lymphoma, antibiotic therapy to treat Helicobacter pylori infection is given first. For tumors that do not respond to antibiotic therapy, treatment is radiation therapy, surgery, or rituximab with or without chemotherapy.
For extragastric MALT lymphoma of the eye and Mediterranean abdominal lymphoma, antibiotic therapy is used to treat infection.
For splenic marginal zone lymphoma, rituximab with or without chemotherapy and B-cell receptor therapy is used as initial treatment. If the tumor does not respond to treatment, a splenectomy may be done.

Treatment Options for Aggressive Non-Hodgkin Lymphoma

For information about the treatments listed below, see the Treatment Option Overviewsection.

Treatment of aggressive stage I and aggressive, contiguous stage II adult non-Hodgkin lymphoma may include the following:

Monoclonal antibody therapy and combination chemotherapy. Sometimes radiation therapy is given later.
A clinical trial of a new regimen of monoclonal antibody therapy and combination chemotherapy.

Treatment of aggressive, noncontiguous stage II, III, or IV adult non-Hodgkin lymphoma may include the following:

Monoclonal antibody therapy with combination chemotherapy.
Combination chemotherapy.
A clinical trial of monoclonal antibody therapy with combination chemotherapy followed by radiation therapy.

Other treatments depend on the type of aggressive non-Hodgkin lymphoma. Treatment may include the following:

For extranodal NK -/T-cell lymphoma, radiation therapy that may be given before, during, or after chemotherapy and CNS prophylaxis.
For mantle cell lymphoma, monoclonal antibody therapy with combination chemotherapy, followed by stem cell transplant. Monoclonal antibody therapy may be given afterwards as maintenance therapy (treatment that is given after initial therapy to help keep cancer from coming back).
For posttransplantation lymphoproliferative disorder, treatment with immunosuppressive drugs may be stopped. If this does not work or cannot be done, monoclonal antibody therapy alone or with chemotherapy may be given. For cancerthat has not spread, surgery to remove the cancer or radiation therapy may be used.
For plasmablastic lymphoma, treatments are like those used for lymphoblastic lymphoma or Burkitt lymphoma.

For information on the treatment of lymphoblastic lymphoma, see Treatment Options for Lymphoblastic Lymphoma and for information on the treatment of Burkitt lymphoma, see Treatment Options for Burkitt Lymphoma.

Treatment Options for Lymphoblastic Lymphoma

For information about the treatments listed below, see the Treatment Option Overviewsection.

Treatment of adult lymphoblastic lymphoma may include the following:

Combination chemotherapy and CNS prophylaxis. Sometimes radiation therapy is also given to shrink a large tumor.
A clinical trial of stem cell transplant after initial treatment.

Treatment Options for Burkitt Lymphoma

For information about the treatments listed below, see the Treatment Option Overviewsection.

Treatment of adult Burkitt lymphoma may include the following:

Combination chemotherapy with or without monoclonal antibody therapy.
CNS prophylaxis.

Treatment Options for Recurrent Non-Hodgkin Lymphoma

For information about the treatments listed below, see the Treatment Option Overviewsection.

Treatment of indolent, recurrent adult non-Hodgkin lymphoma may include the following:

Chemotherapy with one or more drugs.
Monoclonal antibody therapy.
Radiolabeled monoclonal antibody therapy.
Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
A clinical trial of an autologous or allogeneic stem cell transplant.

Treatment of aggressive, recurrent adult non-Hodgkin lymphoma may include the following:

Chemotherapy with or without stem cell transplant.
Monoclonal antibody therapy with or without combination chemotherapy followed by autologous stem cell transplant.
Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
Radiolabeled monoclonal antibody therapy.
CAR T-cell therapy.
For mantle cell lymphoma, treatment may include the following:
- Bruton's tyrosine kinase inhibitor therapy.
- Lenalidomide.
- A clinical trial of lenalidomide with monoclonal antibody therapy.
- A clinical trial comparing lenalidomide to other therapy.
- A clinical trial of proteasome inhibitor therapy (bortezomib).
A clinical trial of autologous or allogeneic stem cell transplant.

Treatment of indolent lymphoma that comes back as aggressive lymphoma depends on the type of non-Hodgkin lymphoma and may include radiation therapy as palliative therapy to relieve symptoms and improve quality of life. Treatment of aggressive lymphoma that comes back as indolent lymphoma may include chemotherapy.

Treatment Options for Non-Hodgkin Lymphoma During Pregnancy

For information about the treatments listed below, see the Treatment Option Overviewsection.

Indolent Non-Hodgkin Lymphoma During Pregnancy

Women who have indolent (slow-growing) non-Hodgkin lymphoma during pregnancy may be treated with watchful waiting until after they give birth. (See the Treatment Options for Indolent Non-Hodgkin Lymphoma section for more information.)

Aggressive Non-Hodgkin Lymphoma During Pregnancy

Treatment of aggressive non-Hodgkin lymphoma during pregnancy may include the following:

Treatment given right away based on the type of non-Hodgkin lymphoma to increase the mother's chance of survival. Treatment may include combination chemotherapyand rituximab.
Early delivery of the baby followed by treatment based on the type of non-Hodgkin lymphoma.
If in the first trimester of pregnancy, medical oncologists may advise ending the pregnancy so that treatment may begin. Treatment depends on the type of non-Hodgkin lymphoma.

To Learn More About Adult Non-Hodgkin Lymphoma

For more information from the National Cancer Institute about adult non-Hodgkin lymphoma, see the following:

For general cancer information and other resources from the National Cancer Institute, see the following:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of adult non-Hodgkin lymphoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

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The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Adult Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389337]

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