Treatment for high grade non Hodgkin's lymphoma

Treatment for high grade non Hodgkin's lymphoma will depend on which type of lymphoma you have and on whether you have limited or advanced lymphoma.

In high grade lymphoma, limited disease means stage 1A. In other words, you have only one group of lymph nodes affected and you do not have B symptoms. You may just have treatment with radiotherapy to the lymph nodes affected by non Hodgkin's lymphoma. Look at the section about radiotherapy for NHL for detailed information about this type of treatment.

The radiotherapy is given to try to cure the lymphoma. But many doctors are now giving short courses of chemotherapy and a monoclonal antibody to their patients in this group, as well as radiotherapy. This is because they think the chemotherapy and antibody will increase the chance of curing the lymphoma. These short courses of chemotherapy usually take about 6 to 12 weeks. Look at the section about chemotherapy for NHL for more information about this type of treatment.

In practice, except for stage 1A disease, most high grade NHL is treated as if it were advanced disease. This means quite intensive chemotherapy treatment, with 3 or 4 different drugs, or more. Some or all of these drugs are given to you through a drip into a vein. Or you may have a central line put into your chest, a portacath or a PICC line into your arm, which stays in throughout your treatment.

The exact choice of treatment depends on which type of high grade NHL you have. Most of the chemotherapy combinations contain a drug called doxorubicin. This is a type of chemotherapy drug called an anthracycline. This type of chemotherapy works well for many types of high grade NHL.

If you have advanced high grade diffuse B cell lymphoma, you will be treated with CHOP chemotherapy together with a monoclonal antibody called rituximab. This is called R-CHOP.

For some types of NHL, or if there is lymphoma affecting the space behind your nose (the paranasal sinuses) or your testicles, you may have chemotherapy into your spine. Usually, you will have a drug called methotrexate. This is because there is a chance of lymphoma cells spreading to the brain in these situations. The treatment is to prevent that happening. You may hear this called prophylactic treatment. Some doctors prefer to use radiotherapy to the brain instead of chemotherapy into the spine. Or high dose methotrexate injections into the bloodstream, instead of into the spine.

Intensive chemotherapy increases the risk of complications like infection, but gives the best chance of curing the lymphoma. Some patients with faster growing types of high grade non Hodgkin's lymphoma have very intensive high dose chemotherapy with bone marrow or stem cell transplant. Faster growing, lymphomas tend to come back fairly soon after you get into remission. Look at the section about transplants for more about this type of treatment.

It is not easy for doctors to decide who will do best with high dose chemotherapy treatment. There are no hard and fast rules. You have to be fit enough to make a good recovery from the treatment. And you are probably more likely to be offered this type of treatment if

• Your lymphoma has come back after it was first treated
• You have a type of NHL that is faster growing and likely to come back quickly after standard chemotherapy
• You have lots of affected lymph nodes
• The NHL is in your bone marrow or other body organs as well as in the lymph nodes
• You have large tumour masses (more than 10cm across)
• You have sweats, fevers and weight loss (B symptoms)

Rituximab with CHOP chemotherapy is the recommended treatment for diffuse large B cell NHL (a type of high grade NHL) as long as you are well enough to have CHOP.