Treatment for low grade non Hodgkin's lymphoma
This page tells you about treatment for low grade non Hodgkin's lymphoma. There is information about
Treatment for limited low grade NHL
You are most likely to have radiotherapy to the affected lymph nodes. For many people this treatment can cure their non Hodgkin's lymphoma.
Treatment for advanced low grade NHL
With advanced low grade NHL, your doctor is usually trying to control the disease rather than cure it. It can often be controlled for several years.
If you have symptoms or have enlarged lymph nodes, your doctor will give you a combination of treatment called R-CVP. This is the most common treatment for advanced follicular lymphoma. You will have chemotherapy with the drugs cyclophosphamide and vincristine, and the steroid prednisolone with a type of monoclonal antibody called rituximab. If you are elderly you may have chlorambucil chemotherapy tablets to take at home.
Some research is looking into maintenance treatment for low grade NHL. This means treatment you have when the lymphoma has gone to try to stop it coming back for as long as possible. This type of treatment is also known as consolidation. The drugs being tested are biological therapies.
Lymphoma tends to come back after a period of time and you will need more treatment. The next lot of treatment you have is called second line treatment. There are a lot of choices. Your doctor decides your treatment by looking at your previous responses to treatment, how quickly they want the treatment to work and convenience for you.
You can view and print the quick guides for all the pages in the Treating NHL section.
Treatment for low grade lymphoma depends on the stage of your lymphoma when it is diagnosed, and on the symptoms you have at the time.
About 1 in 5 people are diagnosed with low grade NHL when it is limited. That means that only one or two groups of lymph nodes on the same side of the diaphragm are affected.
You are most likely to have radiotherapy to the affected lymph nodes. This treatment may cure their non Hodgkin's lymphoma. Or if it isn't cured, then the disease can hopefully be kept under control for a long time.
With advanced low grade NHL, your doctor is usually trying to control the disease for as long as possible rather than cure it. It can often be controlled for several years. The usual pattern is that you have some treatment and the disease disappears clinically for some time. Then it comes back, you have more treatment and it disappears again. The time when the disease disappears is called remission. Remissions can last for many years. But second and later remissions are usually shorter than first remission.
Watch and Wait
If you have no enlarged lymph nodes or other symptoms when you are diagnosed, your doctor may just decide to keep a close eye on you. You may hear this called watch and wait. Your doctor chooses to do this because you have no symptoms bothering you. And all treatments have side effects so doctors don't want to give people treatment they don't need.
First line treatment
When you need treatment you are most likely to have a combination of chemotherapy and a type of drug called a monoclonal antibody.
Maintenance treatment
If your lymphoma has come back and you need further treatment you may be offered regular treatment with rituximab. This is called maintenance therapy.
Zevalin (ibritumomab) is sometimes used as a maintenance treatment for follicular lymphoma in remission. Zevalin is a monoclonal antibody with a radioactive substance attached, which gives a dose of radiation to any lymphoma cells.
Second line treatment
High grade lymphoma tends to come back after a period of time and you will need more treatment. The next lot of treatment you have is called second line treatment. There are a lot of choices for second line treatment. You might have
- Combination chemotherapy with 3 or 4 different drugs with rituximab
- A single chemotherapy drug called fludarabine or fludarabine in combination with rituximab, mitoxantrone and the steroid dexamethasone
There are a lot of choices and your doctor will consider a number of things before deciding what is likely to be best for you. Your doctor decides your treatment by looking at
- Your previous responses to treatment
- How quickly they want the treatment to work
- Convenience for you
If you got a long remission the first time round with chemotherapy tablets, your doctor will probably give them to you again. If your remission was not very long, your doctor is likely to choose a different treatment. If it is difficult for you to make trips backwards and forwards to the hospital, your doctor may choose a treatment that means you don't have to go so often.
Some centres around the world are trying out very intensive treatment to try to cure this type of non Hodgkin's lymphoma. They are trying
- Intensive chemotherapy and radiotherapy
- Bone marrow or stem cell transplants
Look in the sections on chemotherapy for NHL and bone marrow and stem cell transplants for more information about these types of treatment.
If you have low grade NHL you will probably have rituximab. This is a monoclonal antibody, which is a type of biological therapy. Biological therapies are treatments that use natural body substances (or drugs developed from them) to fight cancer.
Doctors use rituximab on its own or with chemotherapy. It controls NHL in about half the people treated. It does not keep the lymphoma under control for ever. But you can have more rituximab if your NHL comes back. The National Institute for Health and Clinical Excellence (NICE) has approved rituximab with chemotherapy as a first line treatment option for people with follicular lymphoma. The treatment aims to get rid of all signs of the lymphoma (in other words, to induce remission). NICE has also approved rituximab alone as a treatment during remission or when all other treatment options have been tried.
Rituximab and chemotherapy may also be used to treat mantle cell lymphoma.
There is more about rituximab in this section of CancerHelp UK.
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