Treatments for aggressive non-Hodgkin lymphoma

The following are treatment options for aggressive (fast-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 aggressive NHL is limited stage (stage 1 or stage 2) or advanced stage (stage 3 or stage 4). Doctors will also consider the type of NHL, your age and your overall health when planning treatments. Aggressive NHL usually responds well to treatment.

Aggressive NHL often causes symptoms soon after it develops. These symptoms usually need to be treated right away.

The following are treatment options for limited-stage aggressive NHL.

Chemotherapy is usually the main treatment. A combination of chemotherapy drugs is usually given along with targeted therapy. Radiation therapy is often given as well. If radiation therapy is going to be given after chemotherapy, fewer cycles of chemotherapy may be needed.

Different combinations of chemotherapy drugs are used for the different types of aggressive NHL. The chemotherapy combination most often used is CHOP, which is:

• cyclophosphamide (Cytoxan, Procytox)
• doxorubicin (Adriamycin)
• vincristine (Oncovin)
• prednisone

When rituximab is added to CHOP, the chemotherapy combination is called R-CHOP.

Targeted therapy may be offered for some types of aggressive B-cell lymphomas.

Rituximab is the targeted therapy given most often. It is used in combination with chemotherapy.

Some people may be offered external beam radiation therapy. It is called involved field radiation therapy (IFRT) because it is given to areas where the NHL is found. Radiation therapy is usually given after chemotherapy.

The following are treatment options for advanced-stage aggressive NHL.

Chemotherapy is the main treatment.

Different combinations of chemotherapy drugs are used for different types of aggressive NHL. The chemotherapy combination most often used is CHOP:

• cyclophosphamide
• doxorubicin
• vincristine
• prednisone

When rituximab is added to CHOP, the chemotherapy combination is called R-CHOP.

BR may be given in some cases. It is a combination of bendamustine (Treanda) and rituximab.

The central nervous system (CNS) is the brain and spinal cord. There is a risk that some types of aggressive NHL can spread to the CNS. CNS prophylaxis is used to prevent cancer cells from entering the tissue covering the brain and spinal cord.

CNS prophylaxis is often given as a combination of chemotherapy drugs and immunotherapy.

Targeted therapy is used for most types of aggressive B-cell lymphoma. Rituximab is the targeted therapy used most often. It is given along with chemotherapy.

External beam radiation therapy may be offered for advanced-stage aggressive NHL. It is given after chemotherapy if the NHL is only in the part of the body where it started or has formed large tumours (called bulky disease) in certain areas of the body.

Some types of aggressive NHL don’t respond to standard doses of chemotherapy or there is a high risk that they will come back (recur) after treatment. Doctors may consider giving a higher dose of chemotherapy followed by a stem cell transplant to treat some of these cases.

Aggressive (fast-growing) NHL can come back (relapse) after treatment. It can also become refractory over time, which means that treatments stop working. The following are treatment options for relapsed or refractory aggressive NHL.

Chemotherapy is given for relapsed or refractory aggressive NHL. Usually different chemotherapy drugs are used than were used at first. Doctors often give higher doses of the drugs than what was used during the first treatment.

Targeted therapy may be offered for relapsed or refractory aggressive NHL. Rituximab is the targeted therapy used most often. It is used in combination with chemotherapy.

Ibritumomab (Zevalin) is a targeted therapy drug that may be given if NHL does not respond to chemotherapy and rituximab. Ibritumomab may also be used when an indolent type of NHL changes into an aggressive type of NHL.

Polatuzumab vedotin (Polivy) may be used to treat diffuse large B-cell lymphoma (DLBCL) that comes back after treatment or did not respond to another treatment. It is combined with bendamustine (Treanda) and rituximab.

Relapsed or refractory aggressive NHL will often respond to different chemotherapy drugs, but it will rarely be cured. If a remission occurs after treatment with different drugs, doctors may offer a stem cell transplant. People with a relapsed or refractory aggressive NHL that responds well to chemotherapy have a better outcome with a stem cell transplant than those whose NHL doesn’t respond well to chemotherapy.

A stem cell transplant may also be used to treat people with an indolent type of NHL that has changed into an aggressive type of NHL.

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