Treating an Aggressive Form of Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma (NHL) is a type of cancer that begins in white blood cells called lymphocytes, which are part of the immune system. There are more than 80 different subtypes of NHL, which are categorized based on the type of lymphocytes where the cancer cells develop, the appearance of the cancer cells, genetic features of the cancer cells and other factors. NHL is also categorized as indolent or aggressive. Indolent NHLs grow slowly, and may not be treated until symptoms appear. Aggressive NHLs spread quickly, will require immediate treatment and more intense treatment.

Here, you will learn more about the goals for treating the aggressive types of this disease, the available treatments, tests that are used to monitor your condition and questions to ask your doctor.

Medically reviewed in March 2020.

The purpose of treating any form of cancer is to improve a patient’s health, along with extending his or her lifespan. Even though some cases of NHL are difficult to treat, incredible advancements have been made over the years in finding new and effective therapies. The current, approved treatments for NHL are designed to reduce symptoms of the disease (which include fever, fatigue, night sweats, enlarged lymph nodes and pain in the areas the tumors may have spread), destroy existing cancer cells and prevent new cancer cells from growing and spreading. While patients can go into remission, this type of cancer can return.

If a physician has determined that a patient’s cancer is aggressive (fast-growing), there are several first-line treatments available. These include:

• Chemotherapy, also referred to ask chemo, uses drugs to destroy cancer cells. There are many chemotherapy drugs available. Some chemotherapies are used on their own, others are used in combination with one another or with other treatments.
• Targeted therapies are drugs that target specific parts of a cancer cell’s biology, such as a certain protein or gene mutation. Targeted therapies can be used in combination with chemotherapy, and are sometimes used when standard chemotherapy treatments don’t work. The side effects from targeted therapies tend to be different and less severe than side effects from standard chemotherapy.
• Radiation therapy uses charged particles to destroy cancer cells. The type of radiation therapy most often used for NHL is called external beam radiation, where a machine outside the body precisely targets a tumor site with radiation.
• Immunotherapy refers to a class of drugs that help the body’s immune system fight cancer.

After a patient has completed a first-line treatment, her or she may be prescribed what is called a maintenance therapy. Maintenance therapy is an ongoing course of medication is prescribed to prevent the cancer from returning or to slow the progress of an advanced cancer.

If a patient does not respond to treatment, another option is receiving a blood stem cell transplant, which help the cells that form inside the bone marrow (known as hematopoietic stem cells) develop properly. These stem cells can be from the patient’s body, called an autologous or auto transplant, or from a donor who has a similar genetic makeup, called an allogeneic transplantation or an allo transplant. In the case of an auto transplant, the patient’s stem cells would need to be collected and stored (frozen) before receiving high-doses of chemotherapy treatment. Patients who have an identical twin can also receive a transplant from their twin, which is called a syngeneic blood cell transplant.

A stem cell transplant may also be recommended after a patient completes their chemotherapy treatments. Since a stem cell transplant is an intensive procedure, it’s usually an option for younger, more fit patients.

During the treatment period and after treatments have been completed, a patient’s condition will be monitored with scans. A CT (computed tomography) scan, also called a CAT scan, uses x-rays to create a three-dimensional image of the body’s interior (including the organs, bones, soft tissues and blood vessels) to determine a tumor’s shape, size and location. It is a painless, outpatient procedure which takes up to 30 minutes. A whole-body PET (positron emission tomography) scan uses a form of radioactive sugar to detect tumors throughout the body. This scan is usually combined with a CT scan. Blood tests will usually be required during and after treatments, as well.

If you or someone you love has been diagnosed with an aggressive form of NHL, consider asking your healthcare team the following questions:

• Which treatment options have been proven to work best for someone with my condition?
• How can I best prepare myself for treatment?
• What are the common side effects from these treatment options?
• How can I treat these side effects?
• What are the common risks of these options?
• When will we know if my treatment is working?
• Will home health care be needed during treatment?
• What would be the second-line (second choice) treatment if the first-line treatment is not effective?
• Do I qualify for a blood stem cell transplant?

Patients who have been diagnosed with advanced NHL may also want to ask their healthcare provider about entering a clinical trial in order to receive treatments that are currently being investigated.