Treating Non-Hodgkin's Lymphoma [4,7,32,39,40]

Treatment for non-Hodgkin’s lymphoma (NHL) will depend on a number of factors, including the stage of the disease and the kind of lymphoma. Be sure to talk to your doctor about your treatment options and how they may affect you.

Treatment options for non-Hodgkin’s lymphoma may include:

• Radiation therapy — Radiation therapy uses high-energy rays (such as x-rays) to kill or shrink cancer cells. Doctors will typically recommend radiation as a primary therapy for early-stage disease. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (internal or implant radiation). Internal radiation is typically a part of radioimmunotherapy (see below). Radiation therapy is often used along with chemotherapy in the treatment of non-Hodgkin's lymphoma.
  
  Possible side effects from radiation therapy include mild skin problems and fatigue. Radiation to the abdomen can lead to an upset stomach and diarrhea. These side effects typically last just a short time. Other side effects are longer-term. For instance, lung damage and breathing issues can result from chest radiation. In rare cases, lung radiation can lead to lung cancer, especially among smokers. Brain radiation side effects usually become most serious 1 or 2 years after treatment and can lead to headaches and trouble with thinking. Radiation in other parts of the body can also result in other cancers.
  
  
• Chemotherapy — Chemotherapy refers to the use of drugs to kill cancer cells. These drugs are given into a vein or by mouth, enter the bloodstream, and spread throughout the body. Many times, different combinations of chemotherapy drugs are given. Treatments for non-Hodgkin's lymphoma are often given several times in cycles 3 or 4 weeks apart. You may take 1 combination of drugs for several cycles and later be switched to a different combination if the first doesn't seem to be working.
  
  The chemotherapy drugs not only kill cancer cells, but may also kill or damage normal cells. This can cause any number of possible side effects (hair loss, fatigue, nausea and vomiting, etc). The exact side effects depend on the type, dose, and length of time chemotherapy drugs are taken.



• Biological therapy/immunotherapy — In immunotherapy, biological substances are used to help kill cancer cells or slow their growth. Treatment with monoclonal antibodies and interferon are 2 types of immunotherapy. Antibodies are made by your immune system to help fight infections. Monoclonal antibodies are similar except they are made in the lab. They are designed to attack specific cells. As opposed to chemotherapy that affects all rapidly dividing cells, biologic/immunotherapy is designed to target specific, cancer cells. Interferon is a protein made by white blood cells to help your body fight infections. Some studies suggest interferon may help in the treatment of NHL.



• Radioimmunotherapy — Newer forms of monoclonal antibodies have radioactive substances attached to them. These are called radioimmunotherapies. The substance is injected into the body through a vein, and emits radiation internally. Your treatment takes advantage of both the radiation and the monoclonal antibody activity (see the Radiation therapy and Biological therapy/immunotherapy sections above).
  
  Like any cancer treatment, there are side effects associated with radioimmunotherapy. The most common is a reduction in blood counts caused by the radiation of the bone marrow. Other side effects may include low blood pressure, diarrhea, or rash. The side effects will depend on whether or not you have previously received chemotherapy and/or external radiation therapy.



• Bone marrow or peripheral blood stem cell transplantation (SCT) — If standard treatment does not work, very high doses of chemotherapy followed by SCT may be recommended.
  
  Stem cells are the earliest form of cells. They are able to grow and change into healthy normal cells. While the high doses of chemotherapy and/or radiation may kill the cancer, they may also damage or kill all or most of the normal cells in your bone marrow. An adequate number of new blood cells can no longer be made, which may present a life-threatening condition. In SCT, stem cells are taken from the bone marrow or the bloodstream from either the cancer patient or a matched donor. A matched donor can be difficult to find. If a patient’s own stem cells are used, there is a small risk that cancer cells may be returned to the body along with the stem cells.
  
  The stem cells that were collected, cleaned, and stored prior to the cancer treatment will be given back to the patient through a vein (similar to a blood transfusion). This will help rebuild the bone marrow that was damaged or destroyed during the high doses of chemotherapy. It normally takes about 2 to 3 weeks for your bone marrow to recover and start making white blood cells, followed by red blood cells and platelets. Even after treating the stem cells to remove cancer cells, some cancer cells may remain.
  
  Please consult with your healthcare provider regarding potential side effects related to this form of treatment.

For more information about treatment options, visit the US Food and Drug Administration (FDA) Web site and the National Cancer Institute Web site.

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