Treatment

What are the Goals of NHL Treatment?

NHL often responds very well to modern treatments. This does not mean that NHL is always curable but it does mean that treatment can often provide long cancer-free periods, reduced symptoms and improved quality of life for many patients. Each patient responds differently to treatment, as does each lymphoma type.

The major goals of lymphoma treatment include:

  • Cure (if possible)
  • Bringing about and prolonging remission (cancer-free period)
  • Minimizing the number of lymph nodes and/or organs affected
  • Preventing the development of symptoms and treating existing ones
  • Improving the patient’s quality of life.

What can I Expect from Treatment?

The International Prognostic Index (IPI) does give statistically valid estimates of which patients are most likely to relapse, and which patients are less likely to relapse.
Click here to review The International Prognostic Index for Aggressive Lymphoma.
Click here to review The International Prognostic Index for Follicular Lymphoma (FLIPI).

Predicting response to treatment depends on many variables, including the exact type, stage and grade of lymphoma. For example, diffuse large B-cell lymphoma, a type of aggressive (fast-growing) lymphoma, is curable in 80% of patients when the disease is localized to one area of the body. Follicular lymphoma, a type of indolent (slow-growing) lymphoma, is usually spread throughout the body upon diagnosis. Follicular lymphoma can often remain dormant for years or decades requiring little or no treatment. It is responsive to treatment and will often go into remission (cancer-free period) for a period of time following treatment; however, it often relapses.

The variables, other than lymphoma type, stage and grade that can affect the choice and success of treatment, are outlined in the following table:

Variable Definition Response Expected
Age Whether a patient is older or younger than 60 years of age. Younger patients (younger than 60 years old) typically show better responses to treatment. Older patients often cannot tolerate side effects and less aggressive treatments are occasionally chosen.
Prior Therapy Any previous cancer treatment the patient has received. Patients who have had fewer previous cancer treatments are usually more responsive to new treatments.
Performance Status A term describing how well a patient is able to perform daily tasks and activities. The better the performance status, the more likely a patient will successfully tolerate and respond to treatment.
Blood Proteins Proteins present in the blood that can be predictors of disease. The important blood proteins in NHL are lactate dehydrogenase (LDH) and beta (2) microglobulin (B2M), both of which indicate aggressive disease if present at high levels. Patients with normal levels of LDH or B2M tend to respond better to treatment compared with patients who have higher levels.
Extranodal Disease A term describing NHL that has spread outside of the lymphatic system. Patients whose NHL is contained within the lymphatic system typically show a better response to treatment.
Bulky Disease Any NHL tumour that is greater than 10 cm in diameter. The presence of bulky disease can indicate a more advanced stage of NHL. Smaller tumours often respond better to therapy than larger ones.
Stage of Disease The extent to which the cancer has spread in the body. NHL is divided into four stages: stages I and II are considered limited (involving a limited area) and stages III and IV are considered advanced (more widespread involvement). Patients with stage I and II (limited stage) NHL usually have a better chance of a successful response to treatment

Non-Hodgkin lymphoma (NHL) often responds very well to modern treatments. This does not mean that it is always curable, but it does mean that treatment can often provide long cancer-free periods, reduced symptoms and improved quality of life for many patients. Certain types of NHL often remain dormant for long periods of time and require little or no treatment, while other types of NHL require immediate treatment. Response to treatment depends on the type of NHL and stage/grade of the disease.

There are many different types of treatments for NHL, the most common of which include:

You can learn about each type of therapy by clicking on each link. As you will learn from reading about chemotherapy, there are many different ways of attacking rapidly dividing cells and hence, many different types of chemotherapy. Some types of chemotherapy drugs interact with receptors on the surface of cancer cells, some damage cell structures necessary for cell division and some directly target the cancer cell’s DNA, the genetic material of the cell.

Because these are all different ways of achieving the same result—death of the cancer cells—chemotherapy drugs are often given in combination in order to attack the lymphoma cells from all possible angles to increase the odds of achieving remission. Chemotherapy combinations are often known by the initials of the names of the drugs in the combination. Two of the most common combinations used in NHL are called CHOP and CVP.

CHOP is a combination of four drugs, namely, three chemotherapy medications and one steroid medication:

  • Cyclophosphamide
  • Doxorubicin (also called Hydroxydaunorubicin)
  • Vincristine (also called Oncovin)
  • Prednisone (the steroid medication).

CVP is a combination of two chemotherapy drugs and a steroid:

  • Cyclophosphamide
  • Vincristine (also called Oncovin)
  • Prednisone (the steroid medication).

Steroid medications are included in these regimens as they are effective therapies for lymphoma and can quickly get NHL symptoms under control.

The type of chemotherapy a patient with NHL receives depends on a number of variables, including:

  • The type of NHL
  • The grade of NHL (whether the NHL is indolent or aggressive)
  • The stage of NHL
  • Whether it’s the first NHL treatment for the patient or if the NHL has relapsed following prior therapy
  • The symptoms the patient is experiencing
  • The overall health of the patient including age, medical history and vitality (often referred to as the performance status of the patient)
  • The recommendations of the medical oncologist
  • The choice and participation of the patient in the treatment decision process.

Remember, you are a partner in your care and therefore it is important to understand your treatment plan – both for the treatment you will receive now and the treatment you may receive down the road should it become necessary. In some cases, the first treatment may affect the next treatment you will be able to receive. To see an overview of the treatment pathway, click on the following links depending what kind of lymphoma you have:

Indolent lymphoma
Aggressive lymphoma