Non-Hodgkin Lymphoma Treatment Options

A personalized treatment plan is created by a hematologist/oncologist for each lymphoma patient at Compass Oncology. The set of treatments and the order they’re given depend on several factors, including:

• The type of non-Hodgkin lymphoma 
• Its stage 
• Where the cancer originated
• How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)
• Your age
• Whether you have other health problems

Treatment options for NHL may include one or a combination of the following:

Watchful Waiting for Lymphoma Patients

Doctors sometimes suggest watchful waiting for patients with indolent (slow-growing) lymphoma. For these patients, treatment may be delayed until symptoms appear. Sometimes, the tumor may even shrink for a while without therapy. By putting off treatment, these patients can avoid the side effects of treatments until they become necessary.

If you and your hematologist/oncologist agree that watchful waiting is a good idea, you will likely be checked every three months. If symptoms occur or get worse, treatment will begin. Some people do not prefer a watchful waiting approach because they don’t want to worry about having cancer that is not being actively treated. Those who choose watchful waiting at first but later become worried should discuss their feelings with the cancer care team. 

Chemotherapy for Non-Hodgkin Lymphoma

Chemotherapy for non-Hodgkin lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually given in our Portland, Oregon, and Vancouver, Washington, cancer centers. Some people need to stay in the hospital during treatment.

The most commonly used treatment for non-Hodgkin lymphoma is known as R-CHOP. This therapy involves administering four different chemotherapy drugs and a type of immunotherapy known as rituximab that targets specific lymphoma cells.

Chemotherapy is given in cycles, which includes a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and the anticancer drugs used.

Targeted Therapy

Targeted therapy is a type of treatment that focuses on specific changes in cells that cause lymphoma. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy. Proteasome inhibitors and kinase inhibitor therapy are types of targeted therapy used to treat adult non-Hodgkin lymphoma.

Kinase Inhibitor Therapy for Lymphoma

This type of treatment uses drugs to block certain proteins, such as P13K proteins, which may help keep NHL cells from growing and kill them. They are used to treat follicular non-Hodgkin lymphomas that have relapsed (come back) or have not gotten better after treatment with at least two other therapies.

Proteasome Inhibitors for Lymphoma

These drugs prevent enzyme complexes known as proteasomes from breaking down essential proteins required for normal cell division. Although this treatment is more frequently used for other blood cancers, it may be used for non-Hodgkin lymphoma in cases where the patient does not respond to other treatments.

Non-Hodgkin Lymphoma Immunotherapy 

Immunotherapy, also called biologic therapy, is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. 

• Monoclonal antibodies: These are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies can kill the cancer cells and then block cancer cells from growing or keep them from spreading. Monoclonal antibodies are given by infusion, the same way as chemotherapy. They may be used alone or in combination with other cancer treatments. 
• Immunomodulators: Lenalidomide is an immunomodulator used to treat adult non-Hodgkin lymphoma.
• Checkpoint Inhibitors: Immunotherapy drugs called immune checkpoint inhibitors work by blocking checkpoint proteins from binding with their partner proteins. This prevents the “off” signal from being sent, allowing the T cells to kill cancer cells. The PD-1 pathway is a target for several checkpoint inhibitors. Primary mediastinal large B-cell lymphoma that at least two other treatments have not stopped may be treated with a pembrolizumab (Keytruda).
• CAR T-cell therapy: This involves changing T cells (a type of immune system cell) so they attack specific proteins on the cancer cell's surface. T cells are taken from the patient, and receptors are added to their surface in the lab. The altered cells, called chimeric antigen receptor (CAR) T-cells, are given to the patient by infusion. They multiply in the patient's blood and attack cancer cells. CAR T-cell therapy treats large B-cell lymphoma that has not responded to treatment. CAR T-cell therapy is also being studied to treat mantle cell lymphoma that has relapsed or not responded to treatment.

Using Radiation Therapy for Lymphoma

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells and may be used to treat NHL in various situations: 

• It can be used as the primary treatment for some types of early-stage NHL if the tumor type is known to respond well to radiation.
• It can be used for more advanced lymphomas, often in combination with chemotherapy.
• It may be used in combination with chemotherapy to eliminate lymphoma cells throughout the body in individuals who undergo a stem cell transplant.
• It can be used for palliative care, providing relief from symptoms caused by lymphoma tumors that developed on an organ or structure in the body, such as the brain or spinal cord, which is causing pain due to pressure on nerves

External beam radiation therapy (ERBT) is the primary method for treating NHL using radiation. This approach directs beams of radiation at the specific size and shape of the tumor or lymph node. This type of treatment is given at an outpatient cancer center, like Compass Oncology. Patients usually come in five days a week for a few weeks. 

At Compass Oncology, your hematologist/oncologist will work with the radiation oncologist if they feel radiation therapy would be beneficial. 

Bone Marrow Transplants 

If non-Hodgkin lymphoma returns after treatment, a bone marrow transplantation may be recommended. After receiving a high-dose treatment of chemotherapy, sometimes with radiation therapy, healthy blood-forming stem cells are replaced in the body. New blood cells develop from the transplanted stem cells. With the new blood cells, lymphoma cells should also be absent. These cells may come from your own body or a donor:

• Autologous transplantation: This type of transplant involves using your own cells, which are extracted before undergoing high-dose treatment. Once removed, these cells will be frozen, stored, and, in some cases, treated to kill lymphoma cells that may be present. After treatment, the stored cells will be thawed and returned to you.
• Allogeneic transplantation: This involves using stem cells that come from someone else (a donor). The donor may be a relative or an unrelated person. Blood tests will be performed to ensure the donor’s cells match your cells. 

The Latest Treatments for Non-Hodgkin Lymphoma Are Available in the Portland, Oregon Area

If you have been diagnosed with non-Hodgkin lymphoma, the lymphoma specialists at Compass Oncology can provide second opinions on the best cancer treatment based on your situation. This may also include the option to participate in a clinical trial, if eligible. We offer the latest cancer treatments close to home at cancer centers located in the Portland-Vancouver area.