Non-Hodgkin's Lymphoma Treatment

  • Treatment

    If you have NHL and have been prescribed chemotherapy, you may need to be hospitalized for treatment. Although chemotherapy is often given in a doctor's office or clinic, sometimes patients are hospitalized for a short time to receive treatment.

    Swollen lymph nodes in the thymus gland, which is located in the neck, may produce life-threatening symptoms. Swollen lymph nodes in the thymus can block bloodflow inside the chest, or block airflow through the trachea. Blocked blood vessels cause the head and arms to swell, which can cause brain damage. Blockage of the trachea may cause shortness or breath, coughing, or suffocation. If you start to experience any of these symptoms, seek immediate medical attention.

    Cancer patients are also at risk for other emergencies that arise either from the cancer or from the treatment. Severe complications can arise when the lymphoma produces too many white cells, called hyperleukocytosis. Other complications can include severe anemia, blood clots, excess calcium levels in the blood, liver disease and blockages in the intestine. All patients should be monitored carefully for these complications by their doctors. If you have NHL and you feel weak, dizzy, light-headed or you notice weakness in one part of your body, you should notify your doctor immediately.

    If you are undergoing chemotherapy, take steps to avoid infection: wash your hands thoroughly, avoid uncooked fruit or other germ-carrying foods, and avoid contact with children or other individuals suspected of having an infection. Patients receiving anticancer drugs are more likely to get an infection because of the alterations such drugs cause in the immune system. Children are more likely than adults to carry infections; however, taking precautions to avoid exposure to germs minimizes the risk for infection. For example, a surgical mask, sterile gown, and/or surgical gloves may be worn to minimize exposure.

    Eat a healthy diet.

    Patients undergoing anticancer treatment need to make every effort to get enough calories and protein in their diet to help them regain strength, increase energy, and prevent weight loss.

    Your doctor is the best source of information on the drug treatment choices available to you.

    If you have NHL, you may be treated with radiation therapy. [Table 1] [Table 2] Radiation therapy involves exposing cancer-infected areas to high-energy radiation. Radiation therapy can also be used to ease the symptoms associated with lymphoma in the internal organs, such as the brain and spinal cord. Radiation treatment—sometimes combined with chemotherapy—is usually given for three to four weeks, and it is often combined with chemotherapy to treat NHL.

    If you currently are taking anticancer drugs or undergoing radiation therapy and your blood cell counts are low, you may need a blood transfusion. Platelet transfusions protect against bleeding; red cell transfusions are used to treat the fatigue associated with radiation therapy.

    You may be prescribed a biological therapy, which can stimulate or restore the immune system's ability to fight infection and disease. [Table 1][Table 2] Three of these therapies are interferon, anti-CD20 therapy, and radioimmunoconjugation therapy. Biological therapies can kill lymphoma cells, slow their growth, or activate the immune system to fight cancer cells more efficiently. These therapies can also lessen the side effects of some cancer treatments. Interferon, a hormone-like substance, is produced by the blood cells of the immune system to fight infection, and can cause some NHL tumors to shrink. Antibodies are also produced by the immune system to help combat infection, and can be designed specifically to attack the cancer cells. Anti-CD20 therapy is an antibody designed to attack a specific type of cancer cell. .

    Radioimmunoconjugation therapy is also a biological therapy, but is different in that it is an antibody attached to a radioactive element. Therefore, radioimmunoconjugation provides highly targeted radiation therapy only to the cancer cells.

    If you relapse, your doctor may recommend bone marrow transplantation. [Table 1][Table 2] Patients who relapse and are still sensitive to anticancer drugs usually receive bone marrow or blood cell transplantation. Bone marrow or blood cells can be retrieved either from the patient or from a relative whose basic cell type is identical. The goal of transplantation is to replace the blood-forming cells that have been destroyed by cancer treatment. Therefore, transplantation is done after chemotherapy. This helps the patient to produce healthy blood cells that are needed to fight infection.

    Joining a support group may be help you cope with NHL. Patients with non-Hodgkin's lymphoma disease often have concerns about such things as holding their jobs, caring for their families, treatments, hospital stays, and meeting expenses. Because support from friends and family may not be enough, some patients benefit from discussing their concerns with other cancer patients.

    If the doctor suspects that you have NHL, he or she may suggest surgery to obtain a tissue sample to confirm the diagnosis. Removing the entire lymph node or a small part of a larger tumor requires surgery. If the node is near the skin surface, local anesthesia is used. If the node or tumor is inside the chest or abdomen, the surgeon will use general anesthesia.

    If the lymphoma starts in an organ, such as the thyroid gland or the stomach, and has not progressed, you may need surgical treatment. Surgery is rarely used to treat NHL; however, it can be useful in particular cases. For example, removing a bulky tumor from the stomach can be useful before starting chemotheapy.

    Consider alternative therapies (in addition to standard cancer treatment) to relieve pain, reduce side effects, and enhance your emotional, physical, and spiritual well-being. Always consult your doctor before starting any alternative therapy to make sure it will not be harmful to you.

    If you are pregnant, discuss treatment options for NHL with your doctor. Data are sparse regarding the long-term effects of anticancer drugs on children who were exposed in utero. For some patients, early delivery, if feasible, may be the best option to avoid exposing the fetus to radiation and anticancer drugs.

    Early-stage, indolent, or low-grade NHL may be put in remission or alleviated effectively with radiation therapy. [Table 1] [Table 2] Indolent NHL responds both to treatment with radiation and anticancer drugs. Thirty percent of patients with NHL can be cured with effective treatment.

    More aggressive NHL may be put into remission or alleviated with an intensive combination of anticancer drugs and/or bone marrow or PBSC transplantation. [Table 1] [Table 2] Thirty to sixty percent of patients with aggressive NHL can attain complete remission. In addition, a combination of anticancer therapy and therapy with an antibody that is used for treating a particular type of lymphoma—may increase survival of these patients.

    The overall survival rate of patients with NHL varies depending on stage and grade, and ranges from 20% to 95%. Patients who have HIV and the develop NHL have a poorer prognosis than the general population. The survival rate depends on the person's age, general health, response to treatment, and grade and stage of the NHL. Thus, a definite prognosis is difficult. Patients with lymphoma at higher stages and grades have a poorer prognosis than other patients, and patients over 60 years of age have a poorer outcome than younger patients.

    Relapses usually occur within the first two years after treatment, and are more common in patients with advanced-stage NHL. Patients who have a relapse can be successfully re-treated. Patients with relapsed NHL who receive bone marrow or blood cell transplantation in combination with anticancer drugs have a 20% to 60% survival rate at two and five years after treatment, repectively. Bone marrow or blood cell transplantation procedures are usually used for patients who have relapsed lymphoma and are still sensitive to anticancer drugs. These procedures predispose a patient to leukemia and death because high doses of anticancer drugs and radiation are administered as a component of transplantation therapy.

    Schedule a visit with your physician every three months after treatment. You will need to follow up with a physician for several years. Regular follow-up visits are necessary to discuss changes in your health. During your appointment, the doctor will take a general medical history and conduct a physical examination, paying careful attention to the size and firmness of the lymph nodes.

    Report any new symptoms to your doctor immediately. New symptoms may be caused by side effects of treatment or recurrent cancer.

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I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!

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