Treatment Options for Non-Hodgkin Lymphoma
Treating non-Hodgkin lymphoma (NHL) involves various approaches, often used in combination depending on the lymphoma type, stage, and the patient’s overall health. Here’s a comprehensive guide to chemotherapy, immunotherapy, radiation therapy, targeted therapy, stem cell transplants, and clinical trials to provide clarity and prepare you for what to expect.
1. Chemotherapy Options for Non-Hodgkin Lymphoma
Chemotherapy uses powerful drugs to kill or slow the growth of cancer cells. Each drug in a chemotherapy regimen has specific side effects, so understanding these can help you prepare.
R-CHOP Regimen
R-CHOP is one of the most common chemo regimens for NHL, combining rituximab with traditional chemotherapy drugs:
- Rituximab: A monoclonal antibody that targets CD20 on B-cells.
- Process: IV infusion over several hours, typically once every three weeks.
- Side Effects: Fever, chills, low blood pressure, nausea, fatigue, and infusion reactions like itching or rash. Long-term use may increase infection risk.
- Cyclophosphamide: A chemotherapy drug that interferes with the DNA of cancer cells.
- Process: Given as an IV infusion, alongside other drugs in the regimen.
- Side Effects: Fatigue, nausea, vomiting, hair loss, low blood cell counts, and potential bladder irritation. Hydration and bladder protection medications are often recommended.
- Doxorubicin: Known as “red devil” due to its color, it disrupts cell DNA.
- Process: Given via IV infusion.
- Side Effects: Hair loss, nausea, mouth sores, fatigue, and increased heart damage risk with prolonged use. Patients often receive heart monitoring during treatment.
- Vincristine: Prevents cells from dividing by inhibiting spindle formation.
- Process: Administered via IV, usually in a hospital or clinic.
- Side Effects: Nerve damage (neuropathy), constipation, jaw pain, and fatigue. Neuropathy may cause tingling or numbness in fingers and toes.
- Prednisone: A corticosteroid that reduces inflammation and aids in side-effect management.
- Process: Taken orally, often for five days with each cycle.
- Side Effects: Insomnia, mood swings, weight gain, increased blood sugar, and infection risk. Gradual tapering may be needed to prevent withdrawal.
2. Immunotherapy Options for Non-Hodgkin Lymphoma
Immunotherapy harnesses the immune system to recognize and attack cancer cells, generally causing different side effects than chemotherapy.
Monoclonal Antibodies (e.g., Rituximab, Obinutuzumab)
These antibodies target specific proteins on lymphoma cells, signaling the immune system to destroy them.
- Process: Administered as an IV infusion, often with pre-medications to prevent infusion reactions.
- Side Effects: Infusion-related reactions (fever, chills, rash, low blood pressure), fatigue, nausea, and infection risk. Some patients may experience flu-like symptoms after infusion.
CAR T-Cell Therapy (e.g., Axicabtagene Ciloleucel)
CAR T-cell therapy involves re-engineering a patient’s T-cells to target lymphoma cells.
- Process: T-cells are extracted, modified, and reinfused. A short chemo regimen precedes this to reduce immune cells.
- Side Effects: Cytokine release syndrome (CRS), which can cause high fever, low blood pressure, and trouble breathing. Neurological effects like confusion or headaches may occur, requiring close monitoring in a hospital.
Checkpoint Inhibitors (e.g., Pembrolizumab, Nivolumab)
These drugs help the immune system recognize and attack cancer cells by blocking proteins that hide cancer cells.
- Process: Administered via IV infusion every few weeks.
- Side Effects: Fatigue, rash, itching, joint pain, and inflammation of organs like lungs or liver. Corticosteroids may help manage these side effects.
Immunomodulatory Drugs (e.g., Lenalidomide)
Lenalidomide alters the immune system to slow or stop cancer growth.
- Process: Taken as an oral pill, typically in cycles.
- Side Effects: Fatigue, low blood counts, blood clot risk, and potential birth defects if taken during pregnancy. Patients may need blood thinners to reduce clotting risk.
3. Radiation Therapy Options for Non-Hodgkin Lymphoma
Radiation therapy uses high-energy beams to target cancer cells in specific areas.
External Beam Radiation (e.g., ISRT)
This is the most common form of radiation therapy and targets specific lymph nodes or affected areas.
- Process: Delivered over a few minutes, typically once a day, five days a week for several weeks.
- Side Effects: Fatigue, skin irritation (similar to sunburn), and localized effects depending on the area treated (e.g., cough or swallowing issues if the chest is treated).
Total Body Irradiation (TBI)
Used in preparation for a stem cell transplant, delivering radiation to the entire body to kill cancer cells.
- Process: Administered over several days in small doses, often combined with chemotherapy.
- Side Effects: Severe fatigue, infection risk, nausea, mouth sores, and low blood cell counts. Patients require careful monitoring and supportive care.
4. Targeted Therapy for Non-Hodgkin Lymphoma
Targeted therapies focus on specific proteins or pathways in cancer cells, reducing harm to normal cells.
BTK Inhibitors (e.g., Ibrutinib, Acalabrutinib)
BTK inhibitors block the enzyme Bruton’s tyrosine kinase, crucial for lymphoma cell growth.
- Process: Taken orally as a daily pill.
- Side Effects: Diarrhea, fatigue, bruising, bleeding risk, and possible heart issues (e.g., atrial fibrillation).
PI3K Inhibitors (e.g., Idelalisib, Copanlisib)
These drugs inhibit a pathway that helps lymphoma cells survive.
- Process: Taken orally or as an IV infusion, depending on the drug.
- Side Effects: Diarrhea, liver enzyme elevations, fatigue, and infections. Regular blood tests help monitor liver function.
BCL-2 Inhibitors (e.g., Venetoclax)
Venetoclax targets the BCL-2 protein, helping cancer cells avoid death.
- Process: Taken orally, starting with a low dose that gradually increases.
- Side Effects: Low white blood cell counts, infection risk, nausea, diarrhea, and tumor lysis syndrome risk (a condition caused by rapid cancer cell breakdown).
Antibody-Drug Conjugates (e.g., Polatuzumab Vedotin)
Combines a monoclonal antibody with a chemotherapy drug to deliver chemo directly to cancer cells.
- Process: Administered as an IV infusion every three weeks.
- Side Effects: Fatigue, low blood counts, nausea, diarrhea, and potential neuropathy (tingling or numbness).
5. Stem Cell Transplants for Non-Hodgkin Lymphoma
Stem cell transplants, or bone marrow transplants, replace damaged bone marrow with healthy cells and are often used after high-dose treatments.
Autologous Stem Cell Transplant
Involves using the patient’s own stem cells after intensive chemotherapy.
- Process: Stem cell collection, high-dose chemo, and reinfusion of stored stem cells.
- Side Effects: Increased infection risk, fatigue, nausea, mouth sores, and low blood counts. Patients may need several weeks in the hospital for recovery.
Allogeneic Stem Cell Transplant
Uses stem cells from a donor to introduce a new immune system that can help fight lymphoma.
- Process: Conditioning regimen (high-dose chemo or TBI), followed by donor stem cell infusion.
- Side Effects: Infection risk, fatigue, nausea, and graft-versus-host disease (GVHD), where the donor cells attack the recipient’s body, causing skin rashes, liver damage, and digestive issues.
6. Clinical Trials for Non-Hodgkin Lymphoma
Clinical trials provide access to new therapies and combinations, offering options when standard treatments are less effective.
- Process: Patients receive a treatment protocol and undergo regular evaluations and follow-up appointments to monitor progress and side effects.
- Side Effects: Vary depending on the trial, as many involve experimental drugs. Benefits include close monitoring and support; risks should be discussed with a healthcare team.
Going through treatment and need help managing side effects? See Wellnest's guide on Must-Have Items for Going Through Treatment, Managing Side Effects of Non-Hodgkin Lymphoma Treatment, and Questions to Ask the Doctor.