Induction and maintenance therapy
If your indolent non-Hodgkin’s lymphoma (NHL) has relapsed, you may be starting to experience NHL symptoms again. Alternatively, your doctors might have noticed that your NHL is returning during a routine check-up, and you may still be feeling relatively healthy.
You may have had treatment such as immunotherapy radiotherapy, or chemotherapy previously, but you’ve probably also just spent time in remission. So it might have been some time since you’ve been to the hospital for treatment.
Whatever your treatment history, if your doctor has recommended induction and maintenance therapy for your relapsed indolent NHL, you now have another chance to fight the disease and stop it affecting you so much.
Although it is unlikely to cure you, induction and maintenance treatment for relapsed NHL can help reduce your symptoms again and give you another period of remission. Many people with relapsed NHL will have several periods of relapse and remission throughout the course of their disease. But most people who do experience such relapses can live successfully with the disease for a long time.
It is likely that you will spend long periods of time in remission, which will far outweigh the amount of time you spend having therapy, and make going through with the treatment worth the effort.
If your doctor has recommended induction and maintenance therapy, you will move on to maintenance therapy only if you have a response to induction therapy. After reducing the lymphoma as much as possible with induction therapy, maintenance therapy is designed to help extend your remission for as long as possible, and further delay the progression of the disease.
How does induction therapy work?
The aim of the initial induction therapy is to reduce your symptoms and help you re-enter remission, which will help you live for as long as possible and delay the time until your next treatment.
Induction therapy for relapsed non-Hodgkin’s lymphoma (NHL) works in the same way as induction therapy for newly diagnosed NHL: by reducing the number of white blood cells in your body.
Remind me about indolent non-Hodgkin’s lymphoma
What does induction therapy involve?
Induction therapy is usually given as a combination of immunotherapy plus chemotherapy. However, immunotherapy or chemotherapy can sometimes be given on their own. Furthermore, for relapsed indolent non-Hodgkin's lymphoma, you may receive radio-immunotherapy either alongside, or instead of, the conventional immunotherapy that you may have had before.
Your doctor will decide what kind of induction therapy is best for you based on your type of disease as well as your personal health and circumstances. You will also receive regular check-ups after induction therapy to monitor your progress.
Find out more about immunotherapy for relapsed non-Hodgkin’s lymphoma
Find out more about chemotherapy for relapsed non-Hodgkin’s lymphoma
Find out more about radio-immunotherapy for relapsed non-Hodgkin’s lymphoma
Tell me more about maintenance therapy
Maintenance therapy is when you continue having doses of immunotherapy after your induction therapy has finished, but with no chemotherapy
Your doctor might prescribe maintenance therapy if the induction therapy for your relapsed disease has worked and you are in remission. Maintenance therapy consists of immunotherapy with a drug called a monoclonal antibody, usually once every 3 months for up to 8 cycles (or 2 years in total). However, your doctor may change this regimen to suit your individual circumstances. You do not receive any chemotherapy during maintenance treatment. Maintenance immunotherapy can be given to people who had a response after induction therapy.
Maintenance therapy is designed to keep you in remission for as long as possible
Induction therapy reduces the number of lymphoma cells in your body, and if it is successful, causes a remission. However, indolent non-Hodgkin’s lymphoma (NHL) is a chronic disease that is unlikely to be completely cured. Usually people with indolent NHL have long periods of remission, when they have no symptoms, followed by times when the symptoms return, known as relapse. So indolent NHL needs to be treated over the long term.
Most people who successfully complete induction treatment do eventually have a relapse and need more therapy. The important thing is to make the remission last as long as possible and so increase the time until your next treatment. Research has already shown that maintenance treatment can achieve this in both newly diagnosed and relapsed patients. However, in most countries maintenance immunotherapy is only approved for relapsed patients, although it is approved for both relapsed patients and newly diagnosed patients in several countries such as Canada and Switzerland.
When it was studied in people with relapsed non-Hodgkin's lymphoma, maintenance therapy was shown to help people live longer, and stay disease free for longerScientists have carried out studies in people with relapsed NHL to find out how well maintenance therapy works. These patients had previously had successful induction therapy with chemotherapy, and many had also received immunotherapy.
The results of these studies are only a guide, because everyone has a different experience. But on average, following induction therapy in patients with relapsed disease, maintenance therapy can increase the length of remission by up to 3 years compared with patients who do not receive maintenance therapy.
As with every anticancer treatment, some patients experience side effects with maintenance therapy, although these were generally mild, or could be controlled. Your physician and nurse will be able to inform you about possible side-effects.
People with relapsed NHL who have had maintenance therapy also live longer overall than those who have not.
Who will I see at the hospital?
You will probably be familiar with many of the members of your healthcare team from treatment and check-up visits that you have had in the past. As a quick reminder, or in case you have had different kinds of treatment before, here is a list of the team members that you might meet during induction or maintenance treatment.
Treatment is often planned by a haematologist – a doctor who specialises in diagnosing and treating diseases of the blood
You might be under the care of a haematologist, who is a specialist doctor who will decide on the best course of treatment for you. He or she will be involved in the planning of your induction therapy, including such things as which drugs should be given, what the doses should be, how often the drugs are given, and how long the course of treatment will be.
You may also see an oncologist – a doctor who specialises in treating cancers, especially through the use of chemotherapy or immunotherapy
You may find yourself under the care of an oncologist, either as well as, or instead of, a haematologist.
A specialised treatment nurse will give you your immunotherapy and chemotherapy
Treatment nurses have had special training in the use and administration of chemotherapy and immunotherapy, and they will be the ones to give you your medication. They will also be able to give advice about side effects of the therapy and about what to do if anything unusual happens during a course of treatment.
Clinical nurse specialist – a nurse who has specialised in non-Hodgkin's lymphoma
Although they might not be directly involved in your therapy, the clinical nurse specialist is often your main point of contact at the clinic. They will be able to talk to you about your induction or maintenance therapy and answer any questions that you might have.
Find out about coping with therapy for relapsed non-Hodgkin’s lymphoma