Induction therapy
When aggressive non-Hodgkin’s lymphoma (NHL) is diagnosed, treatment usually begins as soon as possible. This treatment is known as induction therapy. For patients with diffuse large B-cell NHL (one of the NHL subtypes), it may combine immunotherapy with chemotherapy, as this has been shown to be the most effective way of reducing symptoms and achieving cure. While the term cure is ill-defined in cancer, most doctors believe that a period free of signs and symptoms of disease over 3-5 years for a rapidly growing cancer such as aggressive NHL is synonymous with cure.
Bear in mind that everyone’s experience of NHL is different and chemotherapy plus immunotherapy might not be the best treatment for you. Your doctor or clinical nurse specialist will be able to explain more about your treatment and why it was chosen for you.
What is induction therapy?
Induction therapy is the first course of therapy that you receive when you are diagnosed with aggressive non-Hodgkin’s lymphoma.
Induction therapy for non-Hodgkin’s lymphoma aims to cure the disease if possible
Non-Hodgkin’s lymphoma (NHL) is a type of cancer of your white blood cells (lymphocytes). By killing as many of the cancerous cells as possible, induction therapy can help reduce your symptoms so that you are cured or enter remission (a period of time when you will feel relatively well and have far fewer symptoms than when your disease is active). If cure or remission is not possible, then treatment will aim to minimise your symptoms.
For patients with large diffuse B-cell non-Hodgkin’s lymphoma (a type of aggressive NHL), induction therapy is usually given as a combination of immunotherapy plus chemotherapy
However, immunotherapy or chemotherapy can sometimes be given on their own. 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.
How does induction therapy for non-Hodgkin’s lymphoma work?
Induction therapy aims to reduce the number of lymphocytes in your body. If you are having immunotherapy plus chemotherapy this reduction is brought about in two ways:
- Immunotherapy specifically kills the cells that are affected by NHL (lymphocytes).
Because lymphocytes (a type of white blood cell) are the only type of cells that are affected by lymphoma, killing them can significantly reduce your symptoms. However, healthy lymphocytes are also killed, and this might result in side effects, such as infections.
- Chemotherapy kills any cells in your body that are growing quickly.
Because lymphoma cells grow more rapidly than normal cells, chemotherapy can help remove most of your lymphoma cells from your body and help reduce your symptoms, but is also associated with side effects like nausea and hair loss.
Combining these two treatments can therefore be a very effective way of killing as many lymphoma cells as possible
Find out more about the side effects of chemotherapy for non-Hodgkin’s lymphoma
Immunotherapy that continues after induction therapy is finished is known as maintenance therapy and is being investigated as a treatment option for newly diagnosed patients in Europe. It is currently experimental and its use is rare. Its benefit has not been proven in these patients.
What to expect from induction therapy
Being nervous about induction therapy is understandable, as you will be going through a lot of new experiences and meeting some new staff who will be specialists in the treatment that you’ll be receiving.
Remember that everyone on your healthcare team is dedicated to helping you through your treatment, and they will always have time to talk to you about what to expect on your visits and to give you advice about how to cope with your treatment.
There are also several patient support groups for non-Hodgkin’s lymphoma who will be able to provide you with advice and information. Ask your healthcare team for details of local groups.
Getting yourself ready in advance for your treatment visits can also help make things easier for you. Our section on Preparing for your hospital/doctor visits will give you some tips on things to think about in advance, or what to ask your healthcare team.
When you start induction therapy for non-Hodgkin’s lymphoma, you will probably have a consultation with your doctor at the beginning of each of your treatment visits
You probably visited the specialist non-Hodgkin’s lymphoma clinic or doctor’s office when you were diagnosed. Before treatment your doctor will want to know how you are feeling and assess your general health. They will also be able to talk to you about what to expect from your treatment. However, a specialist nurse from the lymphoma clinic will normally give you your treatment.
Immunotherapy and many types of chemotherapy are usually given intravenously (as an injection or drip)
This means the nurse will use either a needle or catheter (a small hollow tube) that is inserted through the skin to get the medication into a vein, usually in the arm. If the treatment is given as a drip, the medication will be injected into a bag of fluid that is allowed to slowly enter your body through the needle or catheter.
Sometimes, a device known as a central line is used. A central line is a long-lasting catheter or tube that is usually inserted into one of the veins at the top of the chest and can remain there throughout your treatment course. The advantage of a central line is that there is no need to insert a new needle every time intravenous medication has to be given. Central lines can also be used to draw blood samples.
Most people receiving induction treatment will need to have a combination of injections (or drips) and tablets at each visit
Although immunotherapy and chemotherapy medications are usually given as a drip or an injection, some types of chemotherapy and some of the drugs that can help with side effects can be taken as tablets (orally). These may also be given the day before the i.v. chemotherapy starts.
For your first round of induction treatment for non-Hodgkin’s lymphoma, you will probably need to stay in hospital overnight
This is usually so that your healthcare team can monitor you to see how you are responding to the medication. For example, if side effects occur while you’re being given any of the drugs, your nurse may be able to slow down the treatment to allow time for the side effects to pass.
Find out more about coping with induction therapy for non-Hodgkin’s lymphoma and its side effects
After your first treatment, most induction therapy drugs can be given in an outpatient clinic or doctor’s office
This means you should be able to go home the same day. However, for certain medications a short hospital stay might still be needed, but this will depend on exactly what medications you are being prescribed. Your doctor or specialist nurse will be able to advise you of what to expect from your treatment.
You will be treated by several different people (a multidisciplinary team)
Your healthcare team may comprise a haematologist who specialises in diseases of the blood or an oncologist (a cancer specialist), a treatment nurse who will probably give you your therapy and a specialist nurse who will be able to answer any questions that you may have about your treatment.
Find out more about your non-Hodgkin’s lymphoma healthcare team
Tell me more about immunotherapy
Find out more about immunotherapy for aggressive non-Hodgkin’s lymphoma
Tell me more about chemotherapy
Find out more about chemotherapy for aggressive non-Hodgkin’s lymphoma
Preparing for therapy
When starting/receiving therapy, visiting the hospital or doctor can be a stressful time. Read about how to prepare for these times to make them easier to cope with.
Preparing for hospital/doctor visits for treatment for non-Hodgkin’s lymphoma