Treatment and outcomes
Beginning treatment for aggressive non-Hodgkin’s lymphoma can be a difficult and stressful experience. The gap between diagnosis and beginning treatment is often very short, sometimes only a matter of days.
Things may be happening very fast and it can feel as though you are out of control. But remember, your healthcare team, patient support groups, and of course Lymphoma Life, will be here to help you through the whole experience.
Outcomes in aggressive non-Hodgkin’s lymphoma
With aggressive non-Hodgkin’s lymphoma (NHL), there is a good chance of cure. In some cases the disease may not be cured completely by treatment, however you may experience a period of feeling well with no signs of disease (remission) followed by a time when your symptoms return (relapse). More treatment may then be needed and can still achieve a cure in some cases, but if this is not possible your treatment will be aimed at reducing your symptoms.
Treatment for aggressive NHL aims to cure the disease with first-line treatment. If this is not achieved, but a response was seen, then a relapse will tend to occur within the first 6-12 months, but is also possible after being in remission for 2-3 years. The length of remission tends to decrease rapidly with each subsequent treatment and a patient rarely gets more than 3 rounds of therapy. A cure can safely be assumed if response to first line therapy was rapid and complete, no additional risk factors are present, and the disease-free period is 3-5 years in length.
What treatment will I get for aggressive non-Hodgkin’s lymphoma?
Your treatment for aggressive non-Hodgkin's lymphoma (NHL) will probably consist of immunotherapy (sometimes called monoclonal antibody therapy) and chemotherapy. If the two are combined, this is called immunochemotherapy. Radiotherapy is sometimes used in addition to the other treatments.
There are various different treatment options available for aggressive NHL. Your treatment plan will be chosen specifically for you by your healthcare team and will depend on:
- The exact type or grade of your NHL
- The stage of your NHL
- Your own personal health and circumstances
- Your personal wishes and needs
The table shows the common treatments for different stages of aggressive NHL, as well as the likely outcomes.
If you have just been diagnosed with aggressive non-Hodgkin's lymphoma and and you are about to receive treatment, you will begin by receiving induction therapy.
The aim of induction therapy is to achieve a cure or a disease-free period. It usually involves a course of several weeks of intensive chemotherapy or immunotherapy plus chemotherapy, sometimes called immunochemotherapy.
I’m starting induction therapy for aggressive non-Hodgkin’s lymphoma
Chemotherapy
The usual treatment for patients who are diagnosed with aggressive non-Hodgkin's lymphoma (NHL) is several courses of combination chemotherapy, in which more than one chemotherapy drug is given, usually together with a steroid. Patients who are diagnosed with aggressive NHL at an advanced stage (stage III or stage IV) may be given a longer course of chemotherapy than those with early-stage disease.
Find out more about chemotherapy for aggressive non-Hodgkin’s lymphoma
Immunotherapy
In most countries, a monoclonal antibody therapy is given in combination with chemotherapy as standard therapy. This is called immunochemotherapy. The monoclonal antibody increases the effectiveness of the treatment with only limited additional side effects. Immunotherapy can be included with chemotherapy in all stages of aggressive non-Hodgkin's lymphoma.
Find out more about immunotherapy for aggressive non-Hodgkin’s lymphoma
Radiotherapy
Radiotherapy is sometimes given after chemotherapy. The two treatments are sometimes given at the same time, although this is rare. The radiotherapy is directed specifically at the affected areas and lymph nodes.
Find out more about radiotherapy for aggressive non-Hodgkin’s lymphoma
Preparing for therapy
When starting/receiving therapy, visiting the hospital or doctor can be a stressful time. Preparing for these times can make them easier to cope with.
Read how to prepare for hospital/doctor visits for the treatment of non-Hodgkin’s lymphoma
In patients with non-Hodgkin’s lymphoma that does not respond well to treatment, or whose disease relapses, further treatment will be needed.
When induction therapy is not successful, or in cases of relapse, or where the healthcare team believes it offers a good chance of success, high-dose chemotherapy plus immunotherapy may sometimes be tried.
Alternatively, high-dose chemotherapy plus a peripheral blood stem cell transplant may be performed (sometimes immunotherapy is also added as an experimental approach). In a blood cell transplant, blood cells are removed from the body before the high-dose chemotherapy, and are returned afterwards. This can achieve a cure in roughly 30% to 50% of patients. However, due to the intensity of high-dose therapy, this treatment approach is not suitable for everyone.
More about stem cell transplants for non-Hodgkin’s lymphoma
If treatment is not successful, or is not possible, then medical management is likely to be aimed at controlling symptoms and pain relief (palliative care).
Mantle cell lymphoma
Mantle cell lymphoma responds less well to standard treatments than other aggressive non-Hodgkin's lymphomas (NHLs). Other treatments being studied include the use of new chemotherapy drugs, often in combination with monoclonal antibody therapy, and high-dose chemotherapy with stem cell transplant.
Burkitt's lymphoma, Burkitt-like lymphoma and lymphoblastic lymphoma
Burkitt's lymphoma and lymphoblastic lymphoma are very aggressive forms of NHL. Treatment usually involves therapy aimed at the central nervous system plus intravenous chemotherapy regimens. Patients are often given intensive chemotherapy involving many drugs, and will need to stay in hospital during their treatment. However, the majority of younger patients with this form of the disease are cured.
The other forms of aggressive NHL are treated in a similar manner to those listed above.
How will I feel when I’m in remission from non-Hodgkin’s lymphoma?
Your quality of life can be generally very good when you’re in remission
When you’re in periods of remission you will experience far fewer symptoms than you would during times of relapse. And many people find that they can carry on life reasonably normally during these times. However, different people will have different experiences of remission, and your doctor can advise you about how to make living with your disease as easy as possible.
Your healthcare team and various patient organisations can offer lots of advice to help you live successfully with your non-Hodgkin’s lymphoma
Your doctor or nurse should be able to put you in touch with patient organisations in your area.
Find out about living in remission from non-Hodgkin’s lymphoma