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Now that your indolent non-Hodgkin’s lymphoma (NHL) has relapsed, you will probably need to start treatment again. This can be a challenging time, as you will probably be feeling disappointed about having relapsed, as well as worried over what will happen during this round of treatment. However, you should try and concentrate on being positive:

•  You’ve been through treatment before so, even though your treatment may be different this time, you’re familiar with the kinds of things that will happen during treatment appointments and how you coped with it. This will probably give you a head start with being able to cope with treatment this time around
• Although a relapse can feel like a setback, indolent NHL generally responds very well to treatment, and you now have another chance to treat the disease and try to stop it affecting you
• Remember, there is always plenty of help available if you need it. Your healthcare team, patient support groups, and of course Lymphoma Life, will be here to support you through the whole experience

You’ll be familiar with the hospital

You’ve probably already visited the lymphoma clinic at your hospital during check-ups and previous rounds of treatment. So you might be quite familiar with the surroundings and some of the people at the clinic. You may even have had similar treatment before, so you could be quite familiar with what to expect.

You can now use these experiences to your advantage. You will be better prepared for where you’re going and who you’re meeting than you were before. And knowing what to expect can help each treatment visit go more smoothly for you. Any strategies or habits that you learned last time about how to help yourself cope can now be applied again, and can make things easier for you right from the start.

But going back for more treatment can still be practically and emotionally challenging

Even though you are familiar with treatment visits, now that you are about to receive treatment again you are probably having many different thoughts and emotions. You’ve been through this, or something like this, before, but will it work in the same way this time? Will you feel or react differently, or will you have any different results?

As you probably know by now, these questions are very difficult to answer with any certainty when you are dealing with cancer. Although it is possible to give you a good idea of what happens to most people, you should always bear in mind that this may not apply to you. You are an individual, and your personal experience of non-Hodgkin’s lymphoma and its treatment will be unique to you.

Your relapsed indolent non-Hodgkin's lymphoma might be a different type than you had when you were first diagnosed

When you relapse, your healthcare team will be careful to accurately diagnose the precise type of NHL that you have. This may be a different type of NHL to the one that you were originally diagnosed with. In order to do this, you will probably have to have a number of tests, similar to those that you had previously.
Your treatment plan will depend on the NHL type that you currently have, and on how you were treated before.

If a drug was previously used that wasn’t successful in your case, meaning that you did not achieve remission for at least six months, it is common to try a different type of drug next time around. You may hear your doctor describe NHL that does not respond to a particular treatment as being refractory to that treatment. Some chemotherapy drugs are so similar to each other that if one does not work for a patient, then the similar drugs are also unlikely to work – these drugs are sometimes called cross-resisting agents.

When indolent NHL, it has sometimes changed, or 'transformed', into an aggressive form of the disease. Often, the treatment for patients with transformed NHL is difficult. You may be treated with high-dose chemotherapy with or without a peripheral blood stem cell transplant. This can also be combined with monoclonal antibody therapy for 'purging' residual lymphoma cells from the bone marrow.
If such high-dose treatment is not possible, then medical management is likely to be aimed at controlling symptoms, or 'palliative'.

I’m having induction or maintenance therapy

Read more about stem cell transplantation

Help and support will always be available to you, and there are two things that you should bear in mind:

• Your doctor and their associated healthcare team know all about your personal medical history and are also experts in treating people with non-Hodgkin's lymphoma (NHL). So, if you have any worries or questions about your NHL and its treatment, they are the best people to speak to and can help put your mind at rest. Being open with them about your concerns is therefore very important; they will be able help you deal with many issues, but only if they know what these issues are.
• There are many other sources of help and advice, such as patient support groups, friends and family, and maybe even work colleagues, who would all be willing to offer you assistance during this time. So don’t hesitate to ask or look for help if you need it.

Find local non-Hodgkin’s lymphoma support groups.

Lymphoma Life is also here to help

At Lymphoma Life, we believe that helping you understand what to expect, and decide how to proactively help yourself, will make your treatment experience easier for you. We’ll be able to answer a lot of your questions and also help you think about what to ask your healthcare team at your next check-up. Lymphoma Life can also act as a source of information and support for the people around you who are affected by you being ill.

In this section, we explain what will happen to you on your treatment visits and who out of your healthcare team you’ll be meeting. We also have lots of practical tips for coping with the treatments that you’ll be receiving.