The ‘watch and wait’ approach
Because indolent non-Hodgkin’s lymphoma (NHL) grows only very slowly, it is very common to not need any treatment straight away.
This approach is commonly known as ‘watch and wait’, and usually applies to people with advanced disease who are experiencing no symptoms and feeling generally healthy.
However, you will need to be regularly monitored to check that no symptoms are developing and your NHL is not progressing.
How does ‘watch and wait’ work?
If you are not experiencing any symptoms, your doctor might recommend that you do not start treatment until symptoms develop
Waiting until symptoms develop before you begin your treatment means that:
- you won’t have to deal with any of the possible side effects of treatment straight away
- the treatment can be saved until symptoms appear and you really need help to fight your lymphoma
Studies have shown that, in suitable patients, the outcome for 'watch and wait' is no different from that of patients who start active treatment at the time of diagnosis.
And clinical trials to keep assessing the benefits of immediate treatment compared with the ‘watch and wait’ approach, are ongoing.
Watch and wait’ is not a ‘do nothing’ approach
It is important to understand that, while you are on ‘watch and wait’, you will still be receiving all the support you need. You will undergo thorough checks on a regular basis to monitor the progress of your non-Hodgkin’s lymphoma (NHL).
The size of your lymph nodes will be monitored by clinical assessments and/or imaging techniques to make sure that they are not getting bigger and tests will be performed to check that the lymphoma is not affecting any of your major organs or bone marrow.
As long as you feel generally healthy and you do not notice any change in the size of your lymph nodes, and do not start having symptoms, you can keep delaying the treatment.
Who is suitable for ‘watch and wait’?
‘Watch and wait’ is used in a significant proportion of people with indolent non-Hodgkin’s lymphoma
- To be suitable for this ‘watch and wait’ approach, you must have an advanced-stage lymphoma. In other words, one that has spread beyond just one or two groups of lymph nodes.
- You must also be feeling generally healthy and your lymphoma must not be causing any symptoms.
- As long as you remain well, if your lymph nodes are small and are not getting bigger quickly, and if there is no evidence that the lymphoma is affecting the function of any of your major organs, then you can stay on ‘watch and wait’.
- In time, you will probably need to start active treatment. This usually happens about 18 months after the start of the ‘watch and wait’ approach.
Things to look out for if you’re on ‘watch and wait’
If you’re on ‘watch and wait’ you must be aware of the possible symptoms of lymphoma, in particular the three symptoms referred to as 'B symptoms':
- Recurrent or persistent fever (body temperature over 38°C) that cannot be explained by other causes
- Drenching night sweats
- Unexplained weight loss of 10% or more of body weight over 6 months
If these symptoms appear, it may mean that active treatment should be started. So you should speak to your doctor if you notice that you are developing any of these symptoms.
Things to do to keep yourself healthy
While you’re on ‘watch and wait’ it is important to keep yourself as healthy as possible.
Read our lifestyle tips for living with non-Hodgkin’s lymphoma