aggressive lymphoma | Treatment of aggressive non-Hodgkin's lymphoma

Treatment of aggressive non-Hodgkin's lymphoma



In the presence of aggressive (fast-changing) non-Hodgkin's lymphoma, the following treatment options may be used. Your healthcare team will offer treatments based on your needs and discuss with you to develop a treatment plan. The treatments proposed depend on the aggressive NHL stage, i.e. limited (stage 1 or 2) or advanced (Stage 3 or 4). Doctors also take into consideration the type of NHL, your age and overall health when they plan the treatment. In general, aggressive NHL responds well to treatment.

The aggressive NHL often causes symptoms soon after it appears. These symptoms should usually be treated immediately.

Aggressive limited-stage NHL treatments
In the presence of a limited-stage aggressive (rapid-evolution) NHL, the following treatment options may be used.

Chemotherapy
Chemotherapy is usually the primary treatment of the limited stage aggressive NHL. In general, a combination of chemotherapeutic agents and targeted treatment is administered. If radiotherapy is administered after chemotherapy, fewer chemotherapy cycles may be required.

Different combinations of chemotherapeutic agents are administered for the different types of aggressive NHL. The most commonly used Chemotherapeutic association is the CHOP protocol which consists of the following drugs:

Cyclophosphamide (Cytoxan, Procytox)
Doxorubicin (Adriamycin)
Vincristine (Oncovin)
Prednisone
When adding rituximab to the CHOP Protocol, the Chemotherapeutic Association bears the name R-Chop.

Targeted treatment
Targeted treatment for certain types of aggressive B-cell lymphomas may be proposed.

Rituximab is the targeted drug that is most commonly administered. It is associated with chemotherapy.

Radiotherapy

We can offer external radiation therapy to some people. It is called radiation therapy in the field as it is administered to the regions where the NHL was observed. Radiation therapy is usually administered after chemotherapy.

Advanced stage aggressive NHL treatments

In the presence of an advanced, aggressive (fast-paced) NHL, the following treatment options may be used.

Chemotherapy

Chemotherapy is the main treatment of advanced aggressive NHL.

Different combinations of chemotherapeutic agents are administered for the different types of aggressive NHL. The most commonly used Chemotherapeutic association is the CHOP protocol which consists of the following drugs:

Cyclophosphamide

Doxorubicin

Vincristine

Prednisone

When adding rituximab to the CHOP Protocol, the Chemotherapeutic Association bears the name R-Chop.

BR protocol can be administered in some cases, which is an association of Bendamustine (Treanda) and rituximab.

Central nervous system prophylaxis

The central nervous system (CNS) is composed of the brain and the spinal cord. Some types of aggressive NHL are likely to spread to the CNS. CNS prophylaxis prevents lymphoma cells from entering the tissue covering the brain and spinal cord.

CNS prophylaxis is often a combination of chemotherapeutic agents and biological therapy.

Targeted treatment

Targeted treatment is used for most types of aggressive B-lymphocyte lymphoma. Rituximab is the targeted drug that is most commonly administered. It is associated with chemotherapy.

Radiotherapy

External radiation therapy can be offered as an advanced stage aggressive NHL treatment. It is administered after chemotherapy if the NHL is present only in the part of the body where it originated or if it has formed large tumours (large disease) in certain areas of the body.

Stem cell transplant

Some types of aggressive NHL do not respond to standard doses of chemotherapy, or they may strongly reappear (re-offend) after treatment. Doctors could then think about administering a higher dose chemotherapy followed by a stem cell transplant to treat some of these cases.

Aggressive recurrent or refractory NHL treatments

The aggressive (fast-paced) NHL may reappear (re-offend) after treatment. It can also become refractory over time, which means that treatments have ceased to be effective. In the presence of an aggressive recurrent or refractory NHL, the following treatment options may be used.

Chemotherapy

Chemotherapy is administered to treat the aggressive recurrent or refractory NHL. In general, other chemotherapeutic agents are used than those used in the initial treatment. Doctors often administer doses higher than those prescribed in the first treatment.

Targeted treatment

Targeted treatment for an aggressive recurrent or refractory NHL can be proposed. Rituximab is the most widely used targeted drug. It is associated with chemotherapy.

Other targeted drugs, such as ibritumomab (Zevalin), can be used if the NHL is refractory to chemotherapy and rituximab. Ibritumomab can also be used when an indolent type of NHL turns into an aggressive type of NHL.

Stem cell transplant

The aggressive recurrent or refractory NHL often reacts to different chemotherapeutic agents, but it rarely gets cured. If a remission occurs after the administration of different medications, then the doctors can propose a stem cell transplant. In people with an aggressive recurrent or refractory NHL that responds well to chemotherapy, stem cell transplantation is more effective than those whose NHL does not respond well to chemotherapy.

Stem cell transplants can also be used to treat people whose indolent NHL has turned into an aggressive type of NHL.

Clinical trials

You may be asked if you want to participate in a clinical trial on the NHL. Learn more about clinical trials