How Non-Hodgkin Lymphoma Is Treated

There are different forms of Non-Hodgkin lymphoma (NHL). Some forms grow aggressively while others develop over a longer period of time.

Comparatively, some forms of NHL are curable, while others aren't.

As a result, treatment varies depending on the form of NHL a person has and other factors, such as overall health and the aggressiveness of the cancer. 

Specific treatment for NHL may include chemotherapy, radiation therapy, monoclonal antibodies, targeted therapy, and bone marrow or stem cell transplants. In some cases, a healthcare provider may recommend a wait-and-see approach.

This article will detail how NHL is treated.

Chemotherapy

Chemotherapy is a typical treatment for people with NHL. Chemotherapy drugs are administered intravenously. The medications aim to destroy cancer cells. Doctors typically use a combination of chemotherapy drugs to treat NHL in adults.

Common chemotherapy drugs used to treat NHL include:

• Bendamustine
• Carboplatin
• Chlorambucil 
• Cisplatin
• Cladribine (2-CdA)
• Cyclophosphamide
• Cytarabine (ara-C)
• Doxorubicin 
• Etoposide (VP-16)
• Fludarabine
• Gemcitabine
• Ifosfamide
• Methotrexate
• Oxaliplatin 
• Pentostatin
• Pralatrexate
• Vincristine 
  

Side Effects of Chemotherapy

Possible side effects of chemotherapy treatment may include:

• Hair loss
• Nausea and vomiting
• Mouth sores
• Appetite loss
• Constipation
• Diarrhea
• Easy bleeding or bruising 
• Frequent infections
• Fatigue
• Shortness of breath
  

Additionally, some chemotherapy drugs have specific long-term side effects such as:

• Bladder damage
• Heart damage
• Neuropathy
• Fertility problems
• Lung damage

Targeted Therapy

Targeted therapies are drugs that target specific cells, such as cancer cells. This means that, unlike chemotherapy, they are not as likely to affect healthy cells. 

Types used to treat NHL include:

• Monoclonal antibodies such as Rituxan (rituximab)
• Proteasome inhibitors
• Kinase inhibitors
• Histone methyltransferase inhibitors
• B-cell lymphoma-2 (BCL-2) inhibitor therapy
  

Side Effects of Targeted Therapy

Side effects of targeted treatments depend on the drug. Examples of possible adverse effects include:

• Nausea and vomiting
• Appetite loss
• Nerve damage
• Fatigue
• Anemia
• Headache
• Diarrhea
• Muscle pain
• Rash
• Cough
• Abdominal pain
  

Immunotherapy

Immunotherapy uses the body's own immune system to attack cancer cells. Sometimes immunotherapies are also referred to as targeted therapies because they impact the growth of specific cancer cells.

Examples of immunotherapies that a doctor may recommend to treat NHL include:

• Immune checkpoint inhibitors
• Immunomodulators such as Revlimid (lenalidomide)
• CAR T-cell therapy
  

Specialist-Driven Procedures

Radiation Therapy

Radiation therapy involves the use of high-energy radiation to destroy cancer cells. Doctors usually use external radiation therapy to treat NHL. This involves using a machine to send radiation to specific areas of the body affected by cancer.

Radiation is used in the following cases:

• As a frontline treatment for some types of early-stage NHL
• For more aggressive cancer, in conjunction with chemotherapy
• As a palliative care treatment 
• In conjunction with a stem cell transplant
  

Side Effects of Radiation Therapy

Potential side effects of radiation therapy include:

• Skin issues such as blistering 
• Fatigue
• Diarrhea
• Nausea 
• Higher risk of infections
• Mouth sores
• Problems swallowing
  

The side effects may differ depending on the area of the body receiving radiation. For example, radiation to the abdomen may be more likely to cause gastrointestinal side effects. 

Radiation may also cause potential long-term side effects such as:

• Lung damage and breathing problems 
• Increased risk of heart attack
• Thyroid problems 
• Cognitive effects such as difficulty concentrating and memory loss (specifically in the case of brain radiation)
  

Stem Cell Transplant

Doctors may use stem cell transplants to treat those whose NHL comes back after initial treatment. A stem cell transplant allows the use of higher doses of chemotherapy that damage the bone marrow. The bone marrow is then replaced by a stem cell transplant.

Stem cells are cells that are able to produce other cells. In the bone marrow, they produce red cells, white cells, and platelets. They can be harvested either from the bone marrow (by aspiration) or the peripheral blood (by processing the blood to obtain them while returning the red cells and plasma to the donor).

In NHL, usually stem cells are harvested from the person to be treated and stored until it is time to return them via infusion. Sometimes donor stem cells are used, but they must be closely matched.

Surgery 

Rarely in cases of NHL, doctors may recommend surgery to remove cancerous tissue. Surgery is more commonly used to diagnose and stage lymphoma (determine how far it has spread).

Clinical Trials

Some treatments are currently undergoing clinical trials, such as vaccine therapy, in which a substance is given to stimulate the immune system to attack the cancer cells. People with NHL should discuss potential clinical trial enrollment with their doctors.

Home Remedies and Lifestyle

There’s no evidence that home remedies or lifestyle changes can prevent or treat NHL.

However, while under chemotherapy treatment you are at greater risk of contracting infections. Use good infection-prevention tactics such as avoiding crowds, staying away from anyone who is sick, and practicing safe food handling and preparation.

Also, talk to your healthcare team about what vaccinations can help you avoid infection, including COVID-19 vaccination.

Complementary and Alternative Medicine (CAM) 

CAM cannot cure NHL. However, some therapies may help relieve symptoms and improve a person’s quality of life. Examples include:

• Acupuncture: This therapy involves putting very thin needles into specific points on the body. It may help with pain management and chemotherapy side effects like nausea and vomiting. However, some people shouldn’t have acupuncture, including those with a high risk of infection. Always talk to a doctor before trying an alternative treatment.
• Aromatherapy: Inhaling certain essential oils may help a person relax and sleep. 
• Massage: Massage therapy can also help improve sleep, limit fatigue, and manage stress and anxiety.
• Creative therapy: Using the arts (e.g., music, drawing, and painting) may provide a helpful outlet for some people with NHL, which can improve mood and help with fatigue levels.

While some alternative therapies may help treat the side effects of chemotherapy or other doctor-prescribed treatments, they are not a replacement for the treatments recommended by your doctor.

Summary

NHL is a type of cancer that affects white blood cells called lymphocytes. It can be aggressive or slow-growing. Treatment depends on many factors, such as a person’s age, general health, and the type of NHL they have.

Doctors will usually use a combination of treatments to treat NHL, including chemotherapy, radiation, targeted therapy, stem cell transplants, and sometimes surgery. 

A Word From Verywell

There is a wealth of information about available effective treatment options for NHL. However, there are also a lot of sources that make claims for unproven "natural" cures. It’s important to talk to your doctor if you plan to try alternative treatments like acupuncture. Your doctor can help you determine the best course of action in treating NHL.