Table of ContentsView AllTable of ContentsActive SurveillanceChemotherapyRadiation TherapyImmunotherapyStem Cell TransplantCAR T-Cell TherapyFrequently Asked QuestionsNext in Lymphoma GuideWhat Is Lymphoma, and What Happens If You Have It?
Table of ContentsView All
View All
Table of Contents
Active Surveillance
Chemotherapy
Radiation Therapy
Immunotherapy
Stem Cell Transplant
CAR T-Cell Therapy
Frequently Asked Questions
Next in Lymphoma Guide
To someone newly diagnosed withlymphoma, the treatment options may be difficult to understand. There are nearly 30 different types of lymphoma, numerous subtypes, and a variety ofdisease stages, each of which requires different treatment approaches.
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The two main types,Hodgkin lymphoma(HL) andnon-Hodgkin lymphoma(NHL), may involve chemotherapy, radiation therapy, immunotherapy, or a combination of therapies. People with NHL may also benefit from newer biologic drugs and CAR T-cell therapy. Stem cell transplants are sometimes needed iflymphoma relapseoccurs.
Not all lymphomas can be cured. Of the two main types, HL tends to be the most treatable. Certain aggressive forms of NHL can also be cured with aggressive chemotherapy. By contrast, indolent (slow-growing) NHL is not curable, although it can be managed successfully for years and even decades. Many indolent lymphomas may not even require treatment until there are overt signs of disease progression.
The response to treatment can also change over time. Treatments that once kept the disease under control may suddenly become ineffective, making it necessary to keep abreast of new and experimental therapies.
How Hodgkin and Non-Hodgkin Lymphoma Differ
Many low-grade lymphomas remain indolent for years. Rather than exposing you to drugs that are likely to cause side effects, your healthcare provider may recommend the active monitoring of the disease, also known as a “watch-and-wait” approach.
On average, people with indolent lymphoma live just as long if they delay therapy compared to those who start treatment immediately.If you have mild symptoms you can cope with, it is often better to reserve treatment until the lymphoma symptoms are harder to manage.
Active surveillance is commonly used for certain types of indolent NHL, includingfollicular lymphoma, marginal cell lymphoma (includingMALT lymphoma), small lymphocytic lymphoma, Waldenström’s macroglobulinemia, andmantle cell lymphoma.
Active surveillance is sometimes used for a form of HL, known as nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), once the affectedlymph nodeshave been surgically removed.
Active monitoring requires regular follow-up visits with your healthcare provider, typically every two months for the first year and every three to six months thereafter.
Common Signs and Symptoms of Lymphoma
Chemotherapyinvolves the use of cytotoxic (cell-killing) drugs that can halt the spread of cancer cells. Chemotherapy is usually prescribed when the disease is systemic, meaning that the cancer has spread throughout the body. The advantage of chemotherapy is that it can travel throughout the bloodstream to kill cancer cells wherever they are located.
Most of these chemotherapy drugs have been in use for decades. In recent years, newer agents have been developed that appear to be extremely effective and offer fewer side effects.
Newer chemotherapy drugs include Treanda (bendamustine), an intravenous drug used for people with indolent B-cell lymphoma,and the injectable drug Folotyn (pralatrexate) used for those with relapsed or treatment-resistant T-cell lymphoma.
How to Prepare for Chemotherapy
Radiation therapy, also known as radiotherapy, uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation is a local therapy, which means that it only affects cancer cells in the treated area.
Radiation is often used on its own to treat lymphomas that have not spread. These include nodal lymphomas (those occurring within the lymphatic system) andextranodal lymphomas(those occurring outside of the lymphatic system). In other cases, radiation will be combined with chemotherapy.
Radiation treatment is generally confined to the lymph nodes and surrounding tissues, a procedure referred to as involved-field radiation therapy (IFRT). If the lymphoma is extranodal, the radiation will be focused on tissues from which the cancer originated (known as the primary tumor site). In rare cases,extended field radiation(EFR) may be used to treat lymphoma that is widespread (although it is far less commonly used today than it once was).
Radiation treatments are typically given five days a week for several weeks. The procedure itself is painless and lasts only a few minutes. Common side effects include fatigue, skin redness, and blistering.
Radiation to the abdomen can cause nausea, diarrhea, and vomiting. Radiation to the lymph nodes of the neck may cause mouth dryness, mouth sores, hair loss, and difficulty swallowing.
Immunotherapy, also called immune-oncology, refers to treatments that interact with the immune system. Some of the immunotherapeutic drugs used in lymphoma are designed to recognize proteins on the surface of lymphoma cells, called antigens. The drugs target and attach to these antigens, and thereafter signal theimmune systemto attack and kill the “tagged” cells.
Unlike chemotherapy drugs, which kill all fast-replicating cells (both normal and abnormal), immunotherapy drugs target cancer cells alone. Other forms of immunotherapy are designed to stimulate and restore the immune system so that it can better fight lymphoma.
Monoclonal Antibodies
Monoclonal antibodiesare the most common immunotherapeutic agents used in lymphoma therapy. They are classified asbiologic drugsbecause they occur naturally in the body. Those used in lymphoma are genetically engineered to recognize specific lymphoma antigens. Approved monoclonal antibodies include:
Adcetris is unique in that it is attached to a chemotherapy drug and “piggybacks a ride” to the lymphoma cell it intends to kill.Zevalin is paired with a radioactive substance that delivers a targeted dose of radiation to the cancer cells it attaches to.
Common side effects of monoclonal antibody therapy include chills, cough, nausea, diarrhea, constipation, allergic reactions, weakness, and vomiting.
Checkpoint Inhibitors
Common side effects include headache, stomach pain, loss of appetite, nausea, constipation, diarrhea, fatigue, runny nose, sore throat, rash, itching, body aches, shortness of breath and fever.
Other Immunotherapy Drugs
What You Should Know About Immunotherapy
Astem cell transplantis a procedure that replaces damaged or destroyed stem cells in the bone marrow with healthy ones. It is typically used when a person has relapsed from intermediate- or high-grade lymphoma.
According toresearch published inCurrentHematologic Malignancy Reports,30% to 40% of people with NHL and 15% of those with HL will experience a relapse after the initial treatment.
Stem cells have the unique ability to transform into many different types of cells in the body. When used to treat lymphoma, the transplanted cells will stimulate the production of new blood cells. This is important since high-dose chemotherapy can damagebone marrowand impair the production of red andwhite blood cellsneeded to fight disease and function normally.
A stem cell transplant allows you to be treated with a higher dose of chemotherapy than you might otherwise be able to tolerate.
Before the transplant, high doses of chemotherapy (and sometimes radiation) are used to “condition” the body for the procedure. By doing so, the body is less likely to reject the stem cells. The conditioning process takes one to two weeks and is performed in a hospital due to the high risk of infection and side effects.
The main types of stem cell transplant used are:
Although the safety and effectiveness of stem cell transplant continue to improve every year, there are considerable risks. Not everyone is eligible for a transplant, particularly those unable to withstand the conditioning process. Moreover, the procedure does not work for people with tumors that are unresponsive to drugs.
Recovery from a stem cell transplant may take months to years and can permanently affect fertility. An in-depth consultation with a specialist oncologist is needed to fully weigh the benefits and risks of the procedure.
What to Expect From a Stem Cell Transplant
2:35CAR T-Cell Therapy
2:35
CAR T-cell therapy is an immunotherapy procedure in which T-cells are harvested from the blood to create specially engineered molecules known as chimeric antigen receptors (CARs).
T-cells are obtained through a process known as leukapheresis, which is similar to dialysis and takes around three to four hours to perform. The T-cells are then genetically engineered in the lab to match a specific type of lymphoma.
The FDA-approved agents used to modify harvested T-cells to treat lymphoma include:
Common side effects include fever, headache, chills, fatigue, loss of appetite, nausea, diarrhea, constipation, dizziness, trembling, vomiting, rapid heartbeats, irregular heartbeats, and an increased risk of infection.
In 2024, the FDA issued Safety Labeling Changes for these CAR-T therapies. The warnings inform providers and patients of the potential risk of these therapies causing secondary cancer.
Frequently Asked QuestionsThe overall five-year relative survival rate for non-Hodgkin lymphomas is 72%.For Hodgkin lymphoma, the rate is 87%.These rates include localized, regional, and metastatic cancers.Risk factorstypically associated with lymphoma include age (most commonly over 60), gender, immune dysfunction associated with B-cells and T-cells, gene mutations, environmental factors such as exposure to insecticides, and previous radiation therapy for other solid tumors.
The overall five-year relative survival rate for non-Hodgkin lymphomas is 72%.For Hodgkin lymphoma, the rate is 87%.These rates include localized, regional, and metastatic cancers.
Risk factorstypically associated with lymphoma include age (most commonly over 60), gender, immune dysfunction associated with B-cells and T-cells, gene mutations, environmental factors such as exposure to insecticides, and previous radiation therapy for other solid tumors.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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