Non-Hodgkin's Lymphoma: Treatment

by Food and Drug Administration (FDA)

(Page 2 of 3)

Treatment Varies

Doctors tailor treatment of NHL to the type of tumor, the stage of the disease, and the patient's age and general health. Most patients receive chemotherapy, radiation therapy, or both.

Because low-grade lymphomas usually grow slowly and cause few symptoms but eventually become resistant to treatment, doctors may postpone treatment until the cancer shows signs of spreading, or causes systemic symptoms (such as fevers or weight loss), or until the tumors become excessively bulky or threaten vital organs such as the kidneys or lungs. NCI researchers and others have shown that delaying treatment does not adversely affect long-term survival and may actually improve patients' quality of life, as the treatments themselves can be debilitating. A substantial proportion of patients with low-grade NHL have spontaneous remissions, although these disease-free periods rarely last for long.

Chemotherapy for NHL usually involves several different drugs given at the same time. Some drugs, such as chlorambucil (marketed as Leukeran), are given by mouth; others, such as cyclophosphamide (marketed as Cytoxan), are injected into a vein or muscle. To treat disease that has spread to the brain, chemotherapy may be delivered to the fluid that surrounds the brain through a needle in the spine. Chemotherapy is usually given in cycles: a treatment period followed by a rest period, then another treatment period, and so on.

A frequently used chemotherapy regimen for NHL combines cyclophosphamide, doxorubicin hydrochloride (marketed as Adriamycin), vincristine (marketed as Oncovin), and the anti-inflammatory drug prednisone. Although used for about 20 years, recent studies suggest this regimen is as effective and has less serious side effects than some of the newer drug combinations, according to Alan Aisenberg, M.D., of Massachusetts General Hospital.

An experimental NHL chemotherapy compound is a drug called fludarabine. FDA approved this drug as Fludara in 1991 for treating a type of leukemia, and, according to NCI's Bruce Cheson, M.D., early studies suggest that more low-grade NHL patients go into complete remission when they are treated with fludarabine than when they are treated with standard drugs such as chlorambucil.

Chemotherapy kills off rapidly dividing cells. Although its prime targets are the rapidly reproducing cancer cells, it also kills healthy dividing cells such as blood cells and the cells lining the intestinal tract and hair follicles. As a result, its side effects can include anemia, an increased risk of infection, mouth sores or bleeding, hair loss, nausea, and vomiting. Some of these side effects can be countered with anti-nausea medication or injections of hormone-like compounds called growth factors that help the body quickly restore its lost blood cells.

Some of the chemotherapy drugs used to treat NHL, such as doxorubicin and mitoxantrone, can damage heart tissue, making some people with heart disorders unable to tolerate this treatment. These patients may be given alternative kinds of chemotherapy and radiation therapy. Radiation therapy alone may be the treatment of choice for some patients, especially those who have only a single, small tumor. Some types of NHL respond best to chemotherapy followed by radiation therapy.

Radiation therapy uses high-energy x-rays to damage cancer cells and stop their growth. Radiation therapy is directed to the areas of the body known to harbor cancer cells. As an extra precaution, radiation may be directed to a broader area, such as to all the lymph nodes in the region of a known cancerous site. The treatment is generally given on an outpatient basis.

Radiation therapy can cause fatigue and red or dry skin in the treated area. Radiation directed to the chest and neck can cause patients to have a dry, sore throat and some trouble swallowing. Patients may also have shortness of breath or a dry cough. Radiation therapy to the abdomen may cause nausea, vomiting or diarrhea. Some patients who receive radiation to the spine may also have tingling or numbness in their arms, legs and lower back.

The chemotherapy used to treat NHL can cause sterility as can radiation directed to the pelvis. NHL treatments may also make patients more susceptible to other cancers, including those of the lung, brain, kidney, bladder, skin, and blood.

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