There are different types of treatment for patients with non-Hodgkin’s lymphoma.

Different types of treatment are available for patients with non-Hodgkin’s lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

• Radiation therapy
  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
• Chemotherapy
  Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. To treat certain types of adult non-Hodgkin’s lymphoma that spread to the brain, CNS prophylaxis (chemotherapy given to kill cancer cells in the brain or spinal cord) may be used. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
• Watchful waiting
  Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.

Other types of treatment are being tested in clinical trials.

• Biologic therapy
  
  Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
  
  There are different types of biologic therapy used in treating adult non-Hodgkin’s lymphoma, including the following:
• Monoclonal antibody therapy: A cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells or block their growth. Monoclonal antibodies are given by infusion. They may be used alone or to deliver drugs, toxins, or radioactive material directly to cancer cells.
• Vaccine therapy: Vaccine therapy uses a substance or group of substances meant to cause the immune system (the complex group of organs and cells that defends the body against infection or disease) to respond to a tumor and kill it.
• High-dose chemotherapy with stem cell transplantation
  
• This is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the body’s blood cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options by Stage

Indolent, Stage I and Contiguous Stage II Adult Non-Hodgkin’s Lymphoma
Treatment of indolent, stage I and contiguous stage II adult non-Hodgkin’s lymphoma may include the following:

• Radiation therapy directed at the area where cancer is located.
• Radiation therapy directed at the area where cancer is located and nearby lymph nodes.
• Chemotherapy with radiation therapy.
• Chemotherapy alone or watchful waiting for patients who cannot have radiation therapy.
• Radiation therapy directed at part or all of the lymph system.

Aggressive, Stage I and Contiguous Stage II Adult Non-Hodgkin’s Lymphoma
Treatment of aggressive, stage I and contiguous stage II adult non-Hodgkin’s lymphoma is usually combination chemotherapy (chemotherapy using more than one drug) with radiation therapy. Chemotherapy alone may also be used.

Indolent, Noncontiguous Stage II/III/IV Adult Non-Hodgkin’s Lymphoma
Treatment of indolent, noncontiguous stage II/III/IV adult non-Hodgkin’s lymphoma may include the following:

• Watchful waiting for patients who do not have symptoms.
• Chemotherapy with or without steroids (drugs used to relieve swelling and inflammation).
• Combination chemotherapy with steroids.
• Monoclonal antibody therapy with or without combination chemotherapy.
• Radiolabeled monoclonal antibody therapy.
• Radiation therapy directed at the area where cancer is located and nearby lymph nodes, for patients who have stage III disease.
• A clinical trial of chemotherapy and total-body irradiation (radiation therapy to the entire body) followed by autologous or allogeneic stem cell transplantation.
• A clinical trial of chemotherapy with or without vaccine therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Aggressive, Noncontiguous Stage II/III/IV Adult Non-Hodgkin’s Lymphoma
Treatment of aggressive, noncontiguous stage II/III/IV adult non-Hodgkin’s lymphoma may include the following:

• Combination chemotherapy alone.
• Combination chemotherapy with radiation therapy or monoclonal antibody therapy.
• Combination chemotherapy with CNS prophylaxis.
• A clinical trial of autologous or allogeneic stem cell transplantation for patients who are likely to relapse.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Adult Lymphoblastic Lymphoma
Treatment of adult lymphoblastic lymphoma may include the following:

• Combination chemotherapy and CNS prophylaxis.
• A clinical trial of autologous or allogeneic stem cell transplantation.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Diffuse Small Noncleaved Cell/Burkitt Lymphoma
Treatment of adult diffuse small noncleaved cell/Burkitt lymphoma may include the following:

• Combination chemotherapy and CNS prophylaxis.
• A clinical trial of combination chemotherapy.
• A clinical trial of autologous or allogeneic stem cell transplantation.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options for Recurrent Adult Non-Hodgkin’s Lymphoma

Indolent, Recurrent Adult Non-Hodgkin’s Lymphoma
Treatment of indolent, recurrent adult non-Hodgkin’s lymphoma may include the following:

• Chemotherapy with one or more drugs.
• Radiation therapy.
• Radiation therapy and/or chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
• Monoclonal antibody therapy.
• A clinical trial of radiolabeled monoclonal antibody therapy.
• A clinical trial of monoclonal antibody therapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of autologous or allogeneic stem cell transplantation.

Treatment of indolent lymphoma that comes back as aggressive lymphoma may include the following:

• A clinical trial of autologous or allogeneic stem cell transplantation.
• A clinical trial of combination chemotherapy followed by radiation therapy or stem cell transplantation and radiation therapy.
• A clinical trial of stem cell transplantation.
• A clinical trial of monoclonal antibody therapy.
• A clinical trial of radiolabeled monoclonal antibody therapy.
• A clinical trial of continuous-infusion chemotherapy (chemotherapy administered into a blood vessel over a long period of time).

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Aggressive, Recurrent Adult Non-Hodgkin’s Lymphoma
Treatment of aggressive, recurrent adult non-Hodgkin’s lymphoma may include the following:

• Stem cell transplantation.
• Monoclonal antibody therapy.
• A clinical trial of autologous or allogeneic stem cell transplantation.
• A clinical trial of combination chemotherapy followed by radiation therapy or stem cell transplantation and radiation therapy.
• A clinical trial of radiolabeled monoclonal antibody therapy.
• A clinical trial of continuous-infusion chemotherapy.

Treatment of aggressive lymphoma that comes back as indolent lymphoma may include the following:

• Chemotherapy.
• Palliative therapy to relieve symptoms and improve quality of life.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

TO LEARN MORE:

Web sites and Organizations
The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write
For more information from the NCI, please write to this address:
       NCI Public Inquiries Office
       Suite 3036A
       6116 Executive Boulevard, MSC8322
       Bethesda, MD 20892-8322

ABOUT PDQ:

PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.