Treatment for aggressive non-Hodgkin's lymphoma
Patients with aggressive non-Hodgkin's lymphoma can be diagnosed in the early stages of the disease (stage I or stage II). This is because they are likely to notice the rapid growth of affected lymph nodes and therefore visit their doctor and be referred early for specialist treatment.
The usual treatment for patients who are diagnosed with early-stage, aggressive non-Hodgkin's lymphoma is several courses of combination chemotherapy, in which more than one chemotherapy drug is given, usually together with a steroid, such as prednisolone (for example, CHOP). In most countries, the monoclonal antibody rituximab is given in combination with chemotherapy as standard therapy. The monoclonal antibody increases the effectiveness of the treatment without significantly increasing the side effects.
Radiotherapy is sometimes given after chemotherapy. Rarely, the two treatments are given at the same time. The radiotherapy is directed specifically at the affected lymph nodes.
Treatment of early-stage (stage I and II) aggressive non-Hodgkin's lymphoma achieves a cure or a remission in around 80% of patients. Some patients do not respond to standard treatment. In these patients, and in those who relapse, further treatment will be needed.
Patients who are diagnosed with aggressive non-Hodgkin's lymphoma at an advanced stage (stage III or stage IV) are given combination chemotherapy with or without monoclonal antibodies. However, the chemotherapy is sometimes given for longer than in early-stage disease, and radiotherapy may also be given. Overall, between 40% and 70% of patients with aggressive non-Hodgkin's lymphoma are cured by the first treatment they are given.
The table shows the common treatments for different
stages of aggressive non-Hodgkin's lymphoma, as well as the likely
Mantle cell lymphoma
Mantle cell lymphoma responds less well to standard treatments than other aggressive non-Hodgkin's lymphomas. Other treatments being studied include the use of new chemotherapy drugs, often in combination with monoclonal antibody therapy, and high-dose chemotherapy with stem cell transplant.
Burkitt's lymphoma and lymphoblastic lymphoma are very aggressive forms of non-Hodgkin's lymphoma. Treatment is aggressive and usually involves therapy aimed at the central nervous system plus intravenous chemotherapy regimens. Patients are often given intensive chemotherapy involving many drugs, and will need to stay in hospital during their treatment. However, the majority of younger patients with this form of the disease are cured.