Most patients with indolent non-Hodgkin's lymphoma have a relapse, despite having had treatment. The length of time between treatment and relapse can vary, but it is typically between 1.5 and 4 years.
The best treatment for relapsed non-Hodgkin's lymphoma depends on many factors. A 'watch and wait' approach may be recommended for some patients if they have no symptoms that are troubling them.
Monoclonal antibodies, for example, rituximab, are used for some types of lymphoma in this group of patients. It can be given as a single treatment (monotherapy) for relapsed disease. It is also often given with chemotherapy, and it can increase the effectiveness of the treatment, without significantly increasing the side effects.
When an indolent non-Hodgkin's lymphoma relapses, it has sometimes changed, or 'transformed', into an aggressive form of the disease. Often, the treatment for patients with transformed non-Hodgkin's lymphoma is difficult. They may be treated with high-dose chemotherapy with or without a peripheral blood stem cell transplant. This can also be combined with monoclonal antibody therapy for 'purging' residual lymphoma cells from the bone marrow.
If such high-dose treatment is not possible, then medical management is likely to be aimed at controlling symptoms, or 'palliative'.
Around a fifth of patients with aggressive non-Hodgkin's lymphoma do not respond to treatment, and about three out of 10 of those that do respond have a relapse after a remission. Although treatment is difficult, cure or remission can be achieved in up to 50% of such patients with second line, or 'salvage' treatment. This consists of combination chemotherapy of ifosfamide, vincristine, and etoposide (IVE), ifosfamide, carboplatin, etoposide (ICE), etoposide, cytarabine, cisplatin and the steroid methylprednisolone (ESHAP), or diamminedichloroplatinum, cytarabine and the steroid dexamethasone (DHAP), sometimes followed by a high-dose chemotherapy and autologous peripheral blood stem cell transplant.
If neither cure nor remission is possible, the aim will be to relieve symptoms. Some patients may consider taking part in a clinical trial to help to test a new treatment or combination of treatments. For further information, see Clinical trials.