Treatment options

Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.

Treatment for lymphoma depends on:

the stage and grade of the disease
the location of the cancer
the severity of symptoms
your general health and wishes.

Treatment may involve the following.

Surgery

Surgery is rarely used to treat lymphoma. However, it may be used for lymphomas that have started in organs such as the spleen, thyroid or stomach and have not spread from these organs. It can also be used to treat skin lymphomas (if there is only a small number of skin lesions that can be removed completely).

Chemotherapy

Together with radiation therapy, chemotherapy is one of the main treatments for lymphoma. The 2 treatments are often used together. Chemotherapy is the main treatment for aggressive non-Hodgkin lymphoma^[21]. Treatment may involve a combination of medicines given as pills or injected into a vein (intravenously)^[22]. You will be monitored throughout the treatment, and may receive multiple treatments until tests show no signs of cancer^[23].

Using chemotherapy to treat lymphoma may cause a side effect called tumour lysis syndrome. This occurs when the large number of lymphoma cells in the body break open after they are killed by the chemotherapy medications, releasing their contents into the bloodstream. This can overwhelm the kidneys and cause serious problems. Extra fluids and certain medicines may be given to avoid this syndrome.

Steroids

Steroids are hormones naturally made in the body. They can also be made in a lab and used as drugs. Steroids may be used to increase the effect of chemotherapy, help destroy lymphoma, and treat nausea or vomiting. They are usually given as a pill but may also be injected into a vein (intravenously).

The most common steroids used for non-Hodgkin lymphoma are corticosteroids^[24].

The most common steroids used for Hodgkin lymphoma are prednisone or prednisolone^[25].

Radiation therapy

Together with chemotherapy, radiation therapy is one of the main treatments for lymphoma. The 2 treatments are often used together. Radiation therapy can have long-term side effects, so it is often limited or avoided when treating lymphoma in children.

Radiation therapy for Hodgkin lymphoma usually targets only the lymph nodes that originally contained the lymphoma and nearby areas that the lymphoma has spread to. This reduces the area of the body that is exposed to radiation.

Radiation therapy can also be used to relieve symptoms caused by lymphoma that has spread to other organs.

For skin lymphomas that are not very thick, the skin may be treated with ultraviolet (UV) light to kill the cancer cells. This may be combined with a medicine called psoralen. This is taken as a pill to increase the cell-killing effect of the UV light.

Targeted therapy

Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells. These types of medicines affect the way that cancer cells grow, divide, repair themselves or interact with other cells.

These medicines work by targeting the proteins that cancer cells need to grow and survive. Some of these medicines use radioactive substances to kill the cancer cells. Others are used with chemotherapy medicines to help kill cancer cells. Some types of non-Hodgkin lymphoma are treated with a group of targeted therapy drugs called monoclonal antibodies^[26]. The most common monoclonal antibody used to treat non-Hodgkin Bcell lymphomas is rituximab (this medicine doesn’t work for non-Hodgkin Tcell lymphomas)^[27]. Other types of monoclonal antibodies include brentuximab vedotin, obinutuzumab and alemtuzumab.

Other targeted medicines may be used to treat skin lymphomas.

Immunotherapy

Immunotherapy involves treatment with medicines that boost the ability of the immune system to attack cancer cells. A medicine called interferon may be used in immunotherapy to treat some types of lymphoma, although it can have serious side effects.

Newer types of immunotherapies called checkpoint inhibitors, such as pembrolizumab, are used for the treatment of Hodgkin’s lymphoma and certain types of non-Hodgkin’s lymphoma. These treatments are given intravenously and usually are well tolerated with less common serious side effects.

Other medicines such as thalidomide and lenalidomide may be used when other treatments have not worked. These medicines affect the immune system – but how they work exactly is not yet known.

Topical medicines

Medicines applied directly to the skin (topical medicines) can be used to treat early-stage skin lymphomas. These include topical corticosteroids, chemotherapy medicines, retinoids and immunotherapy medicines.

Stem cell transplant

A stem cell transplant may be used if bone marrow has been destroyed by high doses of chemotherapy treatment. This is used to replace damaged or destroyed blood stem cells in the bone marrow with healthy ones. These can be your own blood stem cells (called an autologous stem cell transplant) or from a donor (called an allogeneic stem cell transplant).

A stem cell transplant from another person is only possible if that person has a tissue type that closely matches yours. The best donor is often a close relative. Stem cell transplants from the patient’s own body are more common in treating lymphoma. The cells are removed from the blood or bone marrow in the weeks before chemotherapy treatment and are then returned to the patient’s bloodstream.

Active monitoring^[28]

Low-grade non-Hodgkin lymphoma may not need to be treated straight away. Instead, you may have regular check-ups to monitor the cancer (called active monitoring, watchful waiting, or watch and wait). Watchful waiting can be better than treating the cancer straight away, because early treatment can cause side effects or make your body resistant to treatment.

Follow-up

After treatment, you will need regular follow-up examinations and tests to check if the cancer has come back (recurred) or to check for side effects of the treatment. Different types of lymphoma have different treatments and outlooks, so the follow-up care that you need will depend on the type of lymphoma.

Some people may require ongoing chemotherapy or radiation therapy to keep the lymphoma under control.

Advanced disease

If treatment is unsuccessful, palliative treatment to control the symptoms of the disease may be the best option. This might include radiation therapy and chemotherapy to shrink tumours or slow their growth, and medicines to relieve pain and nausea.

Recurrent cancer

Lymphoma may come back (recur) after treatment. The cancer may come back in the same place that the original cancer developed. If cancer comes back in another part of the body, it is called secondary cancer.

Treatment for recurrent or secondary lymphoma may involve chemotherapy, radiation therapy, targeted therapy or a stem cell transplant. The treatment option depends on: