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Treatment for high grade non Hodgkin lymphoma

High grade non Hodgkin lymphoma (NHL) tends to grow faster than low grade NHL. Find out more about treatment for the different stages of high grade NHL. 

How doctors decide on your treatment

The type of treatment you have for high grade NHL depends on the stage of your lymphoma when it is diagnosed (limited or advanced stage).

And it depends on the type of lymphoma you have. Diffuse large B cell lymphoma is the most common type of high grade non Hodgkin lymphoma.

Treatment for limited high grade NHL

What limited disease means

In high grade NHL, limited disease means stage 1A. The lymphoma is in only one group of lymph nodes and you don't have symptoms such as night sweats, temperatures or weight loss (B symptoms).

Treatment

You might have a short course of chemotherapy and a biological therapy drug, followed by radiotherapy to the affected lymph nodes. A short course of chemotherapy usually takes about 6 to 12 weeks.

Or you might have a longer course of chemotherapy and a biological therapy drug without radiotherapy. Whether you have radiotherapy depends on factors such as where the lymphoma is in the body and how fit you are.

For diffuse large B cell lymphoma, you are most likely to have CHOP chemotherapy. You have it with a biological therapy drug called rituximab. This treatment is known as R-CHOP.

Treatment for advanced high grade NHL

What advanced disease means

Advanced high grade NHL means one of the following: 

  • you have lymphoma in more than one area of the body
  • you have a lymph gland that measures more than 10cm
  • you have night sweats, temperatures or weight loss

Treatment

In practice, most people with high grade NHL have treatment as if it is advanced cancer. This usually means quite intensive chemotherapy treatment with 3 or 4 different drugs, over 6 to 8 months. You have some or all of these drugs through:

  • a drip into a vein
  • a tube put into a vein in your chest, such as a central line or a portacath
  • a PICC line into a vein in your arm

The exact choice of treatment depends on which type of high grade NHL you have. Most of the chemotherapy combinations contain a drug called doxorubicin. This works well for many types of high grade non Hodgkin lymphoma.

For advanced diffuse large B cell lymphoma, you have a combination treatment called R-CHOP. This is CHOP chemotherapy together with a biological therapy drug called rituximab.

Treatment to prevent spread to the brain

You might have chemotherapy into the fluid around your spinal cord:

  • for some types of NHL
  • if the lymphoma is affecting the space behind your nose (the paranasal sinuses)
  • if the lymphoma is affecting your testicles

This is because there is a chance of lymphoma cells spreading to the brain in these situations. The treatment is to prevent that happening. You might hear it called prophylactic treatment. Usually, you have a chemotherapy drug called methotrexate. 

Doctors call this intrathecal chemotherapy. It is similar to having a lumbar puncture. 

Some doctors prefer to use radiotherapy to the brain instead of chemotherapy into the spine. Or you might have high dose methotrexate injections into the bloodstream, instead of into the fluid around the spinal cord.

Bone marrow or stem cell transplants

Some people with faster growing types of high grade NHL have intensive high dose chemotherapy. This gives the best chance of curing the lymphoma. But it also increases the risk of complications such as infection. The treatment is followed with a bone marrow or stem cell transplant.

When you have it

It isn't easy for doctors to decide who will do best with high dose chemotherapy treatment. You have to be fit enough to make a good recovery from the treatment.

You're probably more likely to be offered this type of treatment if:

  • your lymphoma has come back after other treatments
  • you have a type of NHL that is faster growing and likely to come back quickly after standard chemotherapy
  • you have lots of affected lymph nodes
  • the NHL is in your bone marrow or other body organs as well as in the lymph nodes
  • you have large tumours (more than 10cm across)
  • you have sweats, fevers and weight loss (B symptoms)

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:

  • making existing treatments better
  • developing new treatments
For information, you can call the Cancer Research UK nurses free on 0808 800 4040, from 9am to 5pm, Monday to Friday. They are happy to help. They can give advice about who can help you and what kind of support is available.
Last reviewed: 
10 Sep 2014
  • Non-Hodgkin lymphoma
    K Shankland and others
    Lancet 2012 September, Volume 380, Issue 9844, Pages 848-57

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