Low grade non Hodgkin lymphoma (NHL) tends to grow slowly. Find out about treatment for limited and advanced low grade NHL.
How doctors decide on your treatment
The type of treatment you have for low grade (indolent) NHL depends on:
- the stage of your lymphoma when it is diagnosed
- the symptoms you have at the time
- your general health and fitness
Treatment for limited low grade NHL
What limited disease means
About 20 out of 100 people (20%) diagnosed with low grade NHL have limited stage disease. This means that the lymphoma is in only one or two groups of lymph nodes on the same side of the diaphragm. The diaphragm is a sheet of muscle just under the lungs.
The most common type of low grade NHL is follicular lymphoma. For limited disease, you are most likely to have radiotherapy to the affected lymph nodes. This can help control the lymphoma for a long time, and may cure it.
Treatment for advanced low grade NHL
What advanced disease means
Advanced disease means you have NHL on both sides of your diaphragm. Or you have a tumour measuring more than 10cm, or you have any of the B symptoms.
Aim of treatment
The treatment for advanced low grade NHL aims to control it for as long as possible, rather than cure it. Treatment can often control the disease for several years.
Usually, after some treatment your lymphoma can't be detected by tests or symptoms for some time. Then the lymphoma comes back, and you have more treatment. And the lymphoma disappears again.
The time when the lymphoma disappears is called remission. Remission can last for many years. But second and later remissions are usually shorter than the first remission.
There are several phases of treatment. These are:
- watch and wait
- first line treatment
- maintenance treatment
- second line treatment
Watch and wait
Your doctor might decide not to give treatment if you don't have any symptoms when you are diagnosed. Instead, they keep a close eye on you. You might hear this called watch and wait.
Your doctor chooses to do this because you have no symptoms bothering you and your lymphoma can be very slow growing. All treatment has side effects, so doctors don't want to give people treatment they don't need. There is no evidence to show that it is helpful to give treatment straight away to people with advanced low grade NHL, if they don't have symptoms.
First line treatment
Your first treatment is called first line treatment.
Your doctor might offer you treatment if you have symptoms or if you have very enlarged lymph nodes.
For follicular lymphoma, you are most likely to have a combination of chemotherapy and a type of biological therapy called a monoclonal antibody. The most common combination is called R-CVP. This combines the chemotherapy drugs cyclophosphamide and vincristine, the steroid prednisolone and a monoclonal antibody called rituximab.
If you are not fit enough to have combination chemotherapy, you might have chlorambucil chemotherapy tablets. You can take these at home. You might take them with the steroid prednisolone.
Once you are in remission you might have maintenance treatment for some types of low grade lymphoma. Maintenance treatment might help to delay the lymphoma from coming back.
For follicular lymphoma, you have the biological therapy drug rituximab every 2 months for up to 2 years.
Second line treatment
Some types of low grade lymphoma tend to come back after a period of time. You need more treatment if this happens. The next lot of treatment you have is called second line treatment.
There are lots of options. You might have one of the following:
- a combination of 3 or 4 chemotherapy drugs with rituximab
- R-CVP again if you were in remission for a long time
- a single chemotherapy drug called fludarabine
- fludarabine in combination with rituximab, mitoxantrone and the steroid dexamethasone
Your doctor considers a number of things before deciding what is likely to be the best treatment for you. These include:
- your previous responses to treatment
- how quickly they want the treatment to work
- convenience for you
You might have rituximab as a maintenance treatment for up to 2 years if your lymphoma goes back into remission after chemotherapy.
Your doctor will probably give you chemotherapy tablets if you got a long remission the first time around. But if your remission was short, your doctor is likely to choose a different treatment.
Your doctor might choose a treatment that means you don't have to make as many trips to the hospital if the travel would be difficult for you.
Some hospitals around the world are trying out very intensive treatment to try to cure low grade non Hodgkin lymphoma. This treatment includes intensive chemotherapy and radiotherapy, and bone marrow or stem cell transplants
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 make existing treatments better and develop new treatments.