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Treatment for low grade non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about treatment for low grade non Hodgkin lymphoma. You can find the following information

 

A quick guide to what's on this page

Factors affecting treatment

Treatment for low grade (indolent) lymphoma depends on how many lymph nodes are affected by lymphoma and their position in the body. It also depends on the type of lymphoma, the symptoms you have at the time, and your general health and fitness.

If you don't have any symptoms, your doctor may decide to keep a close eye on you and not give treatment straight away. This is called watch and wait. All treatments have side effects so doctors don't want to give people treatment they don't need. 

Treatment for limited low grade NHL

Follicular lymphoma is the most common type of low grade lymphoma. If the lymphoma is only in a few lymph nodes in the same area of the body, you are most likely to have radiotherapy to the affected lymph nodes. This can help to control the lymphoma for a long time, and may cure it. 

Treatment for advanced low grade NHL

Advanced low grade NHL means the lymphoma is in more than one area of the body, or a lymph gland measures more than 10cm, or you have night sweats, temperatures or weight loss. In this case, treatment aims to control the disease rather than cure it. It can often be controlled for several years.

For follicular lymphoma you usually have a combination of chemotherapy and a type of biological therapy called a monoclonal antibody. The most common combination is called R-CVP. This stands for the chemotherapy drugs cyclophosphamide and vincristine, the steroid prednisolone, and a type of monoclonal antibody called rituximab. If you are not fit enough for combination treatment you may have chlorambucil chemotherapy tablets to take at home. 

After treatment

Once there is no sign of the lymphoma (remission), you may just have regular check ups. Some types of lymphoma tend to come back after a period of time and you will then need more treatment. The next lot of treatment you have is called second line treatment. There are a lot of choices. Your doctor decides your treatment by looking at your previous responses to treatment, how quickly they want the treatment to work, and convenience for you.

For some types of lymphoma, when you go into remission you have maintenance treatment to help to delay the lymphoma from coming back. For follicular lymphoma you have rituximab every 2 months for up to 2 years.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating NHL section.

 

 

How doctors decide on treatment

Treatment for low grade (indolent) non Hodgkin lymphoma 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

About 1 in 5 people are diagnosed with low grade NHL when it is at a limited stage. This means that you have lymphoma 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. 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.

We have information about having radiotherapy for non Hodgkin lymphoma.

 

Treatment for advanced low grade NHL

With advanced low grade NHL, the treatment aims to control the lymphoma for as long as possible rather than cure it. It can often be controlled for several years. 

The usual pattern is that you have some treatment and the lymphoma can't be detected by tests or symptoms for some time. Then the lymphoma comes back, you have more treatment and it disappears again. The time when the lymphoma disappears is called remission. Remissions can last for many years. But second and later remissions are usually shorter than the first remission.

Watch and Wait

If you don't have any symptoms when you are diagnosed, your doctor may decide not to give treatment but to keep a close eye on you. You may hear this called watch and wait. Your doctor chooses to do this because you have no symptoms bothering you and lymphoma can be very slow growing. And all treatments have 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 who don't have symptoms.

First line treatment

If you have symptoms or very enlarged lymph nodes, your doctor may offer you treatment. 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 R-CVP. It stands for the chemotherapy drugs cyclophosphamide and vincristine, the steroid prednisolone and a monoclonal antibody called rituximab

We have information about R-CVP and its possible side effects.

If you are not fit enough to have combination chemotherapy, you may have chlorambucil chemotherapy tablets, which you can take at home. You may take these with prednisolone.

Maintenance treatment

Once you are in remission you may have maintenance treatment for some types of low grade lymphoma. This may help to delay the lymphoma from coming back. For follicular lymphoma, you have 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 and you will need more treatment. The next lot of treatment you have is called second line treatment. There are a lot of choices. You might have one of the following

  • Combination chemotherapy with 3 or 4 different 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

There are a lot of choices and your doctor will consider a number of things before deciding what is likely to be best for you. Your doctor decides your treatment by looking at

  • Your previous responses to treatment
  • How quickly they want the treatment to work
  • Convenience for you

If your lymphoma goes back into remission after chemotherapy, you may have rituximab as a maintenance treatment for up to 2 years.

If you got a long remission the first time round with chemotherapy tablets, your doctor will probably give them to you again. If your remission was not very long, your doctor is likely to choose a different treatment. If it is difficult for you to make trips backwards and forwards to the hospital, your doctor may choose a treatment that means you don't have to go so often.

 

Intensive treatment

Some hospitals around the world are trying out very intensive treatment to try to cure low grade non Hodgkin lymphoma. They are trying

  • Intensive chemotherapy and radiotherapy
  • Bone marrow or stem cell transplants

You can look at the sections about chemotherapy for NHL and bone marrow and stem cell transplants for more information about these types of treatment.

 

More about low grade NHL treatments

We have detailed information about non Hodgkin lymphoma treatments in this section.

If you would like more information about any aspect of non Hodgkin lymphoma, you can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our non Hodgkin lymphoma organisations page gives details of other people who can provide information about NHL and its treatment. Some organisations can put you in touch with a cancer support group. They often have free factsheets and information which they can send to you. 

There are also books, booklets, CDs and other resources available about non Hodgkin lymphoma. Some of these are free. Look at our NHL reading list for details.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 8 September 2014