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Treatment for high grade non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about treatment for high grade non Hodgkin lymphoma. There is information about

 

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Treatment for high grade non Hodgkin lymphoma

Treatment for high grade (aggressive) non Hodgkin lymphoma will depend on which type of lymphoma you have and on whether you have limited or advanced lymphoma.

If you have limited high grade NHL, you may have a short course of chemotherapy and a monoclonal antibody, followed by radiotherapy to the affected lymph nodes. Or you may have a longer course of chemotherapy and a monoclonal antibody without radiotherapy. Whether you have radiotherapy depends on different factors such as where the lymphoma is and how fit you are.

If you have advanced high grade NHL, you will probably have chemotherapy treatment with 3 or 4 different drugs, or more, and a monoclonal antibody. The exact choice of treatment depends on which type of high grade NHL you have. 

Diffuse large B cell lymphoma (DLBCL) is the most common type of high grade NHL. You will have CHOP chemotherapy together with the monoclonal antibody rituximab. This is called R-CHOP.

For some types of NHL, you may have chemotherapy into the fluid around your spine to prevent lymphoma cells spreading to the brain. Usually, you will have a drug called methotrexate. High dose methotrexate injections into the bloodstream, instead of into the spine, can sometimes replace the need for injections into the spinal fluid. 

Some patients with faster growing types of high grade non Hodgkin lymphoma have very intensive high dose chemotherapy with a bone marrow or stem cell transplant.
 

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How your doctor chooses treatment

Treatment for high grade (aggressive) non Hodgkin lymphoma will depend on which type of lymphoma you have and on whether you have limited or advanced stage lymphoma. Diffuse large B cell lymphoma (DLBCL) is the most common type of of high grade NHL.

 

Treatment for limited high grade NHL

In high grade lymphoma, limited disease means stage 1A. In other words, you have lymphoma in only one group of lymph nodes and you do not have B symptoms. You may have a short course of chemotherapy and a monoclonal antibody, followed by radiotherapy to the affected lymph nodes. A short course of chemotherapy usually takes about 6 to 12 weeks.

Or you may have a longer course of chemotherapy and a monoclonal antibody without radiotherapy. Whether you have radiotherapy will depend on different factors such as where the lymphoma is and how fit you are.

For diffuse large B cell lymphoma (DLBCL), you are most likely to have CHOP chemotherapy together with a monoclonal antibody called rituximab. This is called R-CHOP.

 

Treatment for advanced high grade NHL

In practice, most people with high grade NHL are treated as if it were advanced disease. This means quite intensive chemotherapy treatment, with 3 or 4 different drugs, or more, usually over 6 to 8 months. You have some or all of these drugs through a drip into a vein. Or you may have a central line put into your chest, a portacath or a PICC line into your arm, which stays in throughout your treatment.

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 is a type of chemotherapy drug called an anthracycline. This type of chemotherapy works well for many types of high grade NHL.

If you have advanced diffuse large B cell lymphoma, you will have the combination treatment called R-CHOP. This is CHOP chemotherapy together with a monoclonal antibody called rituximab.

 

Treatment to prevent spread to the brain

For some types of NHL, or if there is lymphoma affecting the space behind your nose (the paranasal sinuses) or your testicles, you may have chemotherapy into your spine. Usually, you will have a drug called methotrexate. 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 may hear this called prophylactic treatment. Some doctors prefer to use radiotherapy to the brain instead of chemotherapy into the spine. Or high dose methotrexate injections into the bloodstream, instead of into the spine.

 

Bone marrow or stem cell transplants

Intensive chemotherapy increases the risk of complications like infection, but gives the best chance of curing the lymphoma. Some patients with faster growing types of high grade non Hodgkin lymphoma have very intensive high dose chemotherapy with a bone marrow or stem cell transplant. Faster growing lymphomas tend to come back fairly soon after you get into remission. Look at the section about transplants for more information about this type of treatment.

It is not easy for doctors to decide who will do best with high dose chemotherapy treatment. There are no hard and fast rules. You have to be fit enough to make a good recovery from the treatment. And you are 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)
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Updated: 29 October 2012