The treatment you have for high grade NHL depends on the type of lymphoma you have. Diffuse large B cell lymphoma is the most common type of high grade NHL.
It might also depend on the stage of your lymphoma when it is diagnosed (limited or advanced stage).
Treatment for limited high grade NHL
Limited disease generally means you have stage 1 or stage 2 NHL.
You might have a short course of chemotherapy and a targeted drug, followed by radiotherapy to the affected lymph nodes. A short course of treatment usually takes about 6 to 12 weeks.
Or you might have a longer course of chemotherapy and a targeted 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 targeted immunotherapy drug called rituximab. This treatment is known as R-CHOP.
Treatment for advanced high grade NHL
Advanced disease means you have stage 3 or stage 4 lymphoma. Some people with stage 2 bulky lymphoma might have advanced disease, depending on their circumstances.
In practice, most people with high grade NHL have treatment as if it is an 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 into your bloodsteam. You will probably have a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in the whole time you are having 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 works well for many types of high grade NHL.
For advanced diffuse large B cell lymphoma, you have a combination treatment called R-CHOP. This is CHOP chemotherapy together with a targeted immunotherapy 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 fluid around your spinal cord. Or you might have high dose methotrexate injections into the bloodstream instead.
Stem cell transplants or bone marrow transplant
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 stem cell or bone marrow 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 might 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 (called bulky disease)
- you have sweats, fevers and weight loss (B symptoms)
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.