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
Limited disease generally means you have stage 1 or stage 2 NHL.
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
Advanced disease generally means you have stage 3 or stage 4 lymphoma. Some people with stage 2 bulky lymphoma might have advanced disease, depending on their circumstances.
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.
Phases of treatment
There are several phases of treatment for advanced low grade NHL. 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.
At the moment, 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
This is your first 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 targeted immunotherapy called a monoclonal antibody (MAB). For example, R-CVP includes the following:
- the chemotherapy drugs cyclophosphamide and vincristine
- the steroid prednisolone
- a MAB called rituximab
You might have chlorambucil chemotherapy tablets If you are not fit enough to have combination chemotherapy. You can take these at home. You might have 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 might 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. You need more treatment if this happens. The next lot of treatment you have is called second line treatment.
Your doctor considers a number of things before deciding what is likely to be the best treatment for you. For example, they will look at how well your lymphoma responded to the first treatment. And how long the remission was for. They will also ask you what you want to do.
There are lots of different options for second line treatment. You might have a combination of chemotherapy drugs and a drug like rituximab. Or you might have a drug on its own, such as the chemotherapy drug bendamustine.
If it is difficult for you to make trips to the hospital, your doctor may choose a treatment that means you don't have to go so often.
You might have maintenance treatment again if your disease goes into remission. Your doctor will discuss the possibility of further treatment if your lymphoma comes back again.
Some hospitals around the world are trying out very intensive treatment to try to cure low grade NHL. This treatment includes intensive chemotherapy and radiotherapy followed by a stem cell or bone marrow transplant.
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.