Non-Hodgkin Lymphoma Treatment

Non-Hodgkin lymphoma (NHL) is a cancer that affects the body’s lymphatic system. The cancerous changes begin in certain infection-fighting white blood cells (lymphocytes) that play a crucial role in the immune system. The exact cause of the changes is not always clear. In some cases, the cancer is linked to a weakened immune system, Epstein-Barr virus (EBV) infection, chemical exposure or genetic mutation. Symptoms can include swollen lymph nodes, often in the neck, armpits or groin, along with fever, night sweats, unexplained weight loss, fatigue and persistent infections.

Accounting for approximately 4% of all cancers diagnosed in the United States, non-Hodgkin lymphoma is relatively common. Although it can occur at any age, it primarily affects older adults. Treatment can vary based on the type and stage of the cancer and the patient’s overall health. Common options include observation for slow-growing (indolent) lymphomas, radiation therapy, chemotherapy, targeted therapy, immunotherapy and, in some cases, bone marrow transplantation.

Surgery for non-Hodgkin lymphoma

Unlike many other types of cancer, NHL does not form solid tumors. Instead, it often affects multiple lymph nodes and organs simultaneously. As a result, surgery is rarely used as a primary treatment. However, in specific situations, it may be performed to:

• Remove a tissue sample for biopsy
• Excise a single localized tumor or cancerous lymph node
• Address certain lymphoma complications, such as gastrointestinal obstruction

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Radiation therapy for non-Hodgkin lymphoma

The most common type of radiation therapy for NHL is external beam radiation therapy (EBRT). During EBRT, an external machine (linear accelerator) generates and delivers high-energy beams to destroy cancerous cells in a targeted area of the body. For non-Hodgkin lymphoma, radiation therapy may be used to:

• Treat indolent NHL in one or two groups of lymph nodes
• Destroy microscopic cancer cells left behind after chemotherapy to reduce the risk of NHL recurrence
• Prepare the patient for bone marrow transplantation
• Treat NHL that has spread to the brain or spinal cord
• Relieve pain or control the symptoms of advanced NHL

The radiation dose and treatment site will be carefully planned to precisely target the lymphoma while avoiding healthy tissues. Usually, EBRT is given once daily, five days a week, for several weeks.

Chemotherapy for non-Hodgkin lymphoma

Chemotherapy involves the administration of powerful cancer-fighting drugs, which enter the bloodstream and circulate throughout the body to target and destroy widespread cancer cells. For non-Hodgkin lymphoma, chemo may be delivered:

• Intravenously – Injected into a vein (most common)
• Orally – Swallowed in pill or capsule form
• Intrathecally – Injected into the cerebrospinal fluid via a lumbar puncture (spinal tap)
• Intraventricularly – Injected into the ventricles of the brain via a special device (Ommaya reservoir) that is surgically implanted under the scalp

Chemotherapy is usually given in cycles, with each period of treatment followed by a period of rest to allow the body time to recover from any side effects.

Targeted therapy for non-Hodgkin lymphoma

Targeted therapy utilizes specialized drugs designed to recognize and attack cancer cells based on their unique molecular characteristics, with minimal impact on healthy cells. The drugs often target specific proteins or genes that drive cancer cell growth and survival. For non-Hodgkin lymphoma, common forms of targeted therapy include:

• Monoclonal antibodies – Bind to specific proteins on the surface of cancer cells, marking them for destruction by the immune system
• Small molecule inhibitors – Block signaling pathways that are essential for cancer cell growth and division

Targeted therapy can be used as a standalone treatment or combined with chemotherapy, particularly in cases of aggressive or recurrent NHL, to improve treatment outcomes and reduce the risk of relapse.

Immunotherapy for non-Hodgkin lymphoma

Immunotherapy harnesses the body’s natural defenses by using biological substances to stimulate the immune system or enhance its ability to recognize and destroy cancer cells. For non-Hodgkin lymphoma, key types of immunotherapy include:

• Monoclonal antibodies – Specialized drugs are designed to bind to specific proteins on the surface of lymphoma cells, flagging them for destruction by the immune system.
• Chimeric antigen receptor (CAR)-T cell therapy – The patient’s own immune cells are genetically modified to specifically target and eliminate cancer cells.

Immunotherapy can be used alone or in combination with other treatments, such as chemotherapy, especially in aggressive or recurrent cases of NHL. Additionally, radiation therapy can be paired with immunotherapy (radioimmunotherapy), where biological agents deliver radiation directly to lymphoma cells, enhancing the treatment’s precision and effectiveness.

Bone marrow transplantation for non-Hodgkin lymphoma

A treatment that replaces damaged or destroyed bone marrow with healthy blood-forming cells, bone marrow transplantation may be considered for aggressive or recurrent non-Hodgkin lymphoma that has not responded well to other therapies. There are two main types of bone marrow transplants:

• Autologous transplant – The patient’s own blood-forming cells are harvested and stored. Then, after the patient receives high-dose chemotherapy and/or radiation therapy to destroy the lymphoma cells, the stored cells are reintroduced to the patient’s body to help restore bone marrow function.
• Allogeneic transplant – The patient receives healthy blood-forming cells from a compatible donor. Following high-dose chemotherapy and/or radiation therapy to eliminate the lymphoma cells, the donor cells are infused into the patient to replace the damaged or diseased bone marrow.

Both approaches offer the potential for long-term remission, especially in cases of NHL that have resisted standard treatments.

Benefit from world-class care at Moffitt Cancer Center

Moffitt’s renowned Malignant Hematology Program offers a comprehensive range of non-Hodgkin lymphoma treatment options in a single location. Each patient works with a multispecialty team to determine which therapies are most appropriate for their unique needs. The patient’s individualized treatment plan is then administered by experienced and compassionate medical oncologists, hematologists and radiation oncologists. In some cases, our patients work with our clinical trials team to access promising new options that are not yet available in other settings.

A nationally recognized leader in cancer research, Moffitt is proud to have been a driving force in securing approval for several immunotherapies by the U.S. Food and Drug Administration (FDA). One notable example is axicabtagene ciloleucel (Yescarta), which can be used to treat adult patients with large B-cell lymphoma that did not improve with, was not adequately controlled by or relapsed within 12 months of an initial treatment combination of chemotherapy and immunotherapy

If you would like to learn more about non-Hodgkin lymphoma treatment, you can request an appointment with a specialist at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.