Management

Management

Treatment of NHL varies according to the the histologic type and stage of the disease. (1,2,3)

• asymptomatic patients with indolent forms of advanced NHL may require frequent and careful observation in order to initiate treatment when the clinical course of the disease accelerates
  • some patients may have a prolonged indolent while some may have more aggressive types of the disease which evolves rapidly and require immediate treatment
• radiation may be used for curative or palliative purposes and may be used alone or in combination with chemotherapy

Treatment can be divided into 2 broad categories:

• indolent NHL
  • some examples of indolent NHL include - follicular lymphoma, lymphoplasmacytic lymphoma (Waldenström macroglobulinemia), marginal zone lymphoma, primary cutaneous anaplastic large cell lymphoma
  • standard treatment options include
    • local radiotherapy is the first-line treatment to people with localised stage IIA follicular lymphoma
    • watchful waiting for asymptomatic patients
    • Rituximab
    • Rituximab with chemotherapy
    • combination chemotherapy
    • palliative radiation therapy
      
      
• aggressive NHL
  • increasingly seen in human immunodeficiency virus (HIV)-positive patients;
  • examples of aggressive NHL include - diffuse large B-cell lymphoma, Burkitt's lymphoma, mantle cell lymphoma, follicular lymphoma, peripheral T cell lymphoma
  • standard treatment options include
    • R-CHOP = Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.
    • other combination chemotherapy
    • radiation therapy
    • bone marrow or stem cell transplantation

Reference:

1. National Cancer Institute at the National Institutes of Health (NIH). Adult Non-Hodgkin Lymphoma Treatment
2. NICE. Non-Hodgkin’s lymphoma: diagnosis and management. NICE guideline NG52. Published July 2016
3. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: B-cell lymphomas [internet publication].