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There are various therapies for treating lymphoma, a type of cancer affecting the lymphatic system. The best treatment plan for each person is based on their specific type of lymphoma, overall prognosis, age, and personal preferences. Depending on the type and stage of Hodgkin or non-Hodgkin lymphoma (NHL), treatment may involve a combination of therapies.
Treatment goals differ by lymphoma type. In some cases, the aim is remission, meaning the cancer becomes undetectable. In others, the goal may be to slow the cancer’s growth, manage symptoms, or improve quality of life.
This article will cover the main categories of treatments used in lymphoma and explain how each option works to fight cancer.
More than 50 types of drugs can be used to treat lymphoma and other blood cancers. Your health care team considers several factors when determining the best treatment option for your cancer. These factors include:
Your personal preferences and priorities are also key factors in your cancer treatment decisions. For instance, is it more important to you to live as long as possible or to maintain a high quality of life, with few side effects from treatment? Is it your top priority to use the most effective treatment or to avoid the risk of serious side effects? Do you plan to have children in the future? The best treatment plan for you will be the one you and your doctor agree on in a shared decision-making process.
Several options are available for treating the various types of Hodgkin and non-Hodgkin lymphoma.
Lymphoma begins when abnormal white blood cells in the lymphatic system grow and divide rapidly and uncontrollably. The lymphatic system is a part of both the circulatory and immune systems. Chemotherapy (chemo) works by targeting and killing or damaging rapidly dividing cells, including cancer cells, but these potent drugs can also damage your body’s healthy cells.
Most chemotherapy drugs are given intravenously (through a vein), but some can be injected into the skin or muscle or taken orally (by mouth) as pills or capsules. Some types of chemo may be administered at home, but others require travel to a cancer treatment center or even a hospital stay for the duration of a treatment cycle, which may last weeks. Each cycle is followed by a rest period to help the body recover before the next round. Your specific therapy plan will determine how many chemo treatments for lymphoma you receive.
Chemo is often given before a stem cell transplant. It can also be combined with other types of treatment, including radiation therapy or targeted therapy.
Chemo for lymphoma is often delivered in combination regimens. Using multiple medications can improve treatment results and reduce the chance of lymphoma cells becoming resistant to any one drug.
Chemo is often the main treatment for Hodgkin lymphoma. One of the most common chemo regimens used in the United States is known as ABVD, which is named after the drugs it includes:
Your doctor may instead choose from several other regimens. For example, BEACOPP includes the following chemo drugs:
The Stanford V regimen may be given after ABVD or BEACOPP and is usually followed by radiation therapy. Stanford V includes:
Various combinations of chemo drugs can be effective for NHL. Your treatment plan will depend on the specifics of your disease. One of the most common first-line treatments for NHL is a chemo regimen called CHOP, which includes:
Your health care team may also prescribe a variation of CHOP. When doxorubicin is left out, the regimen is called CVP. When rituximab (Rituxan) is added, it’s referred to as R-CHOP. Other chemo regimen options depend on the type and stage of your NHL.
Chemotherapy often causes side effects. Some of the most common side effects include:
Your care team can help you manage these side effects.
Radiation therapy (also called radiotherapy) works by damaging cancer cells so they can no longer divide. Radiation is effective only in the area of the body where it’s delivered. Lymphoma radiation therapy is usually provided in an outpatient setting at a hospital or cancer clinic.
Radiation may be used to treat lymphoma in several ways, including:
External beam radiation is the most common type of radiation therapy used to treat Hodgkin lymphoma and NHL. A machine outside your body delivers a focused beam of radiation to the affected area. Involved site radiation therapy and involved field radiation therapy aim at the lymph nodes or regions of lymph nodes where the cancer started.
The side effects of radiation therapy depend on the part of your body where the radiation is focused. Possible short-term side effects may include:
Radiation therapy can also lead to long-lasting side effects such as:
Targeted therapies interfere with specific genes or proteins that cancer cells rely on to grow and survive. These treatments work only on cells with a specific molecular target, such as lymphoma cells, so they damage fewer healthy cells and may cause different side effects than chemotherapy drugs do.
Targeted therapies are used more frequently to treat NHL than Hodgkin lymphoma. Select types of these medications are being studied for use in Hodgkin lymphoma.
Some targeted therapies are pills that can be taken at home, and others are given intravenously. Major classes of targeted therapies for lymphoma are described below.
Histone deacetylase (HDAC) inhibitors work by stopping the cycle of cell growth and division to cause cell death. HDAC inhibitors are often used to treat peripheral T-cell lymphomas and cutaneous T-cell lymphomas that are relapsed or refractory. Examples include:
Proteasome inhibitors destroy cancer cells by causing proteins to build up inside them. The proteasome inhibitor bortezomib (Velcade) can be used to treat mantle cell lymphoma.
Bruton’s tyrosine kinase (BTK) inhibitors block the BTK proteins that B cells, including cancerous B cells, need to survive. BTK inhibitors can be used to treat several types of B-cell non-Hodgkin lymphoma, including mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), Waldenström’s macroglobulinemia, and marginal zone lymphoma. BTK inhibitors approved for use in NHL include:
Tyrosine kinase inhibitors (TKIs) work by blocking substances that help cancer cells grow. Crizotinib (Xalkori) is a TKI that can be used to treat anaplastic large-cell lymphoma that has come back or isn’t responding to other treatments.
Phosphatidylinositol 3-kinases (PI3Ks) are a group of proteins that contribute to cell growth and survival. PI3K inhibitors can be used as second-line treatments for follicular lymphoma and CLL/SLL. Examples of PI3K inhibitors include:
Enhancer of zeste homolog 2 (EZH2) inhibitors work by blocking the EZH2 protein, which plays a role in cancer cell growth. Tazemetostat (Tazverik) is an example of an EZH2 inhibitor that’s used to treat follicular lymphoma, especially after other treatments haven’t been effective.
Nuclear export inhibitors target a protein called XPO1, which normally moves key proteins from the cell’s nucleus to other areas where they perform essential functions. By blocking the activity of XPO1, nuclear export inhibitors disrupt cancer cell survival. Selinexor (Xpovio) is a nuclear export inhibitor that can be used to treat recurrent diffuse large B-cell lymphoma (DLBCL).
Immunotherapy treatments support the immune system in targeting and destroying lymphoma cells or slowing their growth. Below is an outline of the major types of immunotherapy drugs used in treating Hodgkin and non-Hodgkin lymphoma.
Monoclonal antibodies are synthetic versions of antibodies — proteins made by B cells to fight infection by attaching to viruses, bacteria, or other harmful invaders. Each monoclonal antibody attaches to a specific antigen (marker) on cancerous cells and either slows their growth or helps the immune system destroy them. Monoclonal antibodies can be used to treat various types of Hodgkin and non-Hodgkin lymphoma.
Monoclonal antibodies can be classified by their molecular target. Examples include drugs that target:
Monoclonal antibodies that target antigens on cancer cells can also be combined with chemotherapy drugs to deliver the treatment directly to the cancer cells. This type of therapy is called an antibody-drug conjugate (ADC). Examples of ADCs include:
Immune checkpoint inhibitors are drugs that strengthen the immune system’s response to cancer cells. Normally, the immune system uses checkpoint proteins to keep from attacking healthy cells. However, some cancer cells take advantage of the checkpoint proteins to avoid being detected. By blocking these proteins, immune checkpoint inhibitors such as nivolumab (Opdivo) and pembrolizumab (Keytruda) enable the immune system to better target cancer cells. These drugs can be used to treat refractory or recurrent primary mediastinal large B-cell lymphoma (PMBCL) or classic Hodgkin lymphoma.
Chimeric antigen receptor (CAR) T-cell therapy involves altering a person’s own T cells to target and destroy lymphoma cells. In a process similar to blood donation, T cells are first collected and then genetically modified to recognize a specific receptor on cancer cells. The modified T cells are then infused back into the body to fight the cancer.
CAR-T cell therapy can cause serious side effects, including cytokine release syndrome, neurological problems such as confusion or seizures, and increased risk of infection. Because of these risks, CAR-T cell therapies are approved only for treating certain lymphomas, such as B-cell lymphoma or follicular lymphoma, after other treatments have been tried without success.
Examples of CAR-T cell therapies include:
Stem cell transplants, also called bone marrow transplants, replace stem cells damaged by cancer or cancer treatment with healthy stem cells. This procedure is usually combined with high-dose chemotherapy and sometimes with radiation therapy. Healthy stem cells are infused into the bloodstream through an IV, allowing higher chemo doses than the person could otherwise tolerate.
Stem cell transplants can cause severe side effects and may not be a good option depending on a person’s age and other health conditions. Possible side effects include nausea and vomiting, mouth sores, infections, lung inflammation, and more.
There are two main types of stem cell transplant — autologous and allogeneic.
An autologous stem cell transplant uses a person’s own stem cells. The cells are collected before chemotherapy is given and later returned to the body. Autologous stem cell transplants with high-dose chemotherapy are sometimes used for Hodgkin lymphoma or NHL that has relapsed or hasn’t responded to other treatments.
Allogeneic stem cell transplants use stem cells from a donor. This transplant is performed after the person receives high-dose chemotherapy and sometimes radiation to destroy cancer cells. Allogeneic stem cell transplants can be riskier than autologous stem cell transplants because of the possibility that the donor’s immune cells might attack the recipient’s tissues or organs, a complication known as graft-versus-host disease.
Allogeneic stem cell transplants are not a common treatment for Hodgkin lymphoma or NHL. These treatments are generally reserved for cases in which cancer is highly aggressive, has relapsed, or hasn’t responded to other treatments.
Clinical trials offer people with lymphoma the opportunity to access new treatments or treatment combinations that aren’t otherwise available. Clinical trials may be an option for people with any type or stage of lymphoma, depending on individual health factors and trial eligibility criteria.
Participating in a clinical trial may be a particularly good option for people who haven’t responded to existing therapies. For example, the Leukemia & Lymphoma Society encourages people with relapsed or refractory Burkitt lymphoma to consider clinical trial participation. A clinical trial may also be a good option for someone with relapsed classical Hodgkin lymphoma who is not a good candidate for stem cell transplantation.
Some types of indolent (slow-growing) lymphomas may not need immediate treatment. Doctors may instead recommend “watchful waiting,” also known as “watch and wait” or “active surveillance.” During watchful waiting, you’ll be closely monitored by your health care team with regular appointments and blood tests. This approach may continue for years until signs or symptoms suggest that the cancer is starting to grow more quickly.
Adopting healthy habits like eating a nutritious diet, exercising, and quitting smoking can improve your overall health and well-being, whether or not you’re actively treating lymphoma. If you smoke, quitting may help you live longer, reduce side effects and complications from cancer treatment, and speed your recovery from adverse effects.
Many people live long and healthy lives after a lymphoma diagnosis. Improved treatments for lymphoma and other blood cancers have raised remission and survival rates over the past 10 years. Many types of lymphoma are highly treatable, and it’s possible to achieve complete remission — even with some aggressive lymphomas. Although certain lymphomas, such as CLL/SLL, are not yet curable, they grow slowly, allowing people to manage their cancer as a chronic condition.
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Leonora Valdez Rojas, M.D.
received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute.
Learn more about her here.
Alison Channon
has nearly a decade of experience writing about chronic health conditions, mental health, and women's health.
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Amanda Jacot, PharmD
earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014.
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I am a case of early relapse of dlbcl after 6 cycles of R_chop I was given salvage chemotherapy (rgdp) 3 cycles. After which I was in remission looking my history of early relapse my doctor advised… read more
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