Treatment Options for Non-Hodgkin's Lymphoma

Treatment Options for Low-Grade Non-Hodgkin's Lymphomas

Watchful Waiting

Because low-grade lymphomas are indolent and grow slowly, a standard option recommended to newly diagnosed patients with low tumor burden and no symptoms is "watchful waiting". This approach is also referred to as "deferred initial therapy" because initial treatment is deferred (delayed) until the lymphoma progresses and/or the patient develops symptoms of lymphoma. It is important to note that even newly diagnosed patients with low-grade lymphoma who elect the "watchful waiting" option will eventually require treatment for their disease. The critical decision that has to be made during the "watchful waiting" period is when to initiate treatment. During this period, patients have to be monitored closely for progression of the disease and signs/symptoms of non-Hodgkin's lymphoma and, once these develop, primary therapy is started.

Chemotherapy

Numerous chemotherapeutic drugs are available for the treatment of non-Hodgkin's lymphomas. Depending upon the type and stage of lymphoma, chemotherapy may involve the use of a single drug (monotherapy) or a combination of drugs (combination chemotherapy). Patients with low-grade lymphoma with early stage disease (Stage I or II) are usually treated with single agent chemotherapy (e.g., chlorambucil, fludarabine, or rituximab). Patients with more advanced disease (Stage III or IV) usually require combination chemotherapy with several anticancer drugs that are given during the same treatment session. Examples of drug combinations that are commonly used to treat non-Hodgkin's lymphoma include:

• CHOP: cyclophosphamide/doxorubicin/vincristine/prednisone
• CVP: cyclophosphamide/vincristine/prednisone

In general, chemotherapy is administered on an outpatient basis in 3 to 6 cycles that are given at 21 to 28 day intervals. Common side-effects of chemotherapy, that are usually temporary and resolve once chemotherapy has been completed, may include:

• Alopecia (hair loss)
• Mucositis (mouth sores caused by inflammation of the mucous membranes lining of the mouth)
• Nausea and/or vomiting
• Increased susceptibility to infection due to decreased numbers of white blood cells that are affected by the chemotherapy
• Increased susceptibility to bruising and bleeding due to decreased numbers of platelets (blood cells involved in blood clotting) that are affected by the chemotherapy
• Loss of appetite
• Generalized feeling of fatigue
• Peripheral neuropathy - a disorder of the peripheral nerves characterized by symptoms of numbness, tingling or burning sensations, pain, and weakness. These symptoms can affect the feet, hands, legs, arms, or face. This condition is caused by the vincristine component of the CHOP chemotherapy regimen.

Radiation Therapy

External beam radiation therapy is a treatment that uses high-energy x-rays from a radioactive source to destroy cancer cells. The radiation beams from outside the patient's body are targeted to the area of the body that is affected by the cancer. Radiation therapy for non-Hodgkin's lymphoma is usually administered once or twice a day for 5 to 8 weeks depending upon the total dosage that is required.

For patients with low-grade lymphoma with early stage disease (Stage I or II), radiation therapy may be the primary method of treatment. It has been estimated that radiation therapy is curative in about 50% of these patients. In many cases, radiation therapy is combined with chemotherapy. Common, usually temporary, side-effects of radiation therapy may include:

• Generalized fatigue
• Red, dry, tender, or itchy skin near the area of irradiation
• Dry/sore throat and difficulty swallowing if the chest or neck area is the site of irradiation
• Nausea, vomiting, or diarrhea in cases of radiation therapy to the abdomen
• Increased susceptibility to infection due to decreased numbers of white blood cells that are affected by the radiation therapy.