Treatment for Aggressive NHL Subtypes
Aggressive non-Hodgkin lymphoma (NHL) progresses rapidly. It makes up about 60 percent of all NHL cases in the United States. Aggressive subtypes include:
- diffuse large B-cell lymphoma (DLBCL)
- AIDS-associated lymphoma
- anaplastic large cell lymphoma
- Burkitt lymphoma
- central nervous system (CNS) lymphoma
- follicular lymphoma (transformed)
- mantle cell lymphoma
- mucosa-associated lymphoid tissue (MALT) lymphoma (transformed)
- peripheral T-cell lymphoma (most types)
The goal of treatment for many subtypes is a cure. Treatment for aggressive NHL starts at the time of diagnosis.
Chemotherapy has often proved to be an effective approach to treating aggressive subtypes. The standard of care for each subtype varies. Below are some examples of specific approaches to therapy:
- Early-stage disease. Treatment can include the combination chemotherapy CHOP or involved field radiation therapy, or both. Sometimes the monoclonal antibody drug rituximab (Rituxan®) is added to the CHOP regimen (R-CHOP).
- Advanced-stage disease. First-line treatment is CHOP with Rituxan (R-CHOP).
- Disease that's spread to other areas or organs. If lymphoma is in the bone marrow, nasal sinuses or testicles or near the spinal cord, there's a risk that it may spread to the central nervous system. In these circumstances, chemotherapy may be given directly into the spinal fluid.
- High-risk disease. Factors associated with a high risk for relapse after standard therapy include high levels or the presence of certain proteins in the blood and the p53 gene mutation. In these cases, a more aggressive initial treatment than normal is needed. A clinical trial can be an effective treatment option.