Refractory non-Hodgkin lymphoma (NHL) is NHL that has not responded to initial treatment. Refractory disease may be disease that is getting worse or staying the same.
Relapsed non-Hodgkin lymphoma (NHL) is NHL that responded to treatment but then returns.
Drugs Used for Refractory and Relapsed NHL
Most patients with relapsed or refractory NHL receive second-line therapy (treatment other than the type used the first time around), sometimes followed by stem cell transplantation. Second-line drug regimens may include:
- ICE: ifosfamide (Ifex®), carboplatin (Paraplatin®), etoposide (Etopophos®, Toposar®, VePesid®, VP-16)
- RICE: rituximab (Rituxan®), ifosfamide , carboplatin, etoposide
- DHAP: dexamethasone (Decadron®), high-dose cytarabine (Cytosar-U®, Ara-C), cisplatin (Platinol®)
- ESHAP: etoposide, methylprednisolone (Medrol®), high-dose cytarabine, cisplatin
- R-ESHAP: Rituximab, etoposide, methylprednisolone , high-dose cytarabine, cisplatin
There are less aggressive treatments being used for relapsed or refractory lymphomas. Examples include
- Idelalisib (Zydelig®) for patients with indolent lymphomas that have relapsed despite prior monoclonal antibodies against CD20, and chemotherapy with alkylating agents
- Ibrutinib (Imbruvica®) for patients with marginal zone lymphoma (MZL) who require systemic therapy and have received at least one prior anti-CD20-based therapy
- Ibrutinib for patients with mantle cell lymphoma (MCL) who have received at least one prior therapy
- New combinations are being tested in clinical trials for relapsed lymphomas.
For information about the drugs mentioned on this page, visit Drug Listings.
Stem Cell Transplantation
Autologous stem cell transplantation after high-dose chemotherapy may be an option for some patients with lymphoma who have relapsed after R-CHOP chemotherapy.
Allogeneic transplantation is not used as often as autologous stem cell transplantation in NHL patients because it is more toxic and is considered a last option.