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, carboplatin, and etoposide
- RICE: Rituximab, ifosfamide, carboplatin and etoposide
- DHAP: Dexamethasone, high-dose cytarabine (Ara-C®) and cisplatin (Platinol®)
- ESHAP: Etoposide, methylprednisolone, high-dose cytarabine (Ara-C®) and cisplatin (Platinol®)
- R-ESHAP: Rituximab, etoposide, methylprednisolone, high-dose cytarabine (Ara-C®) and cisplatin (Platinol®)
There are less aggressive treatments being used for relapsed or refractory lymphomas. Examples include
- Idelalisib (Zydelig®)
- Ibrutinib (Imbruvica®)
- Obinutuzumab (Gazyva®) in combination with bendamustine followed by obinutuzumab monotherapy
- Obinutuzumab (Gazyva®) in combination with chemotherapy followed by obinutuzumab monotherapy
- Axicabtagene ciloleucel (YescartaTM)
- Tisagenlecleucel (KymriahTM)
- Venetoclax (Venclexta®)
- Pembrolizumab (Keytruda®)
- Mogamulizumab (Poteligeo®)
- Duvelisib (CopiktraTM)
- Bendamustine hydrochloride (Bendeka®)
For information about the drugs listed 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.