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®)
- 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®)
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.