A wide range of treatments are currently available to treat non-Hodgkin lymphoma (NHL). Treatment choices depend on the specifics of your lymphoma, including the type and location and whether it is aggressive or indolent. Lymphomas that are indolent may not need immediate treatment, but rather monitoring to see if it is advancing.1 Treatments are broadly divided into the following 5 categories, with recommended options based on overall health and individual preferences:
Is one of the main treatments for NHL and may be given alone or in combination with other treatments depending on NHL type and stage. Generally given orally or intravenously (IV), it destroys fast growing cancer cells.4 Chemotherapy drug(s) are typically given in cycles, with periods of treatment usually lasting several weeks followed by periods of recovery where no treatment is given. The most common course of chemotherapy is called CHOP and consists of 4 medications: cyclophosphamide, doxorubicin, prednisone, and vincristine. Often, a monoclonal antibody called rituximab (R-CHOP) or obinutuzumab (O-CHOP) is added to this regimen. Other chemotherapy regimens include other drugs including a combination with bendamustine and rituximab, fludarabine, and R-CVP (rituximab, cyclophosphamide, vincristine sulfate, prednisone). Chemotherapy may also be used to prepare your body for bone marrow transplant/stem cell transplant.1,2
Utilizes high energy beams such as x-rays or other types of radiation to destroy cancer cells. Radiation can be used alone to destroy one or two targeted spots that contains cancerous lymphoma and can be used after chemotherapy to destroy any lymphoma cells that remain.2 Treatments are often given 5 days per week over several weeks.5
Uses a patient’s own immune system to fight cancer. Substances made by the body or made in a laboratory are used to enhance or restore the body’s immunity. Chimeric antigen receptor (CAR) T cell therapy and immune checkpoint inhibitors are two immunotherapies available for treatment of NHL.1,2
CAR T-cell therapy includes the use of modified T cells and checkpoint inhibitors. In CAR T therapy some of the patient’s own T cells are removed and modified to contain specific proteins called receptors. The receptors allow these modified T cells to recognize cancer cells that have the target protein that binds to these receptors. These modified T cells are grown in a lab and then returned to the patient’s body. Currently available FDA-approved CAR T therapies include Axicabtagene ciloleucel, Tisagenlecleucel, Brexucabtagene autoleucel, and lisocabtagene maraleucel.1-3
Immune checkpoint inhibitors act as checkpoints to keep them from attacking other healthy cells in the body. They block pathways to stop or slow cancer growth. Pembrolizumab is an example of such an inhibitor.1
Targets specific cancer cells and blocks the abnormalities causing cancer.1 Different types of targeted therapies are listed below:
Monoclonal antibodies are proteins of the immune system that are made in the clinical laboratory. These antibodies attach to the specific target on cancer cells to help destroy them and prevent them from spreading. They are administered as an infusion. Examples of monoclonal antibodies include rituximab, obinutuzumab and ofatumumab that target a protein called CD20.1
Radiolabeled antibodies contain radioactive material that target cancer cells; an example is ibritumomab tiuxetan.1
Antibody-drug conjugates attach to cancer cells and release a drug directly into the tumor cells. Examples of anti-body drug conjugates include brentuximab, loncastuximab tesirine-lpyl, polatuzumab vedotin piiq, and tafasitamab-cxix.2,3
Bispecific antibodies (bsAbs) are designed to recognize two different targets expressed on a cell surface, called antigens. These medicines can be administered intravenously (IV) or subcutaneously (SC, which is underneath the skin). Once in the bloodstream, bsAbs travel throughout the body and attach themselves to the cell(s) that express their specific antigens.6
The key difference between standard antibodies and bsAbs is based on their mechanism of action. Natural antibodies (produced by the body’s immune system) and monoclonal antibodies used in therapy interact with a single antigen in the cell that is being targeted. On the other hand, bsAbs target more than one antigen; they are less susceptible to drug resistance compared to standard monoclonal antibodies, especially in diseases that are caused by multiple factors, such as cancer. Examples of bsAbs include glofitamab, epcoritamab, mosunetuzumab, and odronextamab. 6,7
Further details on each of these therapies can be accessed in the Resources section.2,3
Involves using high doses of radiation and chemotherapy to suppress the patient’s bone marrow and immune system. Fresh and healthy bone marrow is then infused into the patient’s blood to travel to the bone marrow to regenerate healthy bone marrow. Depending on the source of the bone marrow, the transplant may be considered autologous (patient’s own stem cells) or allogenic (donor stem cells).2,8
