Treatment for Other Types of NHL

Central nervous system NHL usually develops in patients with immune system disorders caused by AIDS or anti-rejection medications used for organ transplants. Patients who have primary CNS lymphomas (PCNSL) initially may benefit from treatment with prednisone, or radiation therapy; however, CNS lymphoma tends to recur within 1 to 2 years. Without radiation therapy, patients with AIDS-related lymphoma develop progressive disease.

Most patients with AIDS-related PCNSL are diagnosed with immunoblastic or large cell lymphoma. Researchers currently are examining alternative forms of treatment for PCNSL. Patients with a better performance status, those with no history of infection, and those with a lower stage of NHL, may be able to tolerate more aggressive treatments, including systemic chemotherapy.

Gastric (stomach) NHL is associated with Helicobacter pylori infection. H. pylori are the bacteria that are responsible for stomach ulcers. Infection and inflammation caused by these bacteria are believed to spur an abnormal immune system response by stomach lymphocytes, leading to the development of gastric NHL in some cases. Treatment for low-grade gastric NHL with antibiotics (e.g., ampicillin, metronidazole) may be effective.

Gastric NHL that recurs may require chemotherapy, radiation therapy, and/or surgical resection (cutting away) of the tumor. The choice of treatment depends upon the type of NHL. For example, slow-growing, mucosa-associated lymphoid tissue (MALT) tumors are treated differently than more aggressive, high-grade lymphomas.

Cutaneous (skin) NHL that arises in the skin is known as primary cutaneous lymphoma. Cutaneous lymphomas include cutaneous T-cell lymphoma (CTCL; also known as mycosis fungoides) Sézary syndrome, and other T-cell and B-cell lymphomas. The management of these tumors, which are primarily T-cell in type, differs from the treatment of most other NHLs. A biopsy may be required to confirm a diagnosis of cutaneous lymphoma. Symptoms include redness, thickening of the skin, generalized plaques (patches), or nodules (knot-like lumps).

CTCL may be treated using a variety of methods that directly involve the skin, including the following:

  • Topical (applied to the skin) chemotherapy
  • Electron beam radiation therapy (radiation of the skin surface), a form of radiation that does not penetrate too deeply and thereby does not damage organs below the skin
  • Psoralen plus ultraviolet light (PUVA) therapy—Psoralen is a drug that can make cells light-sensitive. It is taken orally, and then the patient's skin is exposed to ultraviolet light. During PUVA therapy, CTCL cells take up psoralen and are selectively killed by light exposure.

If NHL has spread to the lymph nodes and other organs beyond the skin, other treatments, such as systemic chemotherapy or biological therapies with substances such as interferon, monoclonal antibodies, cis-retinoic acid (a chemical relative of vitamin A), or other new compounds, such as cytotoxic fusion protein, a protein that binds to cancers cells and causes them to die, will be necessary.

Extranodal NHL, also called primary extranodal NHL, arises outside of the lymph nodes in an organ that is considered to be the major site of disease. Typical locations for extranodal NHLs are the sinuses, thyroid, tonsil, salivary gland, eye/eye socket, breast, testis, kidney, lung, stomach, and bowel. Surgery has a controversial role in the management of extranodal NHL. In general, these cancers are not cured by surgery alone, although resection of the tumor may be helpful if the disease remains confined. If the extranodal NHL has spread to other locations, the physician may recommend chemotherapy with/without radiation therapy.

Low-grade recurrent NHL (i.e., NHL that comes back after a remission) usually are treated with chemotherapy or chemotherapy plus radiation therapy. Unfortunately, up to one-third of all low-grade NHLs change into aggressive lymphomas. In such cases, the cancer becomes fast-growing and endangers the patient's life. Therefore, treatment of transformed NHLs usually consists of combination chemotherapy (e.g., a rituximab-containing regimen) or high-dose chemotherapy with stem cell transplantation.

In October 2008, the U.S. Food and Drug Administration (FDA) approved bendamustine hydrochloride (Treanda) to treat some types of non-Hodgkin's lymphoma that progress after standard chemotherapy treatment. This medication also is approved for use in patients who have chronic lymphocytic leukemia (CLL). Treanda is administered via intravenous injection. Side effects include infusion site reaction, skin reaction, and immune system suppression (e.g., neutropenia, thrombocytopenia).

For more information on therapies for the Non-Hodgkin's Lymphomas, please speak with your physician. Open communication, asking questions, and becoming more informed about your condition can leads to improved medical care. Participation in your health care is essential.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 14 Aug 1999

Last Modified: 28 Sep 2015