The following treatments may also be used to treat non-Hodgkin's lymphoma:

Bone Marrow Transplantation

This section discusses the use of bone marrow transplantation for the treatment of non-Hodgkin's lymphoma. For a thorough review of bone marrow transplantation, please see the bone marrow transplantation treatment monograph .

Bone marrow is a soft, sponge-like materiel found inside certain bones, such as the heads of the femur and humerus, the sternum, and the hip bones. Bone marrow contains immature cells called stem cells. Stem cells can mature into blood cells (white blood cells, red blood cells, and platelets), which are often damaged by cancer.

For a stem cell transplant, stem cells from the peripheral blood or bone marrow are collected (harvested) and placed in frozen storage prior to treatment of the cancer with high-dose chemotherapy. Once chemotherapy treatment is complete, the stem cells are put back into your body; they enter your blood stream and travel to your bone marrow where they replace damaged stem cells and begin to make healthy blood cells. If your own stem cells are used the transplant is called autologous. If a donor's cells are used, it is called and allogeneic transplant.

Stem cells transplantation for non-Hodgkin’s lymphoma may involve harvesting stem cells from the patient or a donor. Survival rates are similar with either method. Because this disease often affects the bone marrow, donations from the patient may not be an option.

Results from bone marrow transplantation are better earlier in the course of the disease. Cancer cells seem more sensitive to chemotherapy drugs early in the disease. Bone marrow transplantation is usually an option for higher-grade lymphomas. Its use for low-grade lymphomas is still under investigation. This treatment may be too severe for older adults or someone with other medical problems.

Effectiveness

Bone marrow transplantation with donor stem cells produces disease-free survival in as many as 50% to 60% of lymphoma patients. Using the patient’s own stem cells, 30% to 60% of patients with aggressive tumors who have relapsed but are still sensitive to chemotherapy are likely to achieve long-term, disease-free survival. Only 10% to 20% of patients who are not sensitive to chemotherapy live for an extended period, free of disease. Survival rates are higher for patients with low-grade tumors.

Side Effects

Bone marrow transplantation is a very intense therapy Complications include infection, lung problems, graft vs host disease, failure of the graft, and death.

When to Contact Your Health Care Provider

Call your doctor if your develop any of the following:

  • Signs of infection, such as fever, cough, runny nose, red or swollen skin
  • Signs of abnormal bleeding, such as nosebleeds, bleeding gums, or easy bruising.

Biologic Therapy

This section discusses the use of biologic therapy for the treatment of non-Hodgkin's lymphoma. For a thorough review of biologic therapy, please see the biologic therapy treatment monograph .

Biologic therapy is a treatment that uses drugs to improve the way your body’s immune system fights disease. Your immune system is your body’s natural defense against disease. A healthy and strong immune system can detect the difference between healthy cells and cancer cells. Biologic therapy attempts to repair, stimulate, or enhance the immune system so that it can fight the cancer more effectively. These therapies can be used to fight cancer or to lessen the side effects that may be caused by some cancer treatments.

The main types of biological therapies used to treat non-Hodgkin's lymphoma are monoclonal antibodies and interferon.

Monoclonal Antibodies

Monoclonal antibodies are laboratory-produced substances that are highly specific for a single target antigen (substance foreign to the body). They are designed to attack lymphoma cells, and have been used to treat low-grade lymphomas. They may be given with chemotherapy or after the disease recurs.

Two types of monoclonal antibody therapies may be given to treat non-Hodgkin's lymphoma:

Rituximab (Rituxan) – given intravenously at the doctor’s office or clinic once weekly for four weeks.

Ibritumomab tiuxetan (Zevalin) – given intravenously after two infusions of rituximab. Ibritumomab tiuxetan delivers radiation therapy directly to the tumor. This drug is given in the hospital after receiving two doses of rituximab; the first dose is given one week prior and the second is given no more than four hours before the ibritumomab tiuxetan.

Interferon

Interferon occurs naturally in the body and is produced in the laboratory to help fight cancer. It is a hormone that helps the immune system fight non-Hodgkin's lymphoma. It is used on an experimental basis for lymphoma.

Effectiveness

In clinical trials, rituximab has produced partial responses in about 50% to 60% of the patients it was given to. Studies have shown that ibritumomab tiuxetan can increase response rates and provide longer responses. The use of interferon is controversial. It may produce a partial remission in follicular lymphoma.

Side Effects

Rituximab may cause fever, chills, nausea, rashes, fatigue, and headache. It can produce a life-threatening reaction in some people. Low blood counts are the most frequent adverse reaction with ibritumomab tiuxetan. This sometimes results in an increased risk of infection or bleeding.

Interferon may cause fatigue, fever, chills, headache, muscle and joint pain, and mood changes.

When to Contact Your Health Care Provider

Call your doctor if your develop any of the following:

  • Signs of infection, such as fever, cough, runny nose, red or swollen skin
  • Signs of abnormal bleeding, such as nosebleeds, bleeding gums, or easy bruising.