Non-Hodgkin’s Lymphoma Recurrent
When Non-Hodgkin lymphoma returns after successful treatment or doesn’t respond as expected, it presents new challenges. However, many treatment options remain available, and doctors can often control the disease or even aim for a cure, depending on your specific situation.
Table of contents
- What does relapsed and refractory lymphoma mean?
- How will I know if my lymphoma has come back?
- The aim of further treatment
- Main treatment options
- Treatment challenges
- Coping with lymphoma that comes back
What does relapsed and refractory lymphoma mean?
Doctors use specific terms to describe Non-Hodgkin lymphoma that comes back or doesn’t respond to treatment. Understanding these terms can help you communicate better with your healthcare team.[1]
Relapsed lymphoma means that the cancer has returned after successful treatment. This diagnosis is typically made when you have had a remission (no evidence of lymphoma on tests and scans) that lasts for at least 6 months after treatment.[1][3] Relapse can happen if there are lymphoma cells left in your body after treatment, even though they were not detectable on scans or tests.[1]
Refractory lymphoma describes cancer that doesn’t respond to treatment in the first place. Sometimes Non-Hodgkin lymphoma doesn’t go into remission at all, or treatment stops working.[3][10] Some types of Non-Hodgkin lymphoma are more likely to relapse than other types.[3]
Despite advances in treatment over recent decades, relapsed and refractory disease represents a major treatment challenge. For both aggressive and indolent subtypes of Non-Hodgkin lymphoma, there is no single standard of care for second-line treatment regimens, though multiple options exist.[7]
How will I know if my lymphoma has come back?
After you finish your first course of treatment, you will have regular follow-up appointments. These visits are designed to check how you are doing and whether you have any problems or concerns.[3][10]
Your doctor will tell you about specific symptoms to watch for after treatment. During your follow-up appointments, they will ask about these symptoms and examine you. You can contact your medical team between scheduled appointments if you notice any concerning symptoms or if you’re worried about anything.[3]
If your doctor suspects your lymphoma might have returned, they will arrange additional tests. These may include:[3][10]
- Blood tests
- Scans
- Another lymph node biopsy
If the tests confirm that your Non-Hodgkin lymphoma has come back, the doctor will gather as much information as possible about the lymphoma. They will also consider factors such as what treatment you have already received and your general health. Based on this information, they will determine the best treatment options for your situation.[3]
The aim of further treatment
If your Non-Hodgkin lymphoma comes back or doesn’t respond to treatment, there are usually further treatment options available. The approach depends on several factors, including the grade of your lymphoma, the specific type of Non-Hodgkin lymphoma, the treatment you have already had, and your general health.[3][10]
The aim of treatment might still be to cure the disease, depending on your particular situation. Even if your lymphoma cannot be cured, your doctor can often provide treatment to control it and keep you well for long periods at a time.[3] You might not experience another relapse for many years. This means there may be long periods when you feel well, followed by times when you need treatment.[3]
Main treatment options
The treatments for relapsed Non-Hodgkin lymphoma are generally the same treatments that can be used when the disease is first diagnosed. Treatment varies greatly depending on factors such as tumor stage, the type of cells involved (B-cell or T-cell), whether the lymphoma is low-grade or high-grade, your symptoms, your age, and any other health conditions you may have.[2][14]
Possible treatments include:[3][10]
- Radiotherapy
- Chemotherapy (often combination regimens)
- Stem cell or bone marrow transplant
- Targeted cancer drugs
- Biologic agents such as rituximab or obinutuzumab
You might receive a combination of these treatments. The treatment may be more intensive than what you had initially.[3]
If you have low-grade Non-Hodgkin lymphoma that isn’t causing troublesome symptoms, you might not have treatment straight away. Your doctors might recommend active monitoring (also called “watch and wait”) until you need more treatment.[3]
Some people with certain types of relapsed Non-Hodgkin lymphoma might be eligible for CAR T-cell therapy, a very specialized type of immunotherapy. This depends on the type of Non-Hodgkin lymphoma you have and what treatment you have already received.[3][10]
Treatment challenges
Despite significant advances in treatment over recent decades, relapsed and refractory Non-Hodgkin lymphoma remains a major challenge in cancer care. One important issue is resistance to rituximab, a commonly used antibody treatment.[7]
Rituximab is a monoclonal antibody that targets CD20, a protein found on the surface of many B-cell lymphomas. Over the last two decades, rituximab has dramatically improved outcomes for Non-Hodgkin lymphoma patients and has become part of standard front-line treatment. Standard chemotherapy often includes rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (called R-CHOP).[7]
However, a significant number of patients either relapse after initial treatment or don’t respond to these treatments at all. For both aggressive and indolent subtypes of Non-Hodgkin lymphoma, prognosis after relapse remains relatively poor, though multiple emerging classes of targeted therapies are in development.[7]
Coping with lymphoma that comes back
Receiving news that your lymphoma has returned can be very difficult to cope with, even if your doctor still hopes to cure you. If you found the first treatment challenging, facing further treatment can be especially difficult.[3][10]
It’s important to talk to your nurse or doctor about how you feel. It might help to have someone with you at your appointments. Consider bringing a list of questions so you remember to ask about everything you need to know. Asking questions can help you understand your situation better and feel more in control.[3]
It is very common to feel anxious about your Non-Hodgkin lymphoma coming back. Managing worries about any changes or new symptoms can be difficult. Your doctor will tell you what symptoms to look out for, and you can contact them about any new symptoms or concerns. If you are feeling very anxious, it can be helpful to find ways to manage stress and worry.[10]
Many patients experience different feelings when dealing with recurrent cancer, including shock, sadness, fear, anxiety, anger, or feelings of helplessness. Each person’s experience with cancer is different, and the way you cope with the physical and emotional impacts is unique to your personality and situation.[19]
Some helpful coping strategies include:[19]
- Building a strong support system by talking to family, friends, doctors, and counselors about your fears and concerns
- Finding a support group or peer support program with other individuals who are also coping with cancer
- Watching for signs of depression, such as sleeping more or less than usual, loss of interest in preferred activities, or inability to concentrate, and seeking professional help if needed
- Maintaining a healthy lifestyle with good nutrition, physical exercise, and adequate rest
- Setting reasonable goals for yourself