Indolent, Stage I and Contiguous Stage II Adult Non-Hodgkin Lymphoma
Aggressive, Stage I and Contiguous Stage II Adult Non-Hodgkin Lymphoma
Indolent, Noncontiguous Stage II/III/IV Adult Non-Hodgkin Lymphoma
Aggressive, Noncontiguous Stage II/III/IV Adult Non-Hodgkin Lymphoma
Adult Lymphoblastic Lymphoma
Diffuse Small Noncleaved Cell/Burkitt Lymphoma
Non-Hodgkin Lymphoma During Pregnancy
        Aggressive Non-Hodgkin Lymphoma During the First Trimester of Pregnancy
        Aggressive Non-Hodgkin Lymphoma During the Second and Third Trimester of Pregnancy
        Indolent Non-Hodgkin Lymphoma During Pregnancy
Recurrent Adult Non-Hodgkin Lymphoma
        Indolent, Recurrent Adult Non-Hodgkin Lymphoma
        Aggressive, Recurrent Adult Non-Hodgkin Lymphoma

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Treatment of indolent, stage I and contiguous stage II adult non-Hodgkin lymphoma may include the following:

• Radiation therapy directed at the area where cancer is found.
• Watchful waiting.
• Radiation therapy directed at the area where cancer is found and nearby lymph nodes.
• Chemotherapy with radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with indolent, stage I adult non-Hodgkin lymphoma ¹ and indolent, contiguous stage II adult non-Hodgkin lymphoma ². For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

Treatment of aggressive, stage I and contiguous stage II adult non-Hodgkin lymphoma may include the following:

• Combination chemotherapy with or without radiation therapy to areas where cancer is found.
• A clinical trial of monoclonal antibody therapy and combination chemotherapy with steroids. Radiation therapy may also be given.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with aggressive, stage I adult non-Hodgkin lymphoma ⁴ and aggressive, contiguous stage II adult non-Hodgkin lymphoma ⁵. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

Treatment of indolent, noncontiguous stage II /III /IV adult non-Hodgkin lymphoma may include the following:

• Watchful waiting for patients who do not have symptoms.
• Chemotherapy with or without steroids.
• Combination chemotherapy with steroids.
• Monoclonal antibody therapy with or without combination chemotherapy.
• Radiolabeled monoclonal antibody therapy.
• Radiation therapy directed at the area where cancer is found and nearby lymph nodes, for patients who have stage III disease.
• A clinical trial of chemotherapy with or without total-body irradiation (radiation therapy to the entire body) or radiolabeled monoclonal antibody therapy, followed by autologous or allogeneic stem cell transplant.
• A clinical trial of chemotherapy with or without vaccine therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with indolent, noncontiguous stage II adult non-Hodgkin lymphoma ⁶, indolent, stage III adult non-Hodgkin lymphoma ⁷ and indolent, stage IV adult non-Hodgkin lymphoma ⁸. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

Treatment of aggressive, noncontiguous stage II /III /IV adult non-Hodgkin lymphoma may include the following:

• Combination chemotherapy alone.
• Combination chemotherapy with radiation therapy or monoclonal antibody therapy.
• Combination chemotherapy with CNS prophylaxis.
• A clinical trial of autologous or allogeneic stem cell transplant for patients who are likely to relapse.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with aggressive, noncontiguous stage II adult non-Hodgkin lymphoma ⁹, aggressive, stage III adult non-Hodgkin lymphoma ¹⁰ and aggressive, stage IV adult non-Hodgkin lymphoma ¹¹. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

Treatment of adult lymphoblastic lymphoma may include the following:

• Combination chemotherapy and CNS prophylaxis.
• A clinical trial of autologous or allogeneic stem cell transplant.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult lymphoblastic lymphoma ¹². For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

Treatment of adult diffuse small noncleaved cell/Burkitt lymphoma may include the following:

• Combination chemotherapy and CNS prophylaxis.
• A clinical trial of combination chemotherapy.
• A clinical trial of autologous or allogeneic stem cell transplant.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with adult Burkitt lymphoma ¹³. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

When aggressive non-Hodgkin lymphoma is diagnosed in the first trimester of pregnancy, medical oncologists may advise the patient to end her pregnancy so that treatment may begin. Treatment is usually chemotherapy with or without radiation therapy.

When possible, treatment should be postponed until after an early delivery, so that the fetus will not be exposed to anticancer drugs or radiation therapy. However, sometimes the cancer will need to be treated immediately in order to increase the mother's chance of survival.

Women who have indolent (slow-growing) non-Hodgkin lymphoma can usually delay treatment with watchful waiting.

Treatment of indolent, recurrent adult non-Hodgkin lymphoma may include the following:

• Chemotherapy with one or more drugs.
• Radiation therapy.
• Radiation therapy and/or chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
• Monoclonal antibody therapy.
• A clinical trial of radiolabeled monoclonal antibody therapy.
• A clinical trial of monoclonal antibody therapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of autologous or allogeneic stem cell transplant.

Treatment of indolent lymphoma that comes back as aggressive lymphoma may include the following:

• A clinical trial of autologous or allogeneic stem cell transplant.
• A clinical trial of combination chemotherapy followed by radiation therapy or stem cell transplant and radiation therapy.
• A clinical trial of monoclonal antibody therapy.
• A clinical trial of radiolabeled monoclonal antibody therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with indolent, recurrent adult non-Hodgkin lymphoma ¹⁴. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

Treatment of aggressive, recurrent adult non-Hodgkin lymphoma may include the following:

• Stem cell transplant.
• Monoclonal antibody therapy.
• A clinical trial of autologous or allogeneic stem cell transplant.
• A clinical trial of combination chemotherapy followed by radiation therapy or stem cell transplant and radiation therapy.
• A clinical trial of radiolabeled monoclonal antibody therapy.

Treatment of aggressive lymphoma that comes back as indolent lymphoma may include the following:

• Chemotherapy.
• Palliative therapy to relieve symptoms and improve quality of life.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with aggressive, recurrent adult non-Hodgkin lymphoma ¹⁵. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ³.

Glossary Terms

A quickly growing cancer.

A type of lymphoma that grows and spreads quickly, and has severe symptoms. It is seen frequently in patients who are HIV-positive (AIDS-related lymphoma). Also called high-grade lymphoma and intermediate-grade lymphoma.

A procedure in which a person receives blood-forming stem cells (cells from which all blood cells develop) from a genetically similar, but not identical, donor. This is often a sister or brother, but could be an unrelated donor.

A procedure in which blood-forming stem cells (cells from which all blood cells develop) are removed, stored, and later given back to the same person.

An aggressive (fast-growing) type of B-cell non-Hodgkin lymphoma that occurs most often in children and young adults. The disease may affect the jaw, central nervous system, bowel, kidneys, ovaries, or other organs. There are three main types of Burkitt lymphoma (sporadic, endemic, and immunodeficiency related). Sporadic Burkitt lymphoma occurs throughout the world, and endemic Burkitt lymphoma occurs in Africa. Immunodeficiency-related Burkitt lymphoma is most often seen in AIDS patients.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

Chemotherapy or radiation therapy given to the central nervous system (CNS) as a preventive treatment. It kills cancer cells that may be in the brain and spinal cord, even though no cancer has been detected there. Also called central nervous system prophylaxis, central nervous system sanctuary therapy, and CNS sanctuary therapy.

Treatment using more than one anticancer drug.

Lymphoma in which the lymph nodes containing cancer are next to each other.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

The developing offspring from 7 to 8 weeks after conception until birth.

A type of cancer that grows slowly.

A type of lymphoma that tends to grow and spread slowly, and has few symptoms. Also called low-grade lymphoma.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.

A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

A type of protein made in the laboratory that can locate and bind to substances in the body, including tumor cells. There are many kinds of monoclonal antibodies. Each monoclonal antibody is made to find one substance. Monoclonal antibodies are being used to treat some types of cancer and are being studied in the treatment of other types. They can be used alone or to carry drugs, toxins, or radioactive materials directly to a tumor.

Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.

Lymphoma in which the lymph nodes containing cancer are not next to each other, but are on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).

Treatment given to relieve the symptoms and reduce the suffering caused by cancer and other life-threatening diseases. Palliative cancer therapies are given together with other cancer treatments, from the time of diagnosis, through treatment, survivorship, recurrent or advanced disease, and at the end of life.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Any compound that has been joined with a radioactive substance.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrence.

The return of signs and symptoms of cancer after a period of improvement.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Stage I is divided into stage I and stage IE. In stage I, cancer is found in a single lymph node area. In stage IE, cancer is found in an organ or tissue other than the lymph nodes.

Stage II is divided into stage II and stage IIE. In stage II, cancer is found in two or more lymph node areas on the same side of the diaphragm. In stage IIE, cancer is found in an organ or tissue other than the lymph nodes and may have spread to one or more lymph nodes on the same side of the diaphragm.

Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIS+E. In stage III, cancer is found in lymph node areas on both sides of the diaphragm. In stage IIIE, cancer is found in lymph node areas on both sides of the diaphragm and in a nearby organ or tissue other than the lymph nodes. In stage IIIS, cancer is found in lymph node areas on both sides of the diaphragm and in the spleen. In stage IIIS+E, cancer is found in lymph node areas on both sides of the diaphragm, in a nearby organ or tissue, and in the spleen.

The cancer either (1) is found in at least one organ or tissue other than the lymph nodes and may be in nearby lymph nodes; or (2) has spread to one organ other than the lymph nodes and has spread to lymph nodes far away from that organ.

A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.

A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

Radiation therapy to the entire body. It is usually followed by bone marrow or peripheral stem cell transplantation.

A type of treatment that uses a substance or group of substances to stimulate the immune system to destroy a tumor or infectious microorganisms such as bacteria or viruses.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called active surveillance, expectant management, and observation.