Treatment of Indolent Non-Hodgkin Lymphoma

For information about the treatments listed below, see the Treatment Option Overview section.

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

• Radiation therapy.
• Monoclonal antibody therapy (rituximab) and/or chemotherapy.
• Watchful waiting.

If the tumor is too large to be treated with radiation therapy, the treatment options for indolent, noncontiguous stage II, III, or IV non-Hodgkin lymphoma will be used.

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

• Watchful waiting for patients who do not have signs or symptoms.
• Monoclonal antibody therapy (rituximab) with or without chemotherapy.
• Lenalidomide and rituximab.
• Maintenance therapy with rituximab.
• Monoclonal antibody therapy (obinutuzumab) with or without chemotherapy.
• EZH2 inhibitor therapy (tazemetostat).
• Radiolabeled monoclonal antibody therapy.
• A clinical trial of high-dose chemotherapy with or without total-body irradiation or radiolabeled monoclonal antibody therapy, followed by autologous or allogeneic stem cell transplant.
• A clinical trial of chemotherapy with or without vaccine therapy.
• A clinical trial of new types of monoclonal antibodies.
• A clinical trial of radiation therapy that includes nearby lymph nodes, for patients who have stage III disease.
• A clinical trial of low-dose radiation therapy, to relieve symptoms and improve quality of life.

Other treatments for indolent non-Hodgkin lymphoma depend on the type of non-Hodgkin lymphoma. Treatment may include the following:

• For follicular lymphoma, treatment may be within a clinical trial of new monoclonal antibody therapy, new chemotherapy regimen, or a stem cell transplant.
• For lymphoplasmacytic lymphoma (Waldenström macroglobulinemia), tyrosine kinase inhibitor therapy and/or plasmapheresis or proteasome inhibitor therapy (if needed to make the blood thinner) is used. Other treatments that are like those used for follicular lymphoma may also be given.
• For gastric mucosa-associated lymphoid tissue (MALT) lymphoma, antibiotic therapy to treat Helicobacter pylori infection is given first. For tumors that do not respond to antibiotic therapy, treatment is radiation therapy, surgery, or rituximab with or without chemotherapy.
• For extragastric MALT lymphoma of the eye and Mediterranean abdominal lymphoma, antibiotic therapy is used to treat infection.
• For splenic marginal zone lymphoma, rituximab with or without chemotherapy and B-cell receptor therapy is used as initial treatment. If the tumor does not respond to treatment, a splenectomy may be done.