Recurrent Non-Hodgkin's Lymphoma

The goal of treatment for most patients diagnosed with non-Hodgkin's lymphoma (NHL) is to achieve a cure. Sometimes, treatment is meant to be palliative or supportive, meaning a cure is considered far outside the realm of possibility and doctors are attempting to relieve a patient's symptoms. Every patient should be aware of whether they are being treated to be cured or being treated to relieve symptoms.

When treatment is meant to 'cure', the first term used will be that the patient is in 'remission'. For the NHL patient, remission means that lymphoma can't be detected in the body and the patient isn't experiencing any symptoms.

Doctors are often reluctant to use the word 'cure' and may prefer to use remission, because remission might be permanent, or it might be temporary. In other words, a patient can experience permanent remission and never experience a relapse, or remission may be temporary.

In the case of the latter, it is called recurrent non-Hodgkin's lymphoma. Cancer can recur in three ways:

• Local Recurrence (it comes back in the same place as it was before)
• Regional Recurrence (it comes back nearby the place it was before)
• Distant Recurrence (it comes back somewhere else)

After enduring frontline treatment, nobody wants to hear that their cancer has recurred, but while it may not be very common in Hodgkin's lymphoma, it can be common in non-Hodgkin's lymphoma, depending on many factors, including the lymphoma subtype, the aggressiveness of the cancer, and many other reasons. It is most likely a combination of factors that cause a cancer to recur.

In the event of recurrence, doctors must put the patient through a new cycle of tests in order to determine as much as they can about the recurrent disease. In some cases, lymphoma can transform from one subtype to another when it recurs; it may recur in a different stage than when it was originally found; it may have different molecular characteristics than the original lymphoma.

Treatment for recurrent non-Hodgkin's lymphoma likely will depend on the subtype but often involves another round of combination chemotherapy; this time, it will involve second-line treatments, which are crafted differently than frontline options and often are designed to prepare a patient for a stem cell transplantation.

Learning that one's non-Hodgkin's lymphoma is recurrent can be emotionally devastating. It is important for patients with recurrent lymphoma to be able to discuss the next step with their physician and loved ones, and receive the necessary supportive care.