This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on May 31, 2022.
Non-Hodgkin lymphoma experts develop comprehensive treatment plans specifically tailored to each patient. This individualized plan typically includes evidence-based medical treatments and technologies, combined with supportive care services to help reduce side effects and help the patient maintain his or her strength and quality of life.
The primary treatments for non-Hodgkin lymphoma (NHL) include chemotherapy, radiation therapy, stem cell transplantation and targeted therapy. Immunotherapy has also emerged as one of the potential new treatments for certain types of non-Hodgkin lymphoma.
Non-Hodgkin lymphoma is a complex disease with many types and sub-types, which may develop in either B cells or T cells. Some varieties of the disease may be aggressive (fast-growing) or indolent (slow-growing).
The treatment plan for non-Hodgkin lymphoma often depends on the type and stage of the lymphoma, as well as the patient’s overall health, personal needs and goals. An accurate diagnosis is critical to helping to determine treatment options tailored to each individual.
Almost 90 percent of all non-Hodgkin lymphoma cases originate in B cells. There are many types and sub-types of B-cell lymphoma, but the most common include:
Treatments for B-cell lymphomas include:
Chemotherapy may be used to treat all types of non-Hodgkin lymphoma, including aggressive and non-aggressive forms, and may also be used to help prevent the disease from recurring. Chemotherapy for non-Hodgkin lymphoma often consists of giving several drugs together in a set regimen. A common form used specifically to treat diffuse large B-cell non-Hodgkin lymphoma is CHOP chemotherapy, which is a combination of four chemotherapy drugs.
Depending on the drug, regimen and personal preferences, chemotherapy drugs may be administered:
Several types of immunotherapy drugs are used to treat non-Hodgkin lymphoma. Some immunotherapies, called immunomodulating drugs, affect parts of the immune system, although how they work isn’t clear. Immunomodulating drugs are sometimes used to treat certain types of lymphoma after other treatments have failed. Another treatment, called chimeric antigen receptor, or CAR T-cell therapy, works by altering a patient’s T cells to add receptors that seek out and attack lymphoma cells.
Learn more about CAR T-cell therapy
Radiation therapy for non-Hodgkin lymphoma may be used to destroy lymphoma cells or to prevent the cells from growing and reproducing. It may also be used to relieve pain or discomfort caused by an enlarged spleen or swollen lymph nodes. For patients with non-Hodgkin lymphoma, radiation is generally confined to the lymph nodes and the areas surrounding the lymph nodes.
Depending on the patient's individual needs, the care team may combine radiation treatment with other therapies, such as targeted therapy and chemotherapy, to prevent the growth of new cancer cells.
Learn more about radiation therapy
Before a stem cell transplant for non-Hodgkin lymphoma, the patient will undergo a conditioning regimen that involves intensive treatment, such as high-dose chemotherapy, to destroy as many cancer cells as possible. Following this, the patient will receive the stem cells intravenously (similar to a blood transfusion). After entering the bloodstream, the stem cells travel to the bone marrow and begin to produce healthy new blood cells in a process known as engraftment.
Sometimes, the high doses of chemotherapy or radiation the patient receives before the stem cell transplant cause side effects, such as infection. An allogeneic stem cell transplant (using cells from a donor) poses the risk of graft-versus-host disease (GVHD), a condition where the donated cells attack the patient’s tissues. The patient's cancer care team may prescribe certain drugs to reduce the risk of infection or GVHD.
Learn more about hematology oncology
Monoclonal antibody therapy is a type of targeted therapy that uses immune cells engineered in a laboratory. These cells, when injected back into the body, are designed to target specific features in cells, killing them or preventing them from growing.
Monoclonal antibodies may be used alone to target lymphoma cells, or in combination with chemotherapy or radiation therapy drugs.
Learn more about precision medicine
T-cell non-Hodgkin lymphoma types are rarer than B-cell varieties, but some may be very aggressive. Types of T-cell lymphoma include:
Treatments for T-cell lymphomas include:
Learn more about T-cell lymphoma types
Patients with human immunodeficiency virus (HIV) may be at a higher risk of developing cancer, especially lymphoma. HIV weakens the immune system, making it more difficult to fight off disease, infections and conditions such as acquired immune deficiency syndrome (AIDS).
AIDS-associated lymphoma most often develops in the lymph system, the body’s network of organs, nodes and vessels that help fight infection. Diffuse large B-cell lymphoma and Burkitt lymphoma are among the most common types of non-Hodgkin lymphoma in patients with AIDS. Lymphoma is a leading cause of death among patients with HIV.
These patients are also at a higher risk of developing Hodgkin lymphoma and Kaposi sarcoma, a rare form of skin cancer.
Treatment options for patients with AIDS-associated lymphoma depend on the overall health of the patient and the type of lymphoma diagnosed.
What’s the difference: Hodgkin lymphoma and non-Hodgkin lymphoma
Some patients diagnosed with an indolent, or slow-growing, type of non-Hodgkin lymphoma who are not experiencing symptoms, may not require immediate treatment. These patients are typically put on active surveillance, a program in which their condition is monitored, but not treated.
During active surveillance, sometimes referred to as watchful waiting, patients may receive regular laboratory tests, physical exams and imaging tests such as CT scans or X-rays. Treatment may begin only when symptoms develop or tests indicate the lymphoma is progressing.
After the patient receives treatment for non-Hodgkin lymphoma, the cancer may not completely go away, and additional chemotherapy or radiation may be necessary. Even if the lymphoma does go away, it’s possible for it to come back. This is called a recurrence, and it can be a source of stress and worry. It’s helpful to know that the patient's aftercare plan, which is based on the patient's specific lymphoma type, may include close monitoring by the care team.
Lymphoma that recurs typically does so within two years after initial treatment, but it can come back even years later. That’s why it’s so important to keep all follow-up appointments scheduled by the doctor. During these visits:
Treatment for a lymphoma recurrence will be based on its size and location, as well as on the length of time that has passed since the patient's last treatment. Because a recurrence may involve a different type of lymphoma than the first diagnosis, or one that’s located in another part of the body, treatment options may differ from the original type of treatment.
With a new generation of drugs and treatments in development for non-Hodgkin lymphoma, clinical trials are a critical testing ground for determining their effectiveness and safety. The patient's care team may recommend enrolling in a clinical trial that may offer access to treatment options for non-Hodgkin lymphoma that would otherwise be unavailable.
Each patient is considered for a clinical trial on an individual basis and must meet strict and specific criteria. Patients may qualify at any stage of their disease or treatment. Patients should ask their doctors whether a clinical trial is an option for them and ask about the risks and requirements involved.