Treating Non-Hodgkin lymphoma (NHL)
Treatment for non-Hodgkin lymphoma (NHL) depends on the type and stage of the lymphoma you have. Chemotherapy is the most common treatment for NHL.
There are several types of treatment for NHL. You may need just one type of treatment or a combination of different types.
Monoclonal antibody therapy is also often given with chemotherapy. Together, this is called chemoimmunotherapy.
Other treatments that may be used include:
The treatment you have will depend on:
- the type of lymphoma you have
- the stage of your lymphoma
- whether the lymphoma is high-grade or low-grade
- which part(s) of your body are affected
- your general health
- your preferences.
Early-stage low-grade lymphoma
Up to 1 in 5 people with low-grade lymphoma (20%) have early-stage or localised disease (stage 1 to 2) when they are diagnosed.
The most common treatment is radiotherapy to the affected lymph nodes. This usually makes the lymphoma disappear completely, and many people are cured after having it.
If radiotherapy is not suitable for you, you will be offered the same treatment options as the ones used for advanced lymphoma (see below). The treatment options will depend on whether you have symptoms or not.
Advanced-stage low-grade lymphoma
Most people with low-grade NHL have advanced-stage lymphoma (stage 3 or 4) when they are diagnosed. Because low-grade lymphoma is often very slow-growing, some people do not need to start treatment straight away.
If you have symptoms
When low-grade NHL causes symptoms, the most commonly used treatments are:
These treatments are often very successful at shrinking the lymphoma so you feel well and do not have any symptoms. This is called remission.
When the lymphoma is in remission, some people have a further course of treatment with rituximab. This is called maintenance treatment.
After a period of remission, which may last for years, low-grade lymphoma eventually comes back. But with more treatment, it often shrinks back down again, giving another period of remission. In this way, lymphoma may be controlled for years, even decades, and most people have a good quality of life.
Over time, about 1 in 3 low-grade lymphomas become high-grade. If this happens, the transformed lymphoma is treated as a high-grade lymphoma.
Sometimes both low-grade and high-grade NHL are diagnosed in the same person, at the same time. If this happens, the NHL is treated as a high-grade lymphoma.
High-grade lymphoma is usually fast-growing and needs treatment soon after it is diagnosed. The aim is to make the lymphoma disappear completely. This is called complete remission.
The most common treatment is chemotherapy given into a vein. This is often given in combination with a monoclonal antibody. Most people have their treatment as an outpatient. Chemotherapy can often shrink high-grade lymphoma very quickly.
Sometimes, radiotherapy is used after chemotherapy. It is most likely to be used if the lymphoma was in just one area of the body. It may also be used if the lymph nodes were very enlarged (bulky) before chemotherapy was given.
Many people with high-grade NHL are cured. But in some people, the lymphoma will come back. If this happens, the lymphoma can sometimes be put back into remission with further treatment. Some people are offered more intensive treatment than their first. The aim is to try to cure the lymphoma. This treatment may involve high-dose chemotherapy with stem cell support (autologous stem cell transplant) or using another person’s stem cells (donor or allogeneic stem cell transplant).
Treatment can often cure high-grade lymphoma. But, in some people, high-grade lymphoma comes back. If this happens, it may be possible to have more treatment to try to cure it.
Low-grade NHL cannot usually be cured. It will nearly always come back or start to grow again at some point after treatment. When this happens, further treatment can be used to control the lymphoma. This can often keep people well for long periods of time.
If lymphoma comes back, it might be where it was before. Or it could affect another part of the body. If it causes symptoms, these may be the same as you had before or they may be different.
You may have one of, or a combination of:
For some people with low-grade lymphoma, the doctor may suggest monitoring the lymphoma with regular tests rather than starting more treatment straightaway. This is called watch and wait.
Below is a sample of the sources used in our non-Hodgkin lymphoma (NHL) information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
National Institute for Health and Care Excellence (NICE). Guideline NG46. Haematological cancers: improving outcomes. 2016.
National Institute for Health and Care Excellence (NICE). Guideline NG52. Non-Hodgkin’s lymphoma: diagnosis and management. 2016.
Treleaven, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. British Journal of Haematology. 2011.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Anne Parker, Consultant Haematologist; and Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.
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