Treatment overview for non-Hodgkin lymphoma

Treatment for NHL depends on the type and stage of the lymphoma you have. The aim of treatment is to get rid of all signs of lymphoma. This is called remission.

High-grade lymphoma needs to be treated quickly. But some people with slow growing (low-grade) lymphomas do not need to have treatment immediately. Instead, they have regular check-ups and only begin treatment if they start to have troublesome symptoms.

The most common treatment is chemotherapy. This is often given with steroids. A targeted therapy called rituximab may also be given with chemotherapy. After the lymphoma is in remission some people have further treatment with rituximab. This is called maintenance treatment.

Radiotherapy may be given on its own to treat early-stage low-grade lymphoma.

If lymphoma comes back after treatment, you may have further chemotherapy to put it into remission again. Some people may have a more intensive treatment called a stem cell transplant.

Treatment overview

There are several types of treatment for NHL. You may need just one type of treatment or a combination of different types.

Chemotherapy is the most common treatment and is usually given with steroids. Monoclonal antibody therapy is also often given with chemotherapy. Together, this is called chemoimmunotherapy. Other treatments that may be used include radiotherapy, targeted therapy and stem cell transplant.

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.

An image of Dr Marcus, a lymphoma specialist.

Diagnosing lymphoma

In this cancer information video, Dr Robert Marcus explains what lymphoma is and how it is diagnosed. Linda, who had non-Hodgkin lymphoma, talks about how she felt when she was told of her diagnosis.

About our cancer information videos

Diagnosing lymphoma

In this cancer information video, Dr Robert Marcus explains what lymphoma is and how it is diagnosed. Linda, who had non-Hodgkin lymphoma, talks about how she felt when she was told of her diagnosis.

About our cancer information videos


Treating low-grade lymphomas

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 do not have any symptoms

If you are not having problems with symptoms, your specialist may offer you a choice between:

If you have symptoms

When low-grade NHL causes symptoms, the most commonly used treatments are:

  • chemotherapy
  • rituximab
  • a combination of both chemotherapy and rituximab.

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.

Transforming from low-grade to high-grade lymphoma

Over time, about 1 in 3 low-grade lymphomas become high-grade (33%). 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.


Treating 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.

Some types of high-grade lymphoma may spread to the brain. If there is lymphoma in your brain or a high risk of it spreading there, you may be given additional treatments. This may include having chemotherapy directly into the fluid in the spine. This is called intrathecal chemotherapy.

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).

Back to Treating

Making treatment decisions

Your doctors may tell you there are different options for your treatment. It can be difficult to make a decision, but information and support will help.

Watch and wait

Watch and wait means delaying treatment until it’s needed. For some people with non-Hodgkin lymphoma, this is an option.

Radiotherapy

Sometimes radiotherapy is the only treatment that's needed or you might have it with other treatments.

Chemotherapy

Chemotherapy uses drugs to treat cancer. It can be given in different ways and will be carefully planned.

Clinical trials

You may be asked to take part in a treatment research trial. Find out more.