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.

About treatment for non-Hodgkin lymphoma (NHL)

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

The treatment you have will depend on:

the type and stage of the lymphoma
if it is high-grade or low-grade
the symptoms you have
which parts of your body are affected
your general health
your preferences.

We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our non-Hodgkin lymphoma forum to talk with people who have been affected by non-Hodgkin lymphoma (NHL), share your experience, and ask an expert your questions.

Treating low-grade non-Hodgkin lymphoma (NHL)

Early stage (stage 1 or 2)

If you have low-grade NHL you do not always need to start treatment straight away. This is because it usually grows slowly. Instead, you will be monitored for signs that you need to start treatment. This is called watch and wait.

The most common treatment for early stage (stage 1 or 2), low-grade NHL is radiotherapy. It is given to the affected lymph nodes and can usually make the lymphoma disappear completely. Some people are cured after radiotherapy alone.

If radiotherapy is not suitable for you, your treatment options will be the same as those used for advanced lymphoma.

Advanced-stage low-grade lymphoma

Most people with low-grade NHL have advanced stage lymphoma (stage 3 or 4). Your treatment will depend on whether you have symptoms or not. Some people with stage 1 or 2 lymphoma may be treated as advanced stage.

Treatment aims to control the lymphoma rather than cure it. It is often very successful at shrinking the lymphoma. You will feel well and will not have any symptoms. This is called remission.

Remission may last years. After a period of remission, the lymphoma eventually comes back. But with more treatment, it often shrinks back down again and you have another period of remission. This means the lymphoma can be controlled for a long time. Most people have a good quality of life between courses of treatment.

If you do not have any symptoms
If you are not having problems with symptoms, your doctor may ask you to choose between either:

delaying treatment until symptoms develop – called watch and wait

having treatment with rituximab or a similar drug.
If you have symptoms
When low-grade advanced NHL causes symptoms, the most common treatments are:

chemotherapy

rituximab or a similar targeted and immunotherapy drug

a combination of chemotherapy and a targeted and immunotherapy drug (called chemoimmunotherapy).

These treatments are often very successful at getting the lymphoma into remission. When the lymphoma is in remission, some people continue treatment with rituximab. This is called maintenance treatment. You may have this for up to 2 years.

Sometimes radiotherapy is used to shrink the lymphoma in an area and reduce symptoms.

If low-grade lymphoma becomes high grade

Over time, some low-grade lymphomas change (transform) and become high grade. If this happens, the lymphoma is treated as a high-grade lymphoma.

Some people are diagnosed with low grade and high-grade NHL at the same time. If this happens, you have treatment for high-grade lymphoma.

Although high-grade lymphoma does not usually come back, low-grade lymphoma usually comes back eventually.

Treating high-grade non-Hodgkin lymphoma (NHL)

High-grade lymphoma is usually fast-growing and needs to be treated straightaway. The aim is to make the lymphoma disappear completely. This is called complete remission.

The most commonly used treatments are:

chemotherapy and steroids.
a combination of chemotherapy and a targeted and immunotherapy drug, such as rituximab (chemoimmunotherapy) and steroids.

Treatment can often shrink high-grade lymphoma very quickly. Sometimes, radiotherapy is given after chemotherapy. This is usually if the lymphoma was only in one area of the body. It may also be used if the lymph nodes were very enlarged (bulky) before you had chemotherapy.

Many people with high-grade NHL are cured. But if the lymphoma does not completely respond to treatment your doctor may talk to you about having more intensive treatment. This may involve high-dose chemotherapy with a stem cell transplant using your own or a donor's stem cells.

Treating non-Hodgkin lymphoma (NHL) that has come back

Treatment can often cure high-grade NHL. But, in some people, the lymphoma comes back. If this happens, it may be possible to have more treatment to try to cure it. You usually have a more intensive treatment than your first treatment. This is to try to get the lymphoma into remission.

Low-grade NHL cannot usually be cured. It nearly always comes back or starts to grow again at some point after treatment. You can have further treatment to control the lymphoma. This can often keep people feeling well for long periods of time.

If lymphoma comes back, it might be in the same area where it was before. Or it could affect another part of the body. If it causes symptoms, they may be the same as before or different.

You may have one, or a combination, of the following treatments:

chemotherapy – with different drugs, that are usually stronger than ones you had before.
targeted therapy and immunotherapies – you may have a different drug than you have had before.
radiotherapy – may be used if lymphoma comes back in one group of lymph nodes or to relieve symptoms.
stem cell transplant – with your own cells or a donor’s stem cells. You have this after having intensive chemotherapy that puts the lymphoma into remission.
CAR-T therapy – this is a new treatment. It is not commonly used. It changes some of your immune cells to make them better at fighting cancer cells. It may be used if you have diffuse large B-cell lymphoma or primary mediastinal large B-cell lymphoma that is still growing after 2 or more courses of treatment.

For some people with low-grade lymphoma, the doctor may suggest monitoring the lymphoma with regular tests rather than starting more treatment straight away. This is called watch and wait.

About our information

References

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 cancerinformationteam@macmillan.org.uk

National Institute of Health and Care Excellence (NICE). Blood and bone marrow cancers. NICE Pathways. Last accessed 3 December 2020.

Non-Hodgkin’s lymphoma: diagnosis and management; NICE Guideline (July 2016).

Newly Diagnosed and Relapsed Follicular Lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up; European Society for Medical Oncology (2020).

Reviewers

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 Editor, Professor Rajnish Gupta, Macmillan Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.