Treatment options for non-Hodgkin lymphoma

A team of healthcare professionals decide if you need treatment straight away. They also decide what your treatment options are.

The most common treatment options for non-Hodgkin lymphoma (NHL) are:

• chemotherapy 
• targeted and immunotherapy cancer drugs 
• steroids 
• radiotherapy
• stem cell transplant

Your treatment depends on what type of NHL you have. On this page we provide a general overview of the treatment for low grade and high grade NHL. 

We have more specific information about treatment for some of the different types of NHL. If you know what type you have, you can read more about your treatment by selecting your type from the 'types of NHL' menu page.

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). 

Your MDT usually includes:

• a haematologist - a doctor specialising in blood cancers

• a specialist haematology nurse - also called a clinical nurse specialist (CNS)

• a pathologist - a doctor who diagnoses diseases from examining lymph node biopsies

• a clinical oncologist - a doctor specialising in radiotherapy treatment

• a pharmacist

• a radiologist – a doctor specialising in reading x-rays and scans

Depending on your treatment, your MDT might also include a transplant specialist. You might meet a social worker, psychologist or counsellor.

You might not start treatment straight away if you are well. This depends on your symptoms, and the results of your blood tests and scans. 

If you need treatment, your team plans it depending on:

• your type of NHL

• how fast your NHL is growing - this is the grade

• how many places in your body are affected by NHL and where these are – this is the stage

• your general health

• your age

Your doctor will talk to you about your treatment options. They will discuss the benefits and the possible side effects with you.

The main treatments

Some people only have one type of treatment. Other people need a combination of treatments.

The main types of treatment for NHL are:

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream. Chemotherapy is one of the main treatments for NHL.

There are many chemotherapy drugs. Your treatment depends on what type of NHL you have. You might have a single chemotherapy drug on its own, or a combination of chemotherapy drugs. Or you have chemotherapy together with a targeted drug called rituximab. 

Targeted cancer drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. There are many different types of targeted drugs.

Some targeted drugs are also a type of immunotherapy. These are called monoclonal antibodies (MABs). Rituximab is an example of a MAB. It is a common treatment for NHL. You might have it alongside chemotherapy. This is called chemoimmunotherapy.

Steroids

Steroids are naturally made by our bodies in small amounts. They help to control many body functions. These include the immune system, reducing inflammation and blood pressure.

Prednisolone and dexamethasone are types of steroids. You might have these as part of your NHL treatment.

Radiotherapy

Radiotherapy uses high energy rays similar to x-rays to destroy cancer cells. 

You might have radiotherapy as your main treatment for some low grade NHLs. Or you might have it after chemoimmunotherapy if you have a high grade NHL.

You sometimes have radiotherapy to control symptoms of advanced NHL.

Stem cell transplant

You can have a stem cell transplant after very high doses of chemotherapy. The chemotherapy kills the lymphoma cells and also the stem cells in your bone marrow.  After the chemotherapy you have the new stem cells into your bloodstream through a drip. 

You might have a stem cell transplant if your NHL comes back and you need more treatment. Or, for some high risk lymphomas you might have a stem cell transplant as part of your first treatment.

Treatment for the different types of NHL

There are more than 60 different types of NHL. Your treatment depends on what type you have. We have pages about some of the different types of NHL. If you know what type you have, you can read about your treatment on the page for that NHL type. 

Doctors put NHL into groups depending on whether they tend to grow faster or slower. This is called the grade. NHL can be:

• low grade - these tend to grow slowly
• high grade - these tend to grow more quickly

On this page we provide a general overview of the main treatments for low grade NHL and high grade NHL. 

Treatment for low grade NHL

Your treatment depends on which type of NHL you have. Follicular lymphoma is the most common type of low grade NHL. Other types include:

• mantle cell lymphoma
• marginal zone lymphoma (including MALT lymphoma)
• skin (cutaneous) lymphoma 

Your doctor might not give you treatment straight away if you don't have any symptoms. Instead, they keep a close eye on you. You might hear this called watch and wait or active monitoring.

Treatment for limited stage low grade lymphoma

Limited disease generally means you have stage 1 or stage 2 NHL. It is also called early stage.

If you need treatment, you are most likely to have radiotherapy to the affected lymph nodes.

Treatment for advanced stage low grade lymphoma

Advanced disease generally means you have stage 3 or stage 4 lymphoma. Some people with stage 2 bulky lymphoma might have advanced disease.

Treatment for advanced low grade NHL aims to control it for as long as possible, rather than cure it. Treatment can often control the disease for several years. 

There are several phases of treatment for advanced low grade NHL. These are:

Active monitoring
You might not start treatment straight away. Your doctor monitors you closely.

First line treatment
This is your first treatment. You might have:

• a combination of chemotherapy drugs and rituximab – this is called chemoimmunotherapy
• rituximab on its own
• chemotherapy tablets if you aren’t well enough for combination chemotherapy

Mantle cell lymphoma looks like a low grade lymphoma. But it often grows faster, more like a high grade lymphoma. For mantle cell lymphoma, you might have a stem cell transplant after chemoimmunotherapy. You need to be well enough to have this intensive treatment.

Maintenance treatment
You have this for some types of low grade NHL. It aims to delay your lymphoma from coming back. For example, you might have rituximab every 2 months for up to 2 years.

Second line treatment
This is the next lot of treatment you have when your lymphoma comes back.

You might have:

• a combination of chemotherapy drugs and a drug like rituximab
• a drug on its own, such as the chemotherapy drug bendamustine
• rituximab on its own
• a targeted cancer drug, this might be part of a clinical trial
• a stem cell transplant

Treatment for high grade NHL

Your treatment depends on which type of NHL you have.  The most common types of high grade NHL are:

• diffuse large B cell lymphoma (DLBCL)
• Burkitt lymphoma
• peripheral T cell lymphoma, such as angioimmunoblastic T cell lymphoma

Treatment for limited stage high grade NHL

Limited disease generally means you have stage 1 or stage 2 NHL. It is also called early stage.

You might have:

• a short course of chemotherapy with rituximab, followed by radiotherapy
• a longer course of chemotherapy with rituximab, without radiotherapy

Treatment for advanced stage high grade NHL

Advanced disease means you have stage 3 or stage 4 lymphoma. Some people with stage 2 bulky lymphoma might have advanced disease.

The exact choice of treatment depends on which type of high grade NHL you have.

You might have:

• chemotherapy with 3 or 4 different drugs – this might be with rituximab (chemoimmunotherapy)
• chemotherapy to stop lymphoma spreading to your brain

The chemotherapy combination is quite intensive. You usually have it over 6 to 8 months.

For some types of NHL, you might have a stem cell transplant after chemotherapy, as part of your first treatment. This is usually because your NHL has a very high chance of coming back quickly after standard chemotherapy. You need to be well enough to have this intensive treatment.

Chemotherapy to stop lymphoma spreading to the brain

Some types of NHL are more likely to spread to your brain and spinal cord. To prevent this, you might  have a chemotherapy drug called methotrexate. You might have:

• injections of methotrexate into the fluid around your spinal cord (intrathecal chemotherapy)
• a high dose of methotrexate into your vein (intravenously)

If high grade NHL doesn’t go away or comes back

After treatment, NHL sometimes doesn't go away or it comes back. You might have:

• chemotherapy or chemoimmunotherapy, using a different combination of drugs
• stem cell transplant 
• CAR T-cell therapy
• targeted cancer drugs
• radiotherapy

Treatment if you are older or less fit

You might not be fit or well enough to tolerate intense chemotherapy.

Your doctor might suggest a less intensive treatment. For example, you might have:

• an adapted combination of drugs that doesn't include certain drugs
• lower doses
• fewer cycles of treatment

Your doctor will talk to you about the treatment side effects and how these might affect your general health. They will help you decide the best course of treatment for you own situation. 

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.