Non-Hodgkin Lymphoma Treatment

Non-Hodgkin lymphoma (NHL) is a type of cancer that develops from lymphocytes, a type of white blood cell. Treatment for NHL is based on several factors, including the subtype and the extent of the disease, as well as the individual’s age and overall health. In choosing appropriate treatment options for NHL, doctors also consider possible long-term side effects.1,2

Types of treatment for non-Hodgkin lymphoma

There are several different types of treatment that may be used for NHL in adults, including:

  • Radiation therapy
  • Chemotherapy
  • Immunotherapy
  • Targeted therapy
  • Watchful waiting
  • Surgery
  • Stem cell transplant2

Radiation therapy

Radiation therapy uses high-energy radiation. In NHL, radiation may be given in early stage or late stage cancers. Radiation may also be given prior to a stem cell transplant, and radiation can be used as a palliative treatment (to ease symptoms like pain) when NHL has spread to certain parts of the body.2,3


Chemotherapy is the use of drugs to stop cancer cells. Chemotherapy medications may be used in combination, and they may be taken by mouth or injected into a vein or muscle. Chemotherapy may also be delivered directly into the space around the spinal cord (called intrathecal chemotherapy). Chemotherapy works by targeting fast-growing cells, such as cancer cells. However, there are other fast-growing cells in the body that can also be affected, such as those in the gastrointestinal tract and hair.2


Immunotherapy, also called biologic therapy, is a type of treatment that boosts the body’s immune system to fight the cancer. The types of immunotherapy that may be used to treat NHL include immune checkpoint inhibitors and immunomodulators. Another type of immunotherapy that may be used to treat certain forms of NHL is chimeric antigen receptor (CAR) T-cell therapy. In CAR T-cell therapy, the patient’s own T-cells are removed from the body and altered in a laboratory to specifically target the cancer cells, then administered back into the patient’s bloodstream to fight cancer cells.2,4

Targeted therapy

Targeted therapies are cancer treatments that block or slow the spread of cancer by interfering with specific areas of cancer cells that are involved in the growth of cancer cells, or by focusing on particular characteristics that are unique to cancer cells. While chemotherapy drugs are typically cytotoxic, meaning they kill cancer cells, targeted therapy is typically cytostatic, meaning it blocks the growth of cancer cells. The types of targeted therapy that may be used to treat NHL include monoclonal antibodies, proteasome inhibitors, kinase inhibitors, histone deacetylase inhibitors, nuclear export inhibitors, and EZH2 inhibitors.

  • Monoclonal antibodies are created in the laboratory to identify and block cancer growth or kill cancer cells, or may be used to deliver chemotherapy medications or radioactive particles to cancer cells.2,5
  • Proteasome inhibitors block the action of proteasomes, which remove proteins inside cancer cells. By blocking the normal action of proteasomes, these treatments can help cause the proteins to increase in the cancer cell and can lead to the cancer cell’s death.2,8
  • Kinase inhibitors block specific proteins, and this action can keep certain lymphoma cells from growing and potentially kill them.2,6
  • Histone deacetylase inhibitors can help treat cancer cells by affecting proteins known as histones.
  • Nuclear export inhibitors work by impacting the XPO1 protein to disrupt normal distribution within cancer cells of other important proteins, which can result in cancer cell death
  • EZH2 inhibitors helps block the methyltransferase protein, which can play a key role in cancer cell growth6

Watchful waiting

Depending upon the specific type of NHL, watchful waiting may be recommended if a person with NHL is not experiencing symptoms from their disease. During watchful waiting, the person does not receive treatment for blood cancer, although problems like infections are treated. A person’s health is monitored closely during watchful waiting, and doctors will watch for any changes in their condition and the potential appearance of symptoms, including fatigue, weight loss, or an enlarged spleen.2


Surgery may be used in the treatment of certain cases of NHL in adults, such as to remove the spleen (splenectomy) or in certain people with mucosa-associated lymphoma tissue (MALT) lymphoma, or small bowel T-cell lymphoma.2

Stem cell transplants

Stem cell transplants are used in combination with high doses of chemotherapy and may be a treatment option for certain people with NHL. The high dose of chemotherapy destroys the cancer cells and also damages healthy blood cells. The transplant of stem cells, immature cells that can become new blood cells, is given to restore the bone marrow. The stem cells may be gathered from the patient prior to chemotherapy (called an autologous transplant), or they may be given by a donor (called an allogeneic transplant). Not everyone is a candidate for stem cell transplants, however, as the high doses of chemotherapy can be very taxing on a person’s body and may not be tolerated by older patients or those with other health problems.2,3

Clinical trials

Other, new treatments are being tested in clinical trials, including vaccine therapy. Clinical trials are a type of research where new treatments are studied. Clinical trials are an important part of the scientific process to find and prove the safety and effectiveness of new treatments, and they offer patients a chance to receive the latest treatments and be closely monitored by healthcare professionals. Clinical trials can be found by talking to a doctor or through the website Patients can discuss treatment options, including if they might be eligible for a clinical trial, with their doctor.2,7,8

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Written by: Emily Downward | Last reviewed: October 2020