Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) is a cancer that starts in the lymphatic system. Much more common than Hodgkin lymphoma, it can be classified as indolent (slow-growing) or aggressive (rapidly growing). It affects lymphocytes, which are part of the immune system. The lymphatic system is a network of tissues and vessels that carry fluid, called lymph, throughout the body. Lymph contains lymphocytes (a type of white blood cell) that attack infectious agents. The two main types of lymphocytes that can develop into lymphomas are B-lymphocytes (B-cells) and T-lymphocytes (T-cells). In NHL, B-cells, T-cells or natural killer (NK) cells in the lymphatic system change and grow uncontrollably, sometimes forming a tumor.

NHL can start almost anywhere and spread to almost any organ. It most often begins in the lymph nodes, liver, spleen or bone marrow but can involve the stomach, intestines, skin, thyroid gland, brain or any other part of the body where lymphatic tissue is found.

Staging NHL

Once your NHL is diagnosed, your doctor will stage the cancer to determine the best treatment options for you. The Lugano Classification is the most commonly used system for staging NHL. With this system, lymphoma is assigned a stage of I, II, III or IV, with or without additional factors and can be divided into two groups: limited stage and advanced stage. Additionally, prognostic index tools are used to help predict patient outcomes.

Treating NHL

Depending on the type of NHL you are diagnosed with, your doctor will recommend one or more treatments based on the stage, type and location of your disease, as well as your age and general health. Most NHLs are treated with chemotherapy, immunotherapy, radiation therapy and/or targeted therapy. In some cases, surgery may be considered as well as stem cell transplantation, but not all NHL subtypes will require these options. Following is more information on the most common treatments options for NHL.


Chemotherapy is a systemic treatment that travels throughout the body to damage and destroy cancer cells. Chemotherapy is used to treat many subtypes of NHL. Many combinations may be used, and it may be followed by radiation therapy, targeted therapy or immunotherapy. A corticosteroid may be used with chemotherapy.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other particles to destroy cancer cells and shrink tumors. The most common radiation therapy used for non-Hodgkin lymphoma is external-beam radiation therapy (EBRT) that delivers a beam of radiation from a machine outside of the body. It is usually given after or in addition to chemotherapy, depending on the NHL subtype. It may also be given for the treatment of pain in very low doses in patients with advanced disease who have localized symptoms.


Immunotherapy, including monoclonal antibodies (mAbs), immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapy and an immunomodulator, is approved for some subtypes of NHL. An immunotherapy drug is often combined with chemotherapy. CAR T-cell therapy involves taking a patient’s T-cells and modifying them to recognize and kill lymphoma cells. It may be used after other treatment has failed.

Targeted Therapy

Targeted therapy drugs in the form of monoclonal antibodies (mAbs) (pronounced mabs) target a special protein on the surface of lymphoma cells. Other types include kinase inhibitors, a BCL-2 inhibitor, a proteasome inhibitor and inhibitors that target the PI3K and Bruton’s tyrosine kinase pathways. A CD79b-directed antibody drug conjugate is also approved. It is a substance made up of a mAb chemically linked to a drug. An immunomodulator regulates the function of the immune system and can slow the rate at which cancer cells grow and multiply.

Stem Cell Transplantation

Stem cell transplantation is considered an aggressive treatment and is generally used only for patients with NHL who have progressive or recurrent disease. There are two types of stem cell transplantation: autologous and allogeneic.

With autologous stem cell transplantation, a person’s own stem cells are removed and preserved so that very high doses of chemotherapy and/or radiation therapy can be given to attack cancer cells. The person’s stem cells are then infused back into the body.

Allogeneic stem cell transplantation is the use of stem cells obtained from a donor with healthy bone marrow whose stem cells are a close match to those of the person being treated. People receiving any type of allogeneic transplant may have graft-versus-host disease (GvHD), which occurs when the donor cells attack the patient’s cells. GvHD can be treated with steroids or other drugs that suppress your immune system.


Surgery is rarely used as a treatment option for NHL, but it may be needed for certain NHL subtypes to remove the spleen or other organs. It can also be used to take a biopsy sample.

Watchful Waiting

Watchful waiting is an option for people who do not currently have symptoms. Watchful waiting is an approach sometimes used for pregnant women.

Clinical Trials

Clinical trials are always underway to explore new treatment strategies and combinations for NHL. Ask your doctor and search online to learn about clinical trials for which you may be eligible.

Refractory NHL

Non-Hodgkin lymphoma that does not result in complete remission after treatment is called refractory non-Hodgkin lymphoma. If you receive this diagnosis, talk with your medical team about options, which could include consulting with a specialist who has experience treating refractory non-Hodgkin lymphoma, trying a different treatment and investigating clinical trials.

Side Effects

It is extremely important to prevent and manage side effects for the success of your treatment because the better you feel, the more likely you’ll be able to complete your treatment as planned, which offers a greater chance for a successful outcome.

Some of the common side effects of cancer treatments for NHL include fatigue, low blood counts, risk of infection, hair loss, nausea and vomiting, appetite loss, diarrhea, skin reactions, dry mouth, mouth sores, neuropathy (tingling in hands or feet) and easy bruising or bleeding (see Side Effects).

Your doctor may prescribe prescription medications or suggest over-the-counter drugs to prevent or manage some of the more common side effects. It is extremely important to talk openly with your doctor about any side effects you experience and to call your doctor’s office immediately if one begins suddenly.

Pain Management

Diagnostic procedures, treatments and the disease itself may cause different types of pain. Untreated pain, even if it’s minor, can get out of hand quickly. That is why it’s so important to let your health care team know right away if you are in pain. Although you can’t expect to be entirely pain-free, you can expect your health care team to do everything possible to make sure you’re comfortable.

Additional Resources


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