Non-Hodgkin lymphoma (NHL) treatment

Patients may be treated with one to five drugs at a time. The goal of treatment is a series of remissions—each remission can last a number of years. This can be true even when tests show that the disease remains in some parts of the body. Many patients lead active, good-quality lives. 

High-dose chemotherapy may, unfortunately, kill normal blood-forming cells in the marrow. Chemotherapy may cause very low counts of red blood cells, white blood cells or platelets. A red blood cell transfusion or drugs called blood cell growth factors may be needed until the side effects of chemotherapy wear off.

Most treatment for NHL takes place in an outpatient setting. Some patients may need to stay in the hospital (inpatient) for a short time—for example, if they develop a fever or have other signs of infection. Some patients who need antibiotics may stay in the hospital until the infection is gone.

Learn more about chemotherapy and other drug therapies. 

Common drug combinations used to treat NHL and NHL subtypes

A number of drug combinations include the drug rituximab (Rituxan®). Rituximab kills certain types of cancer cells.  

• R or O-CHOP: rituximab (Rituxan®) or obinutuzumab (Gazyva®) plus cyclophosphamide, hydroxydoxorubicin (doxorubicin), Oncovin® (vincristine) and prednisone
• B+O or R: bendamustine hydrochloride (Bendeka®) plus obinutuzumab (Gazyva®) or rituximab
• B+R: bendamustine hydrochloride (Bendeka®) plus rituximab
• R+ICE: rituximab plus ifosfamide, carboplatin, etoposide
• R or O-CVP: rituximab or obinutuzumab plus cyclophosphamide, vincristine and prednisone
• R-HCVAD: rituximab plus cyclophosphamide, vincristine, Adriamycin® (doxorubicin) and dexamethasone
• R²: rituximab and lenalidomide (Revlimid®)
• R-EPOCH: rituximab plus etoposide, prednisone, Oncovin® (vincristine), cyclophosphamide, hydroxydaunorubicin
• DHAP: dexamethasone, high-dose Ara-C® (cytarabine), Platinol® (cisplatin)
• ICE: ifosfamide, carboplatin, etoposide
• CODOX-M/IVAC: cyclophosphamide, vincristine (Oncovin®), doxorubicin and high-dose methotrexate, alternating with IVAC (ifosfamide, etoposide and high-dose cytarabine)

Many drug combinations are used to treat NHL. The drug choice depends on the type of NHL and the stage of the disease. 

For information about the drugs listed on this page, visit our cancer drug listing.  

Radiation uses high-energy rays to kill lymphoma cells in one area of the body. Radiation can be used along with chemotherapy when there are very large masses of lymphoma cells in a small area of the body. Radiation can also be used when large lymph nodes are pressing on an organ (such as the bowel), and chemotherapy cannot control them. But radiation alone is not usually the only treatment for NHL because the lymphoma cells are likely to be in many areas of the body.

Learn more about radiation therapy.  

The goal of stem cell transplantation is to cure the patient’s cancer by destroying the cancer cells in the bone marrow with high doses of chemotherapy, and then replacing them with new, healthy blood-forming stem cells. The healthy blood stem cells will grow and multiply, forming new bone marrow and blood cells. There are two main types of stem cell transplantation:  

• Autologous: patients receive their own stem cells
• Allogeneic: patients receive stem cells from a matched or a partially matched related donor or an unrelated donor
  • Reduced-intensity: a form of allogeneic transplantation in which patients receive lower doses of chemotherapy drugs and/or radiation therapy in preparation for the transplant

Autologous stem cell transplantation remains a key component of standard medical care for patients with aggressive forms of NHL. For indolent lymphomas, autologous stem cell transplantation is primarily used to treat patients with relapsed NHL.  

Allogeneic transplantation may be considered in the treatment of indolent forms of NHL, particularly for younger patients whose disease behaves more aggressively or has high-risk features.

Stem cell transplantation can cause serious side effects that can be life-threatening, so it may not be a treatment option for all NHL patients. The risks and benefits of transplantation must always be considered when making treatment decisions.  

Learn more about stem cell transplantation.  

This is a treatment that uses a patient’s own T cells to identify and attack cancer cells. The T cells are taken from the patient’s blood and sent to a laboratory, where they are genetically modified to attack cancer cells. The engineered T cells are then multiplied and later re-infused into the patient’s blood stream.

Learn more about CAR T-cell therapy.

Taking part in a clinical trial may be the best treatment choice for some NHL patients. Clinical trials are under way for patients at every treatment stage and for patients in remission. Today's standard treatments for cancer are based on earlier clinical trials. LLS continues to invest funds in NHL research. 

Learn more about clinical trials.  

Treatment can make patients more susceptible to infection because these treatments weaken immune cell function and can lower the number of normal white blood cells.  

Infections can be very dangerous. It is very important to take fevers seriously and to go to the hospital if you have a fever of over 100.4° F. 

Patients with NHL are advised to receive certain vaccinations, including vaccinations for pneumococcal pneumonia and influenza, once they have finished their treatment. There are two types of pneumococcal vaccines available for adults: a pneumococcal polysaccharide vaccine (PPSV23) and a pneumococcal conjugate vaccine (PCV13). Patients with NHL should not be given vaccines that use live organisms or those with high viral loads, such as the herpes zoster (shingles) vaccine, but they can receive Shingrix® because it is an inactivated shingles vaccine. COVID-19 vaccines are also recommended. Your doctor can give you more information.

Learn more about infections, low blood counts, and how to manage them.  

Common side effects of treatment include the following: 

• Mouth sores
• Nausea and vomiting
• Diarrhea
• Constipation
• Bladder irritation
• Blood in the urine
• Temporary hair loss
• Fatigue
• Cough
• Fever
• Rash
• Bone loss and fractures
• Weakness
• Tingling sensation in fingertips and toes (neuropathy)
• Lung, heart or nerve problems

There may be other side effects that are not listed here that you should watch for when receiving a specific treatment. Talk to your doctor about the possible side effects of your treatment.

Not all patients have these side effects. Treatment to prevent or manage nausea, vomiting, diarrhea and other side effects can help patients feel more comfortable.

Learn more about NHL treatment side effects and how to manage them.  

For as long as 30 years after diagnosis, patients are at a significantly elevated risk for second primary cancers (such as lung, brain, and kidney cancers), melanoma, and Hodgkin lymphoma. Therapy with autologous bone marrow or peripheral blood stem cell transplant and treatment with chemotherapy containing alkylating agents are associated with an increased risk of developing myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).

Patients may be less fertile after treatment for NHL. The risk of infertility varies according to the nature of the treatment, including the type and amount of chemotherapy, the location of radiation therapy, and the patient’s age. Men who are at risk of infertility should consider sperm banking before treatment and women should discuss all of their fertility options. Women who have ovarian failure after treatment experience premature menopause and require hormone replacement therapy.

Learn more about the impact NHL treatment may have on fertility and reproductive health.

It is important to discuss all your options and treatment concerns with your doctor. If possible, you may also want to discuss these options with a doctor who specializes in fertility and reproduction. Many cancer centers have reproductive specialists who will suggest specific options for each patient. In couples of childbearing age in which one partner has received treatment, the incidence of pregnancy loss and the health of a newborn are very similar to those of healthy couples.