Treatment for NHL

There are more treatment options today than ever before to control non-Hodgkin lymphoma (NHL) or put it into remission.  

Our NHL specialists work closely with you, your family and each other to get you back to health. At Fred Hutchinson Cancer Center, we provide all standard therapies for NHL and offer you access to the latest innovations through clinical trials. 

Treatment Plan

NHL treatment at Fred Hutch is highly customized and tailored to meet each patient’s needs.

How Do We Create Your Treatment Plan?

Your Fred Hutch hematologist-oncologist works alongside an entire group of lymphoma specialists. They include other hematologist-oncologists, radiation oncologists, neuro-oncologists and researchers who are looking for better ways to treat this disease.

Every week, this team gathers in a meeting called a tumor board. Together, dozens of team members discuss their patients’ treatment plans. This approach means each patient benefits from the experience of the whole group.

With support from the larger team, your physician will:

  • Assesses whether your subtype needs treatment now (sometimes watchful waiting is best) and, if so, when treatment should happen
  • Consider the standard therapy for your subtype
  • Determines if any clinical trials match your needs, so you can consider joining them

Your hematologist-oncologist will walk you and your caregiver through the treatment plan that has been recommended for you by the tumor board. You will have a chance to share your personal preferences and options, and you will decide together what happens next.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many factors, including:

  • Your NHL subtype, because different subtypes start, grow and respond to treatments differently
  • If your NHL is slow-growing (indolent) or fast-growing (aggressive)
  • The stage of your disease
  • If you have had treatment for NHL in the past
  • Your age and overall health
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

What Is The Standard Therapy For NHL?

Because NHL includes more than 60 subtypes of cancer, there is no one way to treat everyone. Broadly speaking, however, many people are treated with chemotherapy, targeted therapy or immunotherapy. Physicians can use these one at a time or combine them. Some people need radiation therapy or a blood or marrow transplant. Others do not need any active treatment for years, but they should be carefully monitored over time. This is called watchful waiting.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.

Our patients can also choose to receive promising, new NHL therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can consider joining them.

Treatment Process

Different subtypes of NHL start, progress and respond to treatments in different ways. We choose, combine and schedule your treatments based on what works for your subtype. Your care team makes sure you understand each type of treatment and all of your choices. 

Watchful Waiting

If you have slow-growing (indolent or low-grade) NHL and no symptoms, your physician may recommend watchful waiting. 

This is also called observation or surveillance. It means you and your physician closely monitor your health for any changes, like the start of symptoms. Symptoms can take many years to appear, or they may never appear, so treatment may not be needed for a long time. 

For NHL patients who have slow-growing NHL and no symptoms, research shows that immediate treatment will not help. Plus, delaying treatment also means you don’t have to go through any difficult side effects that can happen with treatment. 

During watchful waiting, you will visit your physician for exams and have blood tests and imaging tests on a regular schedule. The schedule depends mainly on your NHL subtype.  

In between scheduled visits, you are not on your own. We are here. If you notice health changes, we encourage you to call so we can check whether you do need active treatment. 

Some people do not need active treatment for many years. The main benefits of watchful waiting include: 

  • You can keep living your life without much disruption. You will not have side effects from treatments you do not need.  
  • When you do need treatments later, they will still be just as effective. 
  • More effective options might be available in the future.  


Most people with NHL start by getting chemotherapy. Many of them go into complete remission with a combination of chemotherapy and radiation.  

Chemotherapy uses medicines to kill fast-growing cells (like cancer cells) or to keep them from dividing (which is how cancers grow). 

Your hematologist-oncologist prescribes your chemotherapy and sets your treatment schedule. Usually, chemotherapy is given by infusion. Liquid medicine is put into a vein through an intravenous (IV) line. This can be a line in your arm (peripheral venous catheter) or a port in your chest (central venous catheter). Treatment happens in repeating cycles every two to six weeks. 

You get infusions in a dedicated area of the clinic. Cancer nurses who are experts in infusions will give you these treatments. They will also monitor you during the treatment. They respond to any medical issues that come up and help keep you comfortable. 

For B-cell lymphomas, physicians often use chemotherapy along with an antibody therapy called rituximab. 

CHOP Regimen 

For NHL, many Fred Hutch patients receive a mix of medicines called CHOP. It works against many subtypes of NHL. CHOP stands for: 

  • Cyclophosphamide — Slows or stops cell growth by changing the cell’s DNA. 
  • Doxorubicin hydrochloride — Causes cells to die by harming their DNA. 
  • Vincristine — Keeps cells from dividing. 
  • Prednisone — Helps with inflammation. Lowers immune response. Causes cell death in some tumors. 

For some people, another combination of medications works better. Your Fred Hutch physician will recommend the medicines that are most likely to work for your subtype. 

Learn More About Chemotherapy


Immunotherapies are some of the latest advances in NHL care. They use the power of your immune system to fight your cancer.

Rituximab is one example of a monoclonal antibody that is often used for NHL. It targets a molecule on lymphocytes (a type of white blood cell) and tells other immune system proteins to kill these cells. It is given in cycles by infusion. 

Cellular immunotherapies are another important option. These involve taking immune cells from your body. In a lab, scientists multiply the cells. Sometimes they also re-engineer the cells to recognize and fight cancer. Then they return the cells to your body. 

Fred Hutch was one of the first cancer centers to offer cellular immunotherapies approved for NHL by the U.S. Food and Drug Administration. These therapies include:  

  • Tisagenlecleucel, known by the brand name Kymriah®, available for adults with relapsed or refractory large B-cell lymphoma and relapsed or refractory follicular lymphoma. It is also available for young adults with relapsed or refractory acute lymphoblastic leukemia 
  • Axicabtagene ciloleucel (axi-cel), known by the brand name Yescarta®, available for adults with relapsed or refractory large B-cell lymphoma, as well as relapsed or refractory follicular lymphoma
  • Brexucabtagene autoleucel, known by the brand name Tecartus®,  available for adults with relapsed or refractory mantle cell lymphoma and adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia
  • Lisocabtagene maraleucel, known by the brand name Breyanzi®, approved to treat adults with relapsed or refractory large B-cell lymphoma

Only certified treatment centers, like Fred Hutch, can give these CAR T-cell therapies.

In addition to therapies approved by the U.S. Food and Drug Administration, Fred Hutch also offers many cellular immunotherapy clinical trials for NHL patients.

Learn More About Immunotherapy

Targeted Therapy

For some subtypes of NHL, you may get targeted therapies. These are more exact than standard chemotherapy, which affects all fast-growing cells throughout the body.

Targeted therapies work in one of three ways: 

  • They target a gene or protein that causes cancer growth. 
  • They damage cancer cells directly. 
  • They tell your immune system to attack certain cells. This is also called immunotherapy. 

Some examples of targeted therapies for NHL are ibrutinib, idelalisib and rituximab. Many more options are available, and the list keeps growing as researchers develop and test new ones. 

Like with chemotherapy, your hematologist-oncologist will prescribe your targeted therapy. Sometimes, targeted therapies are a pill that you take at home. Or they can be given by infusion in repeating cycles. They can be used alone or with other treatments. 

Targeted therapies are used for many subtypes of NHL, including: 

  • Anaplastic large-cell lymphoma (ALCL) 
  • Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) 
  • Cutaneous B-cell lymphoma (CBCLs) 
  • Diffuse large B-cell lymphoma (DLBCL) 
  • Lymphomatoid granulomatosis 
  • Waldenström macroglobulinemia (lymphoplasmacytic lymphoma) 
Learn More About Targeted Therapy

Radiation Therapy

Based on your type of lymphoma and if it has spread, your physicians may recommend radiation therapy.  

Radiation therapy uses high-energy rays to kill cancer cells. A radiation oncologist decides on the type, dose and schedule of your treatment. 

Usually, this means that a machine aims rays right at your tumor. This is external-beam radiation therapy. You get this treatment daily, Monday through Friday, for several weeks. 

For NHL, physicians most often use external-beam radiation therapy to treat cancer in the spleen or in lymph nodes in the neck, chest, armpits or groin. 

For some subtypes of NHL, physicians use radioimmunotherapy. This treatment was developed by Fred Hutch. You will be given a liquid through an intravenous (IV) line. In this liquid, there is rituximab linked with a radioactive atom. The rituximab targets lymphocytes. It concentrates radiation in these cells and tells your immune system to attack them. Radioimmunotherapy is used mainly for B-cell lymphomas. 

Learn More About Radiation Therapy

Blood or Marrow Transplant

A blood or marrow transplant resets your body’s ability to make healthy blood cells. Researchers at Fred Hutch pioneered this form of treatment. 

Your physicians may recommend a transplant if your first treatment does not put your NHL into complete remission or if your disease comes back.  

Most transplant recipients with NHL have a transplant using blood-forming stem cells from their own body. This is called an autologous transplant. If your lymphoma is very aggressive or chemotherapy did not shrink your tumors, you might have a transplant using stem cells from a donor instead. This is called an allogeneic transplant. 

A team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, physician assistant or advanced registered nurse practitioner, pharmacist, dietitian, team coordinator and social worker. 

Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today, at Fred Hutch, we continue to refine transplant techniques and to develop new options. 

Learn More About Blood and Marrow Transplants

Monitoring Your Health

While you are in active treatment, your NHL care team will see you regularly for exams and tests to check: 

  • How well your treatment is working 
  • If there is any reason to change your treatment 
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling 

We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer. 

Possible Results of Treatment

Throughout treatment, your care team looks for signs of: 

  • Remission: Fewer signs and symptoms of cancer. Partial remission means some signs and symptoms remain, and complete remission means there are no signs or symptoms. 
  • Stable disease: No change in the extent or severity. The disease is not going away, but it is not getting worse, either.   
  • Disease progression: The disease is getting worse or spreading. 
  • Relapse: The disease, signs or symptoms have come back after they had improved. 
  • Refractory disease: The disease does not respond to treatment. 

What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence is still possible. 

Managing Side Effects

You might be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it might be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause as many side effects as standard chemotherapy.  

You are always at the center of everything we do. NHL physicians, nurses and advanced practice providers are here to help prevent or relieve side effects of treatment.  

Get Help with Side Effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects. 

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us.  

We have many tools to help you feel better, such as: 

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections 
  • Transfusions, steroids and medicines that help the immune system treat low levels of blood cells (low blood counts) 
  • Nutrition care and medicines to help with digestive problems 
  • Conventional and integrative therapies for pain 

Coping with Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other factors, like how strong your immune system is. These are some of the common side effects of NHL treatment: 

  • Unusual tiredness (fatigue) 
  • Hair loss 
  • Higher risk of infection (due to low levels of white blood cells) 
  • Anemia (due to low levels of red blood cells) 
  • Easy bruising or bleeding (due to low levels of platelets) 
  • Problems in your digestive tract, like sores in your mouth, nausea, vomiting, constipation or diarrhea 
  • Rash or other skin changes 
  • Numbness, tingling or pain from nerve damage (neuropathy) 
  • Fever  

Supportive Care Services

Along with treating your NHL, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From registered dietitians to our Spiritual Health team, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is getting chemotherapy, targeted therapy, immunotherapy or radiation therapy, there are many ways you can help. Caregiving during active treatment for NHL often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of things at home that they may not be able to do, like grocery shopping and cleaning

Caregiving for Transplant Patients

Caregivers have a special role in blood and marrow transplants. This intense treatment involves chemotherapy (and sometimes radiation) with serious side effects. During the initial recovery period, which is often a month or more, your loved one will need daily help. We provide classes to help transplant caregivers get ready. During recovery, a transplant registered nurse is available by phone 24 hours a day, 7 days a week, to help you. 

Continuing Care

When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your NHL. They will check your overall health and look for signs that your cancer has come back (signs of recurrence).  

Your team will also help with any long-term side effects (which linger after treatment ends) or late effects (which may start after treatment is over). 

Schedule For Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your hematologist-oncologist will base your schedule on many factors, including: 

  • Your NHL subtype 
  • If your disease was slow-growing (indolent) or fast-growing (aggressive) 
  • Which treatments you had and how your disease responded  
  • How the disease and treatments affected you  
  • How long it has been since your treatment ended 

Most patients have follow-up appointments for at least five years if they have aggressive NHL. If their NHL is indolent, most patients will have follow-up appointments for the rest of their life. It is common to have visits more often in the first months and years after active treatment ends and less often as time goes on. 

What Happens at Follow-up Visits

Follow-up for NHL typically means seeing your hematologist-oncologist for a physical exam and having blood tests to check your blood cell levels. If there are any changes, you might have tests to check the health of your bone marrow.   

Your physician will let you know if you need any imaging tests. You might have tests like a CT (computed tomography) scan or PET (positron-emission tomography) scan. These can help check for recurrence (the cancer has come back), but they also expose you to some radiation. Together, you and your physician will decide on the benefits and risks. 

Meet the Non-Hodgkin Lymphoma Care Team