Treatment

In general, the goal of treatment is to destroy as many lymphoma cells as possible and to induce a complete remission. Complete remission means that all evidence of disease is eliminated. Patients who go into remission are sometimes cured of their disease. Treatment can also keep non-Hodgkin lymphoma (NHL) in check for many years, even though imaging or other studies show remaining sites of disease. This situation may be referred to as a “partial remission.”

It's important that your doctor is experienced in treating patients with NHL or works in consultation with an NHL specialist. This type of specialist is usually called a hematologist oncologist.

Types of Treatment

Doctors use several types of approaches and treatment combinations for NHL, some at different stages. To read about how different types of NHL are treated, visit

To read more about the types of treatments used to treat NHL, use the links below

Factors That Influence Treatment

Each person should discuss treatment options with their doctor and ask for help understanding the benefits and risks of different treatment approaches. The most effective treatment plan for a patient with NHL is individualized and depends on:

  • The disease subtype
  • The disease stage and category
  • Factors, such as fever, drenching night sweats and loss of more than 10 percent of body weight over 6 months, referred to as “B symptoms”
  • The presence of lymphoma in areas of the body outside of the lymph nodes (extranodal involvement)
  • Other prognostic factors, such as age and any underlying medical conditions. 

The patient’s age may be a factor, but older age is no longer a major determinant in treatment for most patients. However, medical problems, including the patient’s overall health status, and the patient’s decisions about treatment, are significant considerations.

As you develop a treatment plan with your doctor, be sure to discuss:

  • The results you can expect from treatment
  • Potential side effects, including long-term and late effects
  • The possibility of participating in a clinical trial, where you'll have access to advanced medical treatment that may be more beneficial to you than standard treatment

To download lists of suggested questions to ask your healthcare providers, click here.

Pretreatment Considerations

  • If you're of child-bearing age, talk with your doctor about the treatment's possible long-term effects on fertility. Download or order The Leukemia & Lymphoma Society's (LLS's) free fact sheet Fertility Facts.
  • If your child is being treated for NHL, therapy may differ from that of the average adult. Children and adolescents with NHL should be referred to medical centers that have a specialized pediatric oncology team to ensure that young patients receive optimal treatment, support and follow-up care. With current treatments, NHL in most children is highly curable. You also need to be concerned about the treatment's long-term effects including effects on fertility. Read more about Childhood Non-Hodgkin Lymphoma.

The International Prognostic Index (IPI)

The IPI is a risk-stratification tool that predicts the prognosis of patients who have NHL. It  helps doctors predict overall survival and the risk of relapse, and provide a basis for recommending either more or less aggressive treatment for high-risk patients. The IPI score is calculated for all patients by totaling the sum of the points scored for each of the risk factors listed below.

Risk factors in patients greater than 60 years (1 point is assigned for each of the following factors):

  • Older than 60 years
  • Elevated serum lactate dehydrogenase (LDH) level
  • Eastern Cooperative Oncology Group (ECOG) performance status* score of 2-4
  • Stage III or IV disease
  • Extranodal involvement in two or more sites

Risk factors in patients less than or equal to 60 years (1 point is assigned for each of the following factors):

  • Elevated serum LDH level
  • Eastern Cooperative Oncology Group (ECOG) performance status score of 2-4
  • Stage III or IV disease

Risk groups. The number of risk factors a person has determines the IPI risk group they are in. This helps predict his or her risk of relapse. Each point represents some level of increased risk for disease relapse. The following risk categories and corresponding point totals are for patients greater than 60 years:

  • Low risk (0 to 1 point)
  • Low-intermediate risk (2 points)
  • High-intermediate risk (3 points)
  • High risk (4 to 5 points)

For patients 60 years of age or younger, the risk categories and corresponding point totals are slightly different. They are

  • Low risk (0 points)
  • Low-intermediate risk (1 point)
  • High-intermediate risk (2 points)
  • High risk (3 points).

*The ECOG performance status is a scale used to evaluate a person’s ability to perform daily tasks of living without help.

Grade ECOG Performance Status
0 Fully active, able to carry on all pre-disease performance without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature (eg, light housework, office work)
2 Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours
3 Capable of only limited self-care; confined to bed or chair more than 50% of waking hours
4 Completely disabled; cannot carry on any self-care; totally confined to bed or chair
5 Deceased 

Treatment Setting

Patients may undergo treatments over long periods, but most therapy can be administered in an outpatient setting. Radiation therapy, chemotherapy or immunotherapy can be administered in an outpatient clinic of an oncology center. Short periods of hospitalization are sometimes required. 

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