Treatment Options for Aggressive Non-Hodgkin's Lymphoma (NHL)

What are the best treatment options for aggressive non-Hodgkin's lymphoma? You are likely confused if you've taken a look at all of the choices online. Here are a few things to consider.

Nurse helping patient during chemotherapy treatment
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How Treatment Choices Are Decided

You and your doctor can work together to find the best treatment plan to fit both your individual cancer (they are all different) and your personal preferences with regard to aggressiveness and side effects. Choices may include chemotherapy, radiotherapy, monoclonal antibody therapy, or a combination of these treatments.

This decision is usually based on a number of factors. The most important is the stage of your disease. Other factors are also important. The specific type of non-Hodgkin lymphoma that you have, the number of nodes involved, the presence of lymphoma in other organs, some blood test reports, and even your age are related to the type of treatment that works best.


Chemotherapy is the main treatment for Non-Hodgkin disease. A combination of three or more drugs are generally used, something called combination therapy. It can be confusing to understand why so many drugs are needed. Chemotherapy drugs all work at different points along the path of a cell dividing and multiplying. Since different cells are at different places in the division process, different drugs are needed in order to stop the growth of all of the cancer cells present.

All or most of the drugs are administered either as quick injections or as slow infusions into your veins. Some may be taken as pills. There are a number of effective drug combinations. The most common is called CHOP. The choice of the exact schedule depends on your doctor. Chemotherapy is typically administered every 2 to 3 weeks for a number of cycles.

Radiation Therapy

Radiation therapy is rarely used alone in Non-Hodgkin Lymphomas. It may be added after a few cycles of chemotherapy. Taking radiation treatment is much like getting an X-ray taken. You lie flat on a couch, and a machine delivers X-rays to a part of your body from a distance. Radiation treatments are usually given 5 days a week for 3 to 5 weeks. Non-Hodgkin lymphoma responds well to radiation and very high doses are not required.

Monoclonal Antibody Therapy

Monoclonal antibodies, a breakthrough in the treatment of many cancers, target unique molecules on lymphoma cells and can target these cells specifically. You may be familiar with how our bodies form antibodies to fight off bacteria and viruses that enter our bodies. Monoclonal antibodies act as "artificial antibodies" to fight off, not bacteria or viruses, but cancer cells instead.

The use of monoclonal antibodies, combined with standard chemotherapy, has shown great results when used as part of the initial treatment, as well as treatment for relapsed NHL. Rituxan (rituximab) is the most used monoclonal antibody drug. It is given as an injection every week for a few weeks.

Early Stage Aggressive NHL: Stage I or Stage II

If you have aggressive Non-Hodgkin Lymphoma in Stage I or Stage II, your treatment usually involves a few cycles of chemotherapy followed by radiation to the areas which were affected by the disease. You may also be offered treatment with monoclonal antibodies.

Advanced Stage Aggressive NHL: Stage III or Stage IV

If you have Non-Hodgkin Lymphoma in Stage III or IV, you may be treated with:

  • Chemotherapy alone
  • Chemotherapy plus monoclonal antibody therapy
  • Chemotherapy plus monoclonal antibody therapy followed by radiation to certain areas where disease remains after chemotherapy.

Those with a high risk of relapse may be given a trial of high-dose chemotherapy followed by bone marrow or stem cell transplant.

Relapsed Aggressive NHL

Treatment options may include:

  • A different chemotherapy combination
  • Monoclonal antibody therapy
  • High-dose chemotherapy with bone marrow or stem cell transplant

The best treatment method is not known. Most patients respond well to second line treatment, but the duration of response—how long a response lasts—is different for each person.

Clinical Trials for Aggressive NHL

Many clinical trials are in progress looking at new and better treatments for aggressive NHL, sometimes with fewer side effects. There are many myths about clinical trials for cancer, and the jokes about being a "guinea pig" still appear. In reality, these trials may sometimes offer treatments that would not otherwise be available. Talk to your doctor to learn if any of these clinical trials may be appropriate for you.


We live in an exciting time in which many people with non-Hodgkin lymphoma can be cured of their disease. While aggressive NHL used to be the most rapidly fatal, it is now—over the long run anyway—perhaps the best type of NHL to develop. Chemotherapy and other cancer treatments work to get rid of rapidly growing cells—and the cells in aggressive NHL are rapidly dividing and growing.

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  1. American Cancer Society. Chemotherapy for Non-hodgkin lymphoma. Updated August 1, 2018.

  2. American Cancer Society. How chemotherapy drugs work. Updated November 22, 2019.

  3. Shuptrine CW, Surana R, Weiner LM. Monoclonal antibodies for the treatment of cancer. Semin Cancer Biol. 2012;22(1):3-13. doi:10.1016/j.semcancer.2011.12.009