Non-Hodgkin lymphoma

Treatment

Today, people facing lymphoma have more options for treatment, with better hope of a cure and long-term survival, than ever before. 

Seattle Cancer Care Alliance (SCCA) experts offer comprehensive non-Hodgkin lymphoma (NHL) treatment, including precise diagnosis, customized care, new options available only through clinical studies, and therapies for cutaneous lymphoma and lymphoma related to human immunodeficiency virus (HIV) infection.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help.

Non-Hodgkin lymphoma expertise at SCCA

Everything you need is here

We have world-class medical oncologists, radiation oncologists, hematologists and pathologists who specialize in lymphoma; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Innovative NHL therapies

SCCA is a world leader in lymphoma research. Our doctors and scientists pioneered bone marrow transplant — used for lymphoma that’s not cured with initial treatment or that comes back — and we advance new therapies every day.  

NHL treatment tailored to you

We view non-Hodgkin’s lymphoma treatment as a collaborative effort. Your SCCA doctor will explain all your options and recommend a treatment plan based on the precise type and stage of your lymphoma and your health, lifestyle and preferences. 

Team-based approach

Your personal team includes an oncologist and nurse case manager. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like an infectious disease doctor, pulmonologist, palliative care professional, geneticist, social worker, physical therapist or dietitian.

Learn More About Supportive Care Services

Ongoing care and support

Measures to decrease symptoms and improve quality of life are part of every patient’s care. After treatment, your team continues to provide follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life as an ALL survivor.

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at SCCA. 

Watchful waiting

This means you and your doctor closely monitor your health for any changes that may mean you need treatment.

  • Studies have shown that an initial period of watchful waiting does not decrease overall survival for people with indolent lymphoma. 
  • If you have fast-growing (aggressive) lymphoma, watchful waiting is not appropriate. It’s important for you to get treatment promptly.
Watchful waiting

If you have slow-growing (also called indolent or low-grade) lymphoma and have no symptoms, your doctor may recommend watchful waiting.

Chemotherapy

Many people are cured with one or more of these treatments. Indolent NHL is rarely cured, but treatment often keeps it well controlled for many years.

Chemotherapy drugs are usually given through an intravenous (IV) line in repeating cycles that range from two to six weeks. 

Your SCCA team will talk with you about the specific drugs we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during and after treatment, and we’ll connect you with medical and support resources throughout SCCA.

For NHL, many of our patients receive a combination of drugs called CHOP:

  • Cyclophosphamide (Cytoxan, Clafen, Neosar)
  • Doxorubicin hydrochloride (Adriamycin)
  • Vincristine (Oncovin, Vincasar, Vincrex)
  • Prednisone

For some people, a different combination is more effective. Your SCCA doctor will recommend the combination most likely to work for your cancer.

Chemotherapy

NHL is most often treated with chemotherapy. Chemo may be combined with radiation therapy or, for B-cell lymphomas, with the targeted therapy rituximab (Rituxan).

Radiation therapy

Depending on the type of lymphoma you have and whether or where it has spread, your doctor may recommend:

  • External-beam radiation therapy, alone or in combination with chemotherapy. Learn more in our radiation oncology section.
  • Radioimmunotherapy — a treatment given by IV in which the antibody rituximab is tagged with a radioactive atom. Rituximab targets lymphocytes, concentrates radiation in them and triggers an immune system attack against them. It is used mainly for B-cell lymphomas. Radioimmunotherapy is a technique developed at SCCA. 
Radiation therapy

For NHL, doctors most often use radiation to treat cancer in the spleen or in the lymph nodes in the neck, chest, armpits or groin. We will tailor your radiation treatment to your specific situation. 

Targeted therapy

They target a gene or protein responsible for allowing cancer to grow, they directly damage cancer cells, or they prompt your immune system to attack particular cells (also called immunotherapy).  

Targeted therapies are given alone or combined with standard treatments, like chemotherapy, to increase the chances of controlling or curing your lymphoma. They are sometimes categorized as small molecules or antibodies. 

  • Ibrutinib (Imbruvica) and idelalisib (Zydelig) are examples of small molecule drugs used against NHL. 
  • The most common example of an antibody used for lymphoma is rituximab.  It targets a specific molecule on lymphocytes and triggers other immune system proteins to kill these cells. 
Targeted therapy

Targeted therapies are newer cancer treatments that work more selectively than standard chemotherapy.

Immunotherapy

SCCA is one of the first cancer centers in the nation to offer five FDA-approved cellular immunotherapies. Axicabtagene ciloleucel (axi-cel), known by the brand name Yescarta®, brexucabtagene autoleucel, known by the brand name Tecartus™, and lisocabtagene maraleucel, known by the brand name Breyanzi® are CAR T-cell therapies available only at authorized treatment centers for non-Hodgkin lymphoma.

Tisagenlecleucel, known as the brand name Kymriah®,is a CAR T-cell therapy for non-Hodgkin lymphoma, as well as acute lymphoblastic leukemia.

Idecabtagene vicleucel, known by the brand name Abecma® is the newest CAR T-cell therapy available for multiple myeloma.

These CAR T-cell therapies are different from other cancer medicines because they are made from the patient's own white blood cells, which have been modified to recognize and attack the patient's cancer cells. 

Immunotherapy

Immunotherapy uses the power of your body’s own immune system to find and destroy tumors. It can be used on its own or along with traditional cancer treatments such as chemotherapy, radiation and surgery.

Bone marrow transplant

Most transplant recipients with NHL have a transplant using their own stem cells (autologous transplant). 

  • First your stem cells are collected, frozen and stored. 
  • Next you receive strong chemotherapy (and possibly radiation therapy) to attack your cancer cells, destroy or suppress your immune system and prevent your body from forming new blood cells. 
  • Then your stored stem cells are thawed and returned to your bloodstream to restart your body’s ability to form blood cells again.

If your lymphoma is very aggressive and chemotherapy has not shrunk your tumors, an autologous transplant is usually not an option. In those cases, patients have a transplant using cells from a donor (allogeneic transplant). 

More people are eligible for allogeneic transplants than ever before, due to advances available at SCCA, such as:

  • Non-myeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy
  • Transplants using stem cells from donated umbilical cord blood or haploidentical (half-matched) donors

Learn more about the Fred Hutch Bone Marrow Transplant Program at SCCA, including the lifelong support you get through our Long-Term Follow-Up Program for transplant recipients.

Bone marrow transplant

If initial treatment doesn’t cure your lymphoma or your disease recurs, your doctor may recommend a bone marrow transplant.