Non-Hodgkin lymphoma

Non-Hodgkin lymphoma overview

Non-Hodgkin lymphoma (NHL) is a blood cancer with more than 60 subtypes. It is one of the most common cancers in the U.S. It happens when a type of white blood cell called a lymphocyte changes and grows out of control.  

Each year at Fred Hutchinson Cancer Center, we care for more than 3,000 patients with NHL —  including more than 60 rare subtypes. We provide all standard therapies. Our experts are national leaders in NHL research and have developed many of these approaches.  

Many of our NHL patients take part in clinical trials — led by world-renowned physicians from Fred Hutch — to get promising therapies that are not available anywhere else.

Following the merger of long-time partners, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, the organization was renamed to Fred Hutchinson Cancer Center. We are an independent, nonprofit organization that also serves as UW Medicine's cancer program. 

Lymphocyte A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes (white blood cells) are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. Lymphoma Cancer that begins in the cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphomas. Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. White blood cell A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system and help the body fight infection and other diseases. A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system. They help the body fight infection and other diseases. Types of white blood cells include granulocytes (neutrophils, eosinophils and basophils), monocytes and lymphocytes (T cells and B cells). Checking the number of white blood cells in the blood is usually part of a complete blood cell (CBC) test. It may be used to look for conditions such as infection, inflammation, allergies and leukemia. Also called leukocyte and WBC.

Fred Hutch: A leader in NHL treatment 

In the past 10 to 15 years, research into targeted therapies and immunotherapies has found new ways to control NHL or put it into remission. Fred Hutch was one of the first cancer centers in the nation to offer both of the cellular immunotherapies approved for NHL by the U.S. Food and Drug Administration. 

Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Confirming your NHL diagnosis

Diagnosing NHL involves a series of blood tests and then a lymph node biopsy, which shows if you have cancer. The biopsy gives details about the type and subtype of cancer you have.  

At Fred Hutch, our experts check and confirm your subtype. Knowing your subtype is important, because each behaves differently and requires a different type of treatment.  

Finding out your subtype can be a challenge. Hematopathologists (lab experts who look at samples of your blood under a microscope) can recognize which subtype you have by carefully studying your blood. At Fred Hutch, our hematopathologists are very experienced in identifying exact NHL subtypes.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids.
Confirming your NHL diagnosis

Part of diagnosis is finding out exactly which subtype of NHL you have. We will check this and other details about your disease so we can provide the most precise treatment for you.  

Your first appointment

From the first time you come to see us, your NHL team will begin getting to know you and your family. What are your questions? What are your concerns?   

At your first appointment, your hematologist-oncologist will also explain your disease, including your subtype. They will tell you how it’s treated and which tests you need to help plan your individual care. Before you leave, your team makes sure you understand the next steps.  

Care at Fred Hutch 

How does Fred Hutch approach treatment? 

The safest, most effective and most widely accepted therapies for cancer are known as the “standard of care.” For many patients, these therapies will be a large part of their treatment. At Fred Hutch, we provide all standard therapies for NHL. We know how to choose the right ones for you and how to deliver them to give you the best chance at a full recovery. 

Our physicians and researchers are always asking how we can make NHL treatments more effective and reduce side effects as much as possible. This is why we conduct clinical trials (also called clinical studies). Through these studies, we are able to offer you therapies that aren’t offered everywhere. A trial therapy today may become the new standard of care tomorrow. 

Along with treating your cancer, a group of world-class professionals is here to support you. This team includes nurses, dietitians, physical therapists, social workers and psychologists. We integrate supportive care services to promote your physical, mental and emotional well-being.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies.

Treatment plan and process

Patients with different subtypes of NHL respond to treatments in different ways. You are unique, and your care team will design a treatment plan specifically for — and with — you. At Fred Hutch, physicians with knowledge and experience in your NHL subtype will design and provide your care.  

For one person with NHL, watchful waiting might be the first step. Someone else might start with chemotherapy, targeted therapy or immunotherapy. Over time, other options, like radiation therapy or a blood or marrow transplant, might be recommended. We combine treatments to fit your unique case. 

As you go through treatment, your needs may change. Your care team at Fred Hutch is with you each step of the way. For example, we will help you cope with any side effects you have. We may suggest adding a new therapy that was just approved. Even after your NHL treatment is done, we will keep seeing you to protect your health over the long term. 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends. Watchful waiting Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. During watchful waiting, patients may be given certain tests and exams. Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits. During watchful waiting, patients may be given certain tests and exams. Watchful waiting is sometimes used in prostate cancer. It is a type of expectant management.
“No matter your diagnosis or treatment, we’re here by your side, every step of the way. If there’s anything we can do to make your experience with cancer better, we will try in every way to do that.”
— Christen N. Martino, ARNP, lymphoma survivor

For caregivers

Caregiver icon

When someone close to you is diagnosed with NHL, you might step into the role of caregiver. Being a caregiver can mean many things, from lending a hand with daily living tasks to helping with medical decisions. It can also mean dealing with your own emotions and stress.  

At Fred Hutch, caregivers are valuable members of a patient’s care team. We see every day that your presence and your support make a difference. We also see that what your friend or family member is going through affects you, too. 

Part of our mission is to help you take care of yourself. Caring for yourself is good for your physical, mental and emotional health. It also helps you give your best to your loved one. Our social workers, Spiritual Health team and Patient and Family Resource Center staff are here to help support you. 

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting.

Other resources

Care team
Care team

At Fred Hutch, a team of dedicated people surrounds you and your family to give you the highest level of care and support. You are the most important person on your care team. Our patients are at the center of everything we do. 

Research
Research

In the past 10 to 15 years, research into targeted therapies and immunotherapies has found new ways to control NHL or put it into remission. Fred Hutch is a national leader in NHL research. 

Resources
Resources

There are many resources for learning about your disease, as well as organizations that provide support. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.