We report a novel phase 2 clinical trial in patients with poor prognosis refractory NHL testing the efficacy of haploidentical donor NK cell therapy (NK dose 0.5–3.27 × 107 NK cells/kg) with rituximab and IL-2.(clinicaltrials.gov NCT01181258) Therapy was tolerated without graft-versus-host-disease, cytokine release syndrome, or neurotoxicity. Of 15 evaluable patients, 4 had objective responses (26.6%) at 2 months: 2 had complete response lasting 3 and 9 months. Circulating donor NK cells persisted for at least 7 days after infusion at the level between 0.6–16 cells/µl. Responding patients had lower levels of circulating host derived Tregs (17±4 vs. 307±152 cells/µL; p=0.008) and myeloid derived suppressor cells (MDSC) at baseline (6.6%±1.4% vs. 13.0%±2.7%; p=0.06) than non-responding patients. Lower circulating Tregs correlated with low serum levels of IL-10 (R2=0.64; p<0.003; n=11), suggestive of an immunosuppressive milieu. Low expression of PD-1 on recipients T cells before therapy was associated with response. Endogenous IL-15 levels were higher in responders than non-responding patients at the day of NK cell infusion (mean±SEM: 30.0±4.0; n=4 vs 19.0±4.0 pg/ml; n=8; p=0.02) and correlated with NK cytotoxicity at day 14 as measured by expression of CD107a (R2=0.74; p=0.0009; n=12). In summary, our observations support development of donor NK cellular therapies for advanced NHL as a strategy to overcome chemoresistance. Therapeutic efficacy may be further improved through disruption of the immunosupressive environment and infusion of exogenous IL-15.