Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is a group of blood cancers that usually develop in your lymphatic system. They’re acquired genetic disorders. You’re not born with these disorders. Instead, they happen when genes inside certain cells mutate or change. In this case, the affected cells are B lymphocytes (B cells) or T lymphocytes (T cells) that are part of your immune system.

There are more than 70 types of non-Hodgkin lymphoma. People are living longer with these conditions thanks to new treatments, including targeted therapies. In some cases, treatments eliminate all non-Hodgkin lymphoma signs and symptoms and cure the condition. In other cases, the goal of the treatment is to put the disease into remission for as long as possible.

Are non-Hodgkin lymphomas common?

They’re relatively common. In the United States, this group of conditions is the sixth most common cancer in men and people designated male at birth (DMAB) and the sixth most common cancer in women and people designated female at birth (DFAB).

The U.S. National Cancer Institute estimates that 2% of all men and people DMAB and women and people DFAB will develop some type of non-Hodgkin lymphoma in their lifetime. Non-Hodgkin lymphomas represent about 3% of all cancer-related deaths in the U.S. Worldwide, approximately 5 in 100,000 people have a type of non-Hodgkin lymphoma and about 3 in 100,000 people die from this condition.

Who is affected by these conditions?

Non-Hodgkin lymphomas typically affect people age 60 and older. They’re somewhat more common in men and people DMAB than in women and people DFAB. They typically affect more people who are white than people who are Black.

How does non-Hodgkin lymphoma affect my body?

Non-Hodgkin lymphoma isn’t a single disease. There are many different types of non-Hodgkin lymphomas. These types have the same kinds of symptoms. However, each type of lymphoma may affect your body in different ways. For example, some types of non-Hodgkin lymphoma spread more quickly than other types. Some types affect organs like your spleen and liver while other types affect your skin.

Some non-Hodgkin lymphomas may affect your lymphatic system and your ability to fight infection. Your lymphatic system is a network of organs, vessels and lymph nodes that works with your immune system. Non-Hodgkin lymphomas happen when white blood cells known as lymphocytes mutate or change.

These cells include B cells, T cells and natural killer (NK) cells. The normal function of B cells is to make antibodies that fight bacteria and infections. T cells target viruses and other foreign cells and help B cells make antibodies. NK cells attack some cancer cells and viruses. Healthcare providers classify lymphomas according to the type of white blood cell in which a lymphoma starts. About 85% of all non-Hodgkin lymphomas start in B cells.

When these cells mutate, they continuously multiply, eventually becoming tumors. Since your lymphatic system touches nearly every part of your body, non-Hodgkin lymphoma frequently spreads from where it started to other areas of your body. Non-Hodgkin lymphomas may grow slowly (indolent) or spread very quickly (aggressive).

What are the most common types of aggressive non-Hodgkin lymphomas?

There are several common forms of aggressive non-Hodgkin lymphomas. These are lymphomas that progress or spread very quickly and cause more serious symptoms than indolent non-Hodgkin lymphoma. They tend to respond quickly to treatment.

Aggressive B-cell lymphomas

• Diffuse Large B-cell lymphoma (DLBCL): This is the most common type of non-Hodgkin lymphoma, accounting for about 30% of all cases in the U.S. DLBCL grows very quickly and may start in lymph nodes or in other parts of your body. Medical researchers have identified three different DLBCL subgroups. These are germinal center B-cell-like (GCB), activated B-cell-like (ABC) and unclassified. GBC and ABC have several different genetic subtypes and react to chemotherapy in different ways.
• Mantle cell lymphoma: This type happens when a B cell located in the so-called mantle zone of a lymph node mutates. It accounts for about 5% to 7% of all non-Hodgkin lymphomas and typically affects males/people DMAB age 60 and older. While mantle cell lymphoma is considered an aggressive B-cell lymphoma, there are times when it grows more slowly. This typically happens in older people who have lymphoma in their spleen and lymphoma cells in their bloodstream.
• Lymphoblastic lymphoma: This is cancer of immature lymphoblasts, which normally produce healthy lymphocytes. This non-Hodgkin lymphoma type is very similar to acute lymphoblastic leukemia (ALL).
• Burkitt lymphoma: This is one of the fastest growing forms of cancer but one with high rates of remission and cure. This lymphoma typically goes into remission after intensive chemotherapy.

Aggressive T-cell and NK lymphomas

• Peripheral T-cell lymphoma (PTCL): In this lymphoma, a group of T-cell and natural killer lymphomas develop in lymphoid tissues including your spleen, skin and gastrointestinal tract. It’s usually diagnosed in people age 60 and older. PTCL accounts for about 6% of all non-Hodgkin lymphomas in the U.S. and Europe.
• Angioimmunoblastic T-cell lymphoma (AITL): This lymphoma type typically affects people age 40 and older. Some AITL symptoms are similar to certain autoimmune disorders.
• Systemic anaplastic large cell lymphoma (ALCL):This is a rare lymphoma type. It may affect your lymph nodes and organs. There are two systemic ALCL subtypes. One affects children and young adults. The other primarily affects older adults.
• Hepatosplenic gamma/delta T-cell lymphoma: This aggressive form of peripheral T-cell lymphoma affects your liver and spleen. Men and people DMAB are more likely to develop this condition than women and people DFAB. This condition typically affects teenagers and adults under age 40.

What are the most common types of indolent non-Hodgkin lymphomas?

These lymphoma types typically grow very slowly. People who have a form of indolent non-Hodgkin lymphoma may not notice changes in their body that turn out to be symptoms of non-Hodgkin lymphoma.

Indolent B-cell lymphomas

People diagnosed with indolent lymphoma may not need immediate treatment. Healthcare providers instead may monitor your health until they determine that treatment is necessary. This is sometimes called “watchful waiting”. Existing treatments often can’t cure this condition yet are very effective. These treatments typically ease and sometimes eliminate symptoms for a long time.

• Follicular lymphoma: This lymphoma type forms in your lymph nodes, bone marrow and other organs. It’s the second most common form of non-Hodgkin lymphoma in the U.S. and Europe.
• Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): Although the term CLL sounds different from the term lymphoma, CLL is similar to other indolent B-cell lymphomas. Healthcare providers use the term CLL when you have large numbers of abnormal B cells in your bloodstream. CLL is essentially the same disease as SLL, in which the abnormal B cells are primarily in your tissues and lymph nodes.
• Marginal zone lymphoma: There are three types of marginal zone lymphoma — nodal marginal lymphoma, splenic marginal zone lymphoma and extranodal marginal zone lymphoma. This last type is sometimes known as mucosa-assisted lymphoid tissue (MALT) lymphoma. MALT lymphoma affects organs other than lymph nodes including the lining of your stomach, your lungs and the structure around your eyes.
• Waldenström macroglobulinemia (lymphoplasmacytic lymphoma): This lymphoma type happens when genetic mutations change B cells that produce a particular type of antibody called IgM. Both the lymphoma cells themselves and the IgM antibody that they produce can cause specific signs and symptoms.

Indolent T-cell/NK-cell lymphomas

• Cutaneous T-cell lymphoma: This rare lymphoma type affects your skin. Mycosis fungoides and Sézary syndrome are examples of cutaneous T-cell lymphomas.

How serious are non-Hodgkin lymphomas?

These serious conditions can sometimes make your body more vulnerable to life-threatening infections, other kinds of cancer or heart disease. Data show about 3 in 100,000 people worldwide die of some type of non-Hodgkin lymphoma.

What is the survival rate of non-Hodgkin lymphomas?

Studies show that overall, 73% percent of people with these conditions are alive five years after their diagnosis. In general, people diagnosed before the condition spreads live longer than people who are diagnosed after the condition spreads.

Can children have a non-Hodgkin lymphoma?

Yes, this group of conditions can affect children. There are three common types of non-Hodgkin lymphoma in children:

• Burkitt lymphoma.
• Diffuse large B-cell lymphoma.
• Primary mediastinal B-cell lymphoma.