ON THIS PAGE: You will find a drawing of the parts of the lymphatic system. Use the menu to see other pages.

The next section in this guide is Risk Factors. It describes the factors that may increase the chance of developing non-Hodgkin lymphoma (NHL). Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about the changes and medical problems that can be a sign of non-Hodgkin lymphoma (NHL). Use the menu to see other pages.

What are the symptoms and signs of NHL?

People with NHL may experience a variety of symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. However, many people, especially those with follicular lymphoma, small lymphocytic lymphoma, marginal zone lymphoma, and indolent subtypes, will have no symptoms or signs. And, conditions that are not lymphoma can also cause many of the symptoms and signs of NHL.

There are very few changes, or symptoms, that are specific to lymphoma. This explains why it is sometimes difficult to make a diagnosis. The symptoms of NHL depend on where the cancer started and the organ that is involved.

General symptoms:

• Enlarged lymph nodes in the abdomen, groin, neck, or underarms

• Enlarged spleen or liver

• Fever that cannot be explained by an infection or other illness

• Weight loss with no known cause

• Sweating and chills

• Fatigue

• Itchy skin, also called pruritus

Examples of symptoms related to a specific tumor location:

• A tumor in the abdomen can cause a stretched belly or pain in the back or abdomen.

• An enlarged spleen may cause back pain and a feeling that the stomach is full.

• A tumor in the groin may cause swelling in the legs.

• A tumor in the underarms may cause swelling in the arms.

• If the lymphoma spreads to the brain, there may be symptoms similar to those of a stroke.

• A tumor in the center of the chest may press on the trachea and cause coughing, chest pain, difficulty breathing, or other respiratory problems.

• Tumors in any location may cause pain, but this is uncommon.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will try to understand what is causing your symptom(s). They may do an exam and order tests to understand the cause of the problem, which is called a diagnosis.

If NHL is diagnosed, your doctor may also use certain symptoms to help describe the disease, called staging. For many decades, doctors divided each stage of NHL into “A” and “B” categories based on specific symptoms, as listed below. However, the most recent staging system published in 2014, known as the Lugano Classification, removed these categories because they do not necessarily change the way the lymphoma is treated.

• A means that a person has not experienced B symptoms.

• B means that a person experienced the following symptoms:

• Unexplained weight loss of more than 10% of their original body weight during the 6 months before diagnosis.

• Unexplained fever with temperatures above 100.4ºF (38ºC).

• Drenching night sweats. Most patients say that either their nightclothes or the sheets on the bed are actually soaked. Sometimes, heavy sweating occurs during the day.

Once a doctor diagnoses and finds out the stage of NHL, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called "palliative and supportive care," which is not the same as hospice care given at the end of life. This type of care focuses on managing symptoms and supporting people who face serious illnesses, such as cancer. You can receive palliative and supportive care at any time during cancer treatment. Learn more in this guide’s section on Coping with Treatment.

Be sure to talk with your health care team about the symptoms and signs you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find descriptions of the most common types and subtypes of non-Hodgkin lymphoma (NHL). Use the menu to see other pages.

There are different types and subtypes of NHL. It is very important to know which type and subtype have been diagnosed. Sometimes more than 1 type of lymphoma can be found in the same patient. This page includes information about the most common types and subtypes.

READ MORE BELOW:

• Cell types of NHL

• Indolent and aggressive NHL

• Subtypes of B-cell lymphoma

• Subtypes of T-cell and NK-cell lymphoma

For information about treatment options, see the Types of Treatment section.

Cell types of NHL

First, the doctor will determine what type of cell the lymphoma started in and classify the disease within 1 of the 3 major groups:

• B-cell lymphoma. About 90% of people in western countries with lymphoma have B-cell lymphoma.

• T-cell lymphoma. About 10% of people with lymphoma have T-cell lymphoma. These lymphomas are more frequent in Asian countries.

• NK-cell lymphoma. Less than 1% of people with lymphoma have NK-cell lymphoma.

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Indolent and aggressive NHL

NHL is also described by how quickly the cancer is growing.

• Indolent NHL grows slowly

• Aggressive NHL may develop rapidly

Indolent and aggressive NHL are equally common in adults. In children, aggressive NHL is more common. Some subtypes of lymphoma cannot easily be classified as indolent or aggressive. For example, mantle cell lymphoma has both indolent and aggressive NHL features.

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Subtypes of NHL

In addition to determining whether the NHL is indolent or aggressive and whether it is B-cell, T-cell, or NK-cell lymphoma, it is very important to determine the subtype of NHL. This is because each subtype can behave differently and may require different treatments. There are more than 60 NHL subtypes, although some are quite rare. The most common subtypes are described below. Learn how they are treated in the Types of Treatment section.

Distinguishing among the different subtypes of NHL can be difficult and requires pathologists or hematopathologists who are experts in the diagnosis of lymphoma. These specialists use sophisticated techniques and work closely with experienced oncologists. The diagnosis is based on how the lymphoma looks under the microscope and which marker proteins are expressed on the lymphoma cells. The doctors confirm the diagnosis with additional information from other tests, including tests of genetic material within the lymphoma cells. For more information on this process, see the Diagnosis section.

The subtypes of lymphoma are regularly reviewed and revised. Be sure to ask your doctor whether your diagnosis and treatment plan correspond to the most recent NHL subtype classifications.

Subtypes of B-cell lymphoma

These are common subtypes of B-cell lymphoma. There are other subtypes that are not described in this guide. If you have questions about your specific subtype and diagnosis, talk with your health care team.

Diffuse large B-cell lymphoma (DLBCL). DLBCL is the most common form of lymphoma. About 30% of NHL in the United States is DLBCL. It is an aggressive form of NHL that involves organs other than the lymph nodes about 40% of the time. Recent research shows that there are different types of DLBCL, including germinal center and non-germinal center. Research studies, called clinical trials, continue to look at whether patients should receive different types of treatment for these different types of DLBCL.

Follicular lymphoma. Follicular lymphoma is the second most common form of lymphoma in the United States and Europe. About 20% of people with NHL have this subtype. It usually begins in the lymph nodes, is most often indolent, and grows very slowly. Over time, follicular lymphoma may turn into DLBCL (see above). This is called transformation. Clinical trials suggest that people with follicular lymphoma have lived longer over the last few decades due to treatment advances. Follicular lymphoma sometimes has a genetic change within the lymphoma cells involving chromosomes 14 and 18. This genetic abnormality changes the function of a protein called BCL2.

Mantle cell lymphoma. About 5% to 7% of people with NHL have mantle cell lymphoma. It most often appears in people older than 60 and is much more common in men than in women. It usually involves the bone marrow, lymph nodes, spleen, and gastrointestinal system, which includes the esophagus, stomach, and intestines. Mantle cell lymphoma is characterized by a genetic change within lymphoma cells involving chromosomes 11 and 14. This genetic change alters the function of a protein called cyclin D1. Some patients have a slower-growing form of the disease, and if they do not have symptoms or a significant amount of disease, they may be monitored using the watchful waiting approach.

Small lymphocytic lymphoma. This type of lymphoma is the same disease as B-cell chronic lymphocytic leukemia (CLL) but without a significant amount of disease circulating in the blood. About 5% of people with NHL have this subtype, which is considered an indolent lymphoma.

Double hit/triple hit lymphoma. This is a highly aggressive subtype of DLBCL, accounting for about 5% of these cases. Rarely, low-grade follicular lymphoma may also transform into double hit lymphoma. Double hit lymphomas have changes in the MYC gene and in either the BCL2 or BCL6 gene. Double hit lymphoma is often diagnosed in older adults. Triple hit lymphomas have changes in the MYC, BCL2, and BCL6 genes.

Primary mediastinal large B-cell lymphoma. This is an aggressive form of DLBCL. It appears as a large mass in the central chest. The mass may cause breathing problems or superior vena cava (SVC) syndrome, a collection of symptoms caused by the partial blockage or compression of the superior vena cava. The superior vena cava is the major vein that carries blood to the heart from the head, neck, upper chest, and arms. Mediastinal large B-cell lymphoma is most common in women between 30 and 40 years old. About 2.5% of people with NHL have this subtype. A closely related lymphoma called mediastinal grey-zone lymphoma (MGZL) may also occur in the same age group.

Splenic marginal zone B-cell lymphoma. This type of lymphoma begins in the spleen and usually involves the bone marrow and the blood. It is usually slow growing.

Extranodal marginal zone B-cell lymphoma of MALT. This type of lymphoma is usually localized at diagnosis. It most commonly occurs in the stomach. However, it may also occur in the lung, skin, thyroid, salivary gland, or in the orbit, adjacent to the eye, or in the bowel. Patients with this type of lymphoma sometimes have a history of autoimmune disease, such as lupus, rheumatoid arthritis, or Sjögren syndrome. When MALT occurs in the stomach, it is sometimes caused by a bacteria called Helicobacter pylori.

Nodal marginal zone B-cell lymphoma. This rare type of indolent lymphoma involves the lymph nodes. About 1% of people with lymphoma have this subtype.

Lymphoplasmacytic lymphoma. This is an indolent form of lymphoma, and 1% of people with NHL have this subtype. This form of lymphoma often involves the bone marrow, sometimes lymph nodes, and spleen. In most patients, this lymphoma produces an immunoglobulin (IgM antibody) protein, called an “M protein,” that is found in the blood. When this occurs, the condition is called Waldenstrom’s macroglobulinemia (WM). Patients with WM sometimes have elevated serum viscosity, or “thickened” blood, which may cause symptoms such as headache, blurry vision, dizziness, and shortness of breath. Changes in the MYD88 gene are found in more than 90% of cases of lymphoplasmacytic lymphoma and WM. Looking for mutations in this gene may be helpful in diagnosing lymphoplasmacytic lymphoma.

Burkitt lymphoma/Burkitt cell leukemia. This is a very rare and aggressive form of lymphoma. There are 3 forms of Burkitt lymphoma:

• Endemic

• Sporadic

• Immunodeficiency-related lymphoma

The endemic subtype occurs most commonly in Africa, appears most often in the jawbones of children, and is usually associated with infection with Epstein-Barr virus (EBV). It can also be associated with the human immunodeficiency virus (HIV). In the United States, Burkitt lymphoma sometimes appears with a mass in the abdomen, but it can affect many other parts of the body. Because this type of lymphoma spreads quickly, it needs immediate treatment. This subtype is characterized by genetic changes on chromosome 8 involving the MYC gene, which contributes to rapid cancer growth.

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Subtypes of T-cell and NK-cell lymphoma

These are the most common subtypes of T-cell and NK-cell lymphoma:

Anaplastic large cell lymphoma, primary cutaneous type. This subtype of lymphoma only involves the skin. It is often indolent, although aggressive subtypes of the disease are possible.

Anaplastic large cell lymphoma, systemic type. This aggressive form of lymphoma makes up about 2% of all lymphomas and about 10% of all childhood lymphomas. Some people with this subtype have genetic changes on chromosome 2, involving the ALK gene. Individuals with cancer cells that have changes in ALK, called ALK-positive, often have a a better prognosis than those without this change, called ALK-negative.

Breast implant-associated anaplastic large cell lymphoma. This is a relatively recently recognized subtype that arises in tissue near breast implants. It is usually less aggressive than the systemic type of anaplastic large cell lymphoma.

Peripheral T-cell lymphoma, not otherwise specified (NOS). This is an aggressive form of lymphoma that is often advanced when doctors find it. It is most common in people older than 60 and makes up about 6% of all lymphomas in the United States and Europe. The cells of this lymphoma vary in size, and they have certain types of proteins, called CD4 or CD8, on their surface. Researchers are studying many new drugs in clinical trials to treat this subtype.

Angioimmunoblastic T-cell lymphoma. This is an aggressive form of lymphoma with specific symptoms:

• Enlarged, often tender, lymph nodes

• Fever

• Weight loss

• Rash

• High levels of immunoglobulins in the blood

People with angioimmunoblastic lymphoma have a lowered immune system function, so infections are also common.

Adult T-cell lymphoma/leukemia (human T-cell lymphotropic virus type I positive). This type of lymphoma is caused by a virus called the human T-cell lymphotropic virus type I. It is an aggressive disease that often involves the bone and skin. Often, lymphoma cells are found in the blood, which is why this condition is sometimes also called leukemia.

Extranodal NK/T-cell lymphoma, nasal type. This is an aggressive type of lymphoma that is very rare in the United States and Europe in general, but more common in Asian and Hispanic communities. It can occur in children or adults, most often involving the nasal area and sinuses. It can also involve the gastrointestinal tract, skin, the testicles, or other areas in the body.

Enteropathy-associated T-cell lymphoma. This type of lymphoma is rare in the United States but is more common in Europe. It is an aggressive form of T-cell lymphoma that involves the intestines. Most people with this subtype have celiac disease or a history of gluten intolerance.

Hepatosplenic T-cell lymphoma. This is an aggressive form of peripheral T-cell lymphoma that involves the liver and spleen. It is more common in males and occurs more frequently in teenagers and young adults, with a median age at diagnosis of 35 years.

Subcutaneous panniculitis-like T-cell lymphoma. This is a form of peripheral T-cell lymphoma that is similar to hepatosplenic T-cell lymphoma (see above). The disease involves the tissue under the skin and is often first diagnosed as panniculitis, which is inflammation of fatty tissues.

Mycosis fungoides. This rare T-cell lymphoma primarily involves the skin, either in patches or with diffuse redness of the skin. It often has a very long and indolent course but may become more aggressive and spread to lymph nodes or internal organs.

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The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with non-Hodgkin lymphoma (NHL). Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for NHL. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for NHL in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How NHL is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

There are 4 main treatments for NHL:

• Chemotherapy

• Immunotherapy

• Targeted therapy

• Radiation therapy

Often, patients receive a combination of these treatments. Occasionally, the doctor and patient may also consider surgery or bone marrow/stem cell transplantation.

The treatment of lymphoma is rapidly changing and has improved outcomes for many patients. It is important to have expert diagnostic confirmation of your subtype and to consider getting a second opinion regarding your treatment plan.

Treatment options and recommendations depend on several factors, including:

• The type and stage of NHL

• Possible side effects

• The patient’s preferences and overall health

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called "shared decision-making." Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for NHL because there are different treatment options. Learn more about making treatment decisions.

The common types of treatments used for NHL are described below. In addition, treatment for specific NHL subtypes is also provided. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

READ MORE BELOW:

• Watchful waiting

• Chemotherapy

• Targeted therapy

• Cellular immunotherapy and checkpoint inhibitors

• Radiation therapy

• Bone marrow/stem cell transplantation

• Physical, emotional, and social effects of cancer

• Treatment by type and subtype

• Remission and the chance of recurrence

• Progressive NHL

• Refractory NHL

• If treatment does not work

Watchful waiting

Some people with indolent lymphoma may not need immediate treatment if they are otherwise healthy and the lymphoma is not causing any symptoms or problems with other organs. This is called watchful waiting, or sometimes called watch-and-wait or active surveillance. During watchful waiting for indolent lymphoma, doctors closely monitor patients using physical examinations, computed tomography (CT) scans or other imaging tests, and laboratory tests on a regular basis. Treatment only begins if the person develops symptoms or tests indicate that the cancer is getting worse. For some people with indolent lymphoma, watchful waiting does not affect the chances of survival, but regular and careful follow-up care is recommended.

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders. A medical oncologist or hematologist is most often the primary cancer specialist for people with lymphoma.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for NHL include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of mediation at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It is the main treatment for NHL.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. The stage and type of NHL determines which chemotherapy is used. The most common chemotherapy combination for the first treatment of aggressive NHL is called CHOP and contains 4 medications:

• Cyclophosphamide (available as a generic drug)

• Doxorubicin (available as a generic drug)

• Prednisone (multiple brand names)

• Vincristine (Vincasar)

For patients with B-cell lymphoma, adding an anti-CD20 monoclonal antibody, such as rituximab (Rituxan) or obinutuzumab (Gazyva), to CHOP works better than using CHOP alone (see “Targeted therapy,” below). There are other common combinations of chemotherapy regimens, including:

• BR, which includes bendamustine (Treanda) and rituximab

• Combinations using fludarabine (available as a generic drug)

• R-CVP (cyclophosphamide, prednisone, rituximab, and vincristine)

The side effects of chemotherapy depend on the individual drug and the dose used. They can include fatigue, temporary lowering of blood counts, risk of infection, nausea and vomiting, hair loss, loss of appetite, rash, and diarrhea. These side effects can be managed during treatment and usually go away after treatment is finished.

Chemotherapy may also cause long-term side effects, also called late effects. People with lymphoma may also have concerns about if or how treatment may affect their sexual health and fertility. Talk with the members of the health care team about these topics before treatment begins. Learn more about late effects of treatment.

Learn more about the basics of chemotherapy.

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapies used for NHL include kinase inhibitors, immunomodulatory drugs, and nuclear export inhibitors. Each category is described below in more detail. Kinase inhibitors block a type of enzyme called a kinase. Kinases help control many functions in the body, and blocking kinases may stop or slow cancer growth. Immunomodulatory drugs modulate, or influence, how the body's immune system responds or works. The type of targeted therapy that may be recommended for your treatment plan depends on the type of NHL, the specific genetic changes in the lymphoma, and other factors.

A certain kind of treatment, called a monoclonal antibody, may be considered a targeted therapy or an immunotherapy. In this guide, monoclonal antibodies for lymphoma are described under "Immunotherapy," below.

Talk with your doctor about possible side effects for a specific targeted therapy and how they can be managed.

Kinase inhibitors (updated 11/2023)

Ibrutinib (Imbruvica). Ibrutinib is a targeted therapy that targets the Bruton’s tyrosine kinase pathway. It is approved to treat several B-cell lymphomas, including mantle cell lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma, as well as chronic lymphocytic leukemia and Waldenstrom macroglobulinemia.

Acalabrutinib (Calquence). Acalabrutinib targets the Bruton’s tyrosine kinase pathway. It is approved to treat adults with mantle cell lymphoma and small lymphocytic lymphoma.

Zanubrutinib (Brukinsa) (updated 03/2024). Zanubrutinib is another Bruton’s tyrosine kinase inhibitor. It is approved to treat mantle cell lymphoma and recurrent or refractory marginal zone lymphoma in people who have received at least 1 previous therapy, as well as small lymphocytic lymphoma. Zanubrutinib combined with obinutuzumab (a monoclonal antibody, see below) may be used to treat recurrent or refractory follicular lymphoma.

Pirtobrutinib (Jaypirca) (updated 12/2023). Pirobrutinib is a reversible, or non-covalent, inhibitor of the Bruton's tyrosine kinase pathway that attaches to its target differently from other Bruton's tyrosine kinase inhibitors. It is approved to treat recurrent or refractory mantle cell lymphoma or small lymphocytic lymphoma after at least 2 previous therapies, including another Bruton's tyrosine kinase inhibitor.

Immunomodulatory drugs

Lenalidomide (Revlimid). Lenalidomide is a thalidomide analog used to treat follicular lymphoma and mantle cell lymphoma that have not been stopped by other treatments. This type of targeted therapy is also used to treat multiple myeloma and myelodysplastic syndromes.

EZH2 inhibitor

Tazemetostat (Tazverik). Tazemetostat is a targeted therapy that targets EZH2. The FDA has approved it for the treatment of follicular lymphoma that has come back after treatment or that has not been stopped by treatment. Adults with follicular lymphoma with an EZH2 mutation who have received 2 or more previous treatments with systemic therapy may receive tazemetostat. It may also be given to people who have no other available treatment options.

BCL2 inhibitor

Venetoclax (Venclexta). Venetoclax is a BCL2 inhibitor. This type of targeted therapy is used in combination with obinutuzumab as a first treatment for small lymphocytic lymphoma. Venetoclax may also be used in combination with rituximab. It is being studied in combinations with a Bruton's tyrosine kinase inhibitor as well as chemotherapy.

Nuclear export inhibitors

Selinexor (Xpovio). Selinexor is a drug that targets and blocks a protein called XPO1 in cancer cells. It is used to treat DLBCL that has come back or has not been stopped by 2 previous treatments, as well as DLBCL that has transformed from follicular lymphoma.

Before starting any cancer medication, talk with your doctor about possible side effects for a specific drug and how they can be managed.

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Cellular immunotherapy and checkpoint inhibitors

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. This category of lymphoma treatments includes monoclonal antibodies, modified T cells, and checkpoint inhibitors. Immunotherapy uses anti-lymphoma strategies to improve, target, or restore immune system function.

Monoclonal antibodies. Monoclonal antibodies are used for many types of NHL. A monoclonal antibody recognizes and attaches to a specific protein and does not affect cells that do not have that protein. Some monoclonal antibodies are used to deliver an attached chemotherapy agent or toxin; these are called antibody-drug conjugates. Monoclonal antibodies may also be considered a form of targeted therapy.

• Rituximab (Rituxan). Rituximab is a targeted therapy used to treat many different types of B-cell NHL. It works by targeting a molecule called CD20 that is located on the surface of normal B cells and B-cell NHL. When the antibody attaches to this molecule, the patient’s immune system is activated to destroy some lymphoma cells or to make lymphoma cells more susceptible to being destroyed by chemotherapy.

  Although the antibody may work well by itself, research shows that it generally works better when added to chemotherapy (see above) for patients with most types of B-cell NHL. Rituximab is also given after remission for indolent lymphoma to keep it from coming back.

  There are 3 rituximab biosimilars that may be used to treat lymphoma: rituximab-abbs (Truxima), rituximab-arrx (Riabni), and rituximab-pvvr (Ruxience). These biosimilars function in a way very similar to rituximab, but they are different medications. Learn more about the basics of biosimilars.

• Brentuximab vedotin (Adcetris). Brentuximab vedotin is an antibody-drug conjugate. An antibody-drug conjugate uses a targeted therapy to attach to targets on cancer cells. The drug then releases a small amount of chemotherapy or other toxin directly into the tumor cells. Brentuximab vedotin combined with chemotherapy is approved to treat adults with certain types of peripheral T-cell lymphoma, such as systemic anaplastic large cell lymphoma, and peripheral T-cell lymphoma, not otherwise specified, as long as the lymphoma expresses the CD30 protein.

• Epcoritamab (Epkinly). Epcoritamab is a monoclonal antibody that targets 2 proteins, 1 on the lymphoma cells and 1 on immune cells, to eliminate lymphoma cells. It may be used to treat DLBCL or high-grade B-cell lymphoma that has come back or that did not respond to at least 2 previous treatments.

• Glofitamab (Columvi) (updated 07/2023). Glofitamab is a monoclonal antibody that targets the CD3 protein on T cells and the CD20 protein on lymphoma cells to eliminate the lymphoma cells. If 2 or more previous lines of treatment have not stopped the disease, glofitamab may be used to treat DLBCL, not otherwise specified, or large B-cell lymphoma that has developed from follicular lymphoma.

• Loncastuximab tesirine-lpyl (Zynlonta). Loncastuximab tesirine-lpyl is an antibody-drug conjugate that targets the CD19 protein. It is approved for the treatment of adults with certain subtypes of B-cell lymphoma that has not been stopped by 2 or more treatments.

• Mosunetuzumab-axgb (Lunsumio). Mosunetuzumab is a bispecific T-cell engager that is approved for the treatment of recurrent or refractory follicular lymphoma after at least 2 previous lines of treatment. Bispecific T-cell engagers are monoclonal antibodies that have more than one target. These antibodies can attach to both a T cell and a lymphoma cell at the same time, activating an immune attack on the cancer cells.

• Obinutuzumab (Gazyva). Obinutuzumab is a monoclonal antibody that targets CD20. It can be used in combination with bendamustine or by itself to treat follicular lymphoma that has come back after treatment with rituximab. It can also be used in combination with other chemotherapy to treat stage II bulky, stage III, and stage IV follicular lymphoma.

• Polatuzumab vedotin-piiq (Polivy). Polatuzumab is a monoclonal antibody that targets CD79b. Like brentuximab vedotin, it is also an antibody-drug conjugate. Polatuzumab is used in combination with rituximab, or bendamustine plus rituximab, to treat DLBCL that has come back after at least 2 other treatments. It may also be given in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (a combination called R-CHP) as first-line treatment for DLBCL or high-grade B-cell lymphoma among people who have higher-risk disease.

• Radiolabeled antibodies. Ibritumomab tiuxetan (Zevalin) is rituximab with radioactive isotopes attached. The isotopes are designed to focus the radiation directly to the lymphoma cells. In general, the radioactive antibodies are thought to be stronger than regular monoclonal antibodies but may be more damaging to the bone marrow. This type of therapy is also called radioimmunotherapy (RIT).

• Tafasitamab-cxix (Monjuvi). This monoclonal antibody targets the CD19 molecule that is expressed on most normal B cells and B-cell lymphomas. It can be used in combination with lenalidomide (see "Immunomodulatory drugs" below) to treat recurrent or refractory DLBCL in those who cannot receive an autologous bone marrow/stem cell transplant (see below).

Research on the benefits of other newer monoclonal antibodies for lymphoma is ongoing.

Chimeric antigen receptor (CAR) T-cell therapy. In CAR T-cell therapy, some T cells are removed from a patient’s blood. Then, the cells are changed so they have specific proteins called receptors. The receptors allow the changed T cells to recognize and immunologically destroy lymphoma cells that have the target protein. The changed T cells are then returned to the patient’s body as a transfusion. Once there, they seek out and destroy cancer cells.

• Axicabtagene ciloleucel (Yescarta) is a CAR T-cell therapy that is approved to treat patients with recurrent or refractory diffuse large B-cell lymphoma (DLBCL) and other forms of large B-cell lymphoma, as well as recurrent or refractory follicular lymphoma. Not all patients are eligible for this type of treatment.

• Tisagenlecleucel (Kymriah) is a CAR T-cell therapy that is approved for the treatment of refractory B-cell lymphoma, including DLBCL and follicular lymphoma, after 2 or more previous systemic treatments.

• Brexucabtagene autoleucel (Tecartus) is approved for adults with recurrent or refractory mantle cell lymphoma.

• Lisocabtagene maraleucel (Breyanzi) is a CAR T-cell therapy approved for the treatment of adults with recurrent or refractory large B-cell lymphoma after at least 1 line of systemic therapy. It can be used to treat DLBCL, not otherwise specified; high-grade B-cell lymphoma; primary mediastinal large B-cell lymphoma; and follicular lymphoma.

Further CAR T-cell therapies are in development and being studied in clinical trials. Learn more about the basics of CAR T-cell therapy.

Immune checkpoint inhibitors. This type of immunotherapy blocks specific pathways to stop or slow the growth of cancer. The PD-1 pathway is a target for several checkpoint inhibitors. One of these drugs, pembrolizumab (Keytruda), can be used to treat primary mediastinal large B-cell lymphoma.

Different types of immunotherapy can cause several different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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Radiation therapy

Radiation therapy is the use of high-energy x-rays, electrons, or protons to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation treatment for NHL is usually external-beam radiation therapy, which is radiation given from a machine outside the body.

A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Radiation therapy is usually given after or in addition to chemotherapy, depending on the NHL subtype. It is most often given to people who have localized lymphoma, which means that it involves only 1 or 2 adjacent areas, or to people who have a lymph node that is particularly large, usually more than 7 to 10 centimeters across. It may also be given for the treatment of pain or in very low doses (just 2 treatments) to people with advanced disease who have localized symptoms that can be relieved using radiation therapy, such as a painful bony lesion.

General side effects from radiation therapy may include fatigue and nausea. Most side effects are related to the region of the body receiving radiation. These side effects may include mild skin reactions, dry mouth, temporary hair loss, or loose bowel movements. People who have had radiation therapy directed at the chest may experience lung inflammation called pneumonitis. People who had radiation therapy directed at the bones may experience low blood counts. Talk with your doctor about what you can expect regarding side effects and how they can be managed.

Most side effects go away soon after treatment is finished, but radiation therapy may also cause late effects, such as second cancers or damage to the heart and blood vessels if they were within the field of radiation. Sexual health problems and infertility may occur after radiation therapy to the pelvis. Before treatment begins, talk with your doctor about possible sexual and fertility-related side effects of your treatment and the available options for maintaining your sexual health and preserving fertility.

Radioimmunotherapy is a specialized form of targeted radiation treatment and is described in the monoclonal antibodies section above.

Learn more about the basics of radiation therapy.

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Bone marrow/stem cell transplant

A bone marrow transplant is a medical procedure in which bone marrow or peripheral blood cells containing highly specialized cells, called hematopoietic stem cells, are used as part of a treatment plan. Hematopoietic stem cells are blood-forming cells found in the bloodstream and the bone marrow. This procedure is also called a stem cell transplant or hematopoietic stem cell transplant.

Transplantation is considered an aggressive treatment for NHL. It is generally used only for people with NHL whose disease is progressive or recurrent (see Stages). For some NHL subtypes, such as mantle cell lymphoma and some T-cell lymphomas, doctors may recommend transplantation as part of the initial treatment plan to prevent or delay recurrence.

Before recommending a transplant, the doctor will talk with you about the risks of this treatment. Doctors also consider several other factors, such as the type of NHL, results of any previous treatment, and your age and general health. It is important to talk with an experienced doctor at a specialized transplant center about the risks and benefits of this treatment.

There are 2 types of bone marrow transplantation, depending on the source of the replacement hematopoietic stem cell:

• Allogeneic (ALLO). ALLO transplantation uses donated stem cells from a healthy individual, ideally a sibling or matched unrelated donor. Treatment includes immunochemotherapy, radiation therapy, or immunotherapy plus “graft versus lymphoma” activity, which is where the donor cells recognize and destroy the patient’s lymphoma cells.

• Autologous (AUTO). AUTO transplantation uses the patient’s own stem cells after high-dose chemotherapy. In AUTO transplantation, the goal is to destroy all of the cancer cells in the body using high doses of chemotherapy, immunotherapy, and/or radiation therapy. The AUTO stem cells are returned to the patient’s body after the high-dose therapy is completed. The AUTO stem cells then work to regenerate healthy bone marrow and normal blood cell production.

Side effects of a bone marrow transplant depend on the type of transplant, your general health, and other factors. Learn more about the basics of stem cell and bone marrow transplant.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Treatment by type and subtype

These are general treatment options for the most common types and subtypes of NHL. Your doctor can help you consider all your individual treatment options. Keep in mind that treatment options are rapidly evolving as results from cancer research are reported. For information on a specific type of treatment, see the information above. For more information about specific stages of NHL, see the Stages section in this guide.

Indolent NHL

Because indolent lymphoma grows slowly, people diagnosed with this type of NHL may not need to start treatment when it is first diagnosed. Instead, watchful waiting may be recommended. In cases where there are many cancer cells in the body, called high-burden disease, treatment will be started even if there are no symptoms.

When indolent lymphoma is located only in 1 or 2 adjacent areas, it is called localized disease (stages I and II). For people with localized disease, radiation therapy is often used. However, most patients with indolent NHL have stage III or IV disease at the time of diagnosis. There are many effective treatments for these stages of indolent NHL, but it may come back months or years after treatment has finished and require more treatment.

Aggressive NHL

These types of lymphoma may develop rapidly, and treatment is usually started within weeks of diagnosis. Aggressive lymphomas usually need more intensive chemotherapy. The doctor may recommend adding radiation therapy to treat stage I or II disease or to treat lymphoma where the site of the disease is large, sometimes called “bulky” disease. Several forms of aggressive lymphoma may be cured with effective treatment.

Subtypes of B-cell lymphoma

DLBCL. About 2 out of 3 people with this aggressive lymphoma are cured with chemotherapy combined with the monoclonal antibody rituximab. There are several subtypes of DLBCL, some listed below, which have different prognoses and treatment approaches.

• Chemotherapy

• Radiation therapy, especially for lymphoma in a limited area or a bulky site of disease

• Monoclonal antibodies, such as rituximab, polatuzumab, or tafasitamab-cxix

• CAR T-cell therapy

• Other targeted treatments

Follicular lymphoma. Early, stage I to stage II follicular lymphoma may be cured with radiation therapy. Bone marrow/stem cell transplantation may cure the disease in cases where the lymphoma comes back after initial chemotherapy as well as with some later recurrences. If follicular lymphoma transforms into DLBCL, it is usually treated the same way as DLBCL.

• Watchful waiting, for lymphoma with a low tumor burden and no symptoms

• Monoclonal antibody therapy, for advanced lymphoma with low tumor burden

• Chemotherapy

• Targeted therapy with a kinase inhibitor, monoclonal antibody, or lenalidomide

• Immunotherapy with CAR T-cell therapy

• Bone marrow/stem cell transplantation

Mantle cell lymphoma. For patients younger than 70, who are otherwise healthy, high-dose chemotherapy and AUTO bone marrow transplantation often results in the longest remission, and they may receive maintenance therapy. For older patients or those who are not able to receive an AUTO bone marrow transplant, maintenance therapy with rituximab is a standard treatment approach.

• Chemotherapy

• Monoclonal antibody, such as rituximab

• Bone marrow/stem cell transplantation

• Maintenance therapy with rituximab after initial treatment

• Kinase inhibitors, such as acalabrutinib, ibrutinib, zanubrutinib, or pirtobrutinib

• Immunomodulatory drug, such as lenalidomide

• CAR T-cell therapy with brexucabtagene autoleucel

Small lymphocytic lymphoma. People with small lymphocytic lymphoma/chronic lymphocytic leukemia (or SLL/CLL) may not require immediate treatment.

• Watchful waiting

• Kinase inhibitors, such as acalabrutinib, ibrutinib, or zanubrutinib

• Monoclonal antibodies, such as obinutuzumab, rituximab, or venetoclax

• Chemotherapy

Double hit/triple hit lymphoma. This is a subtype of DLBCL. There is currently no preferred treatment regimen for this type of aggressive lymphoma that has been confirmed in clinical trials.

• Chemotherapy

• Monoclonal antibodies, such as rituximab

Primary mediastinal large B-cell lymphoma. Most often, doctors treat this subtype of DLBCL with combination chemotherapy plus the monoclonal antibody rituximab. A closely related lymphoma called mediastinal grey-zone lymphoma (MGZL) is also treated in a manner similar to that of primary mediastinal large B-cell lymphoma.

• Chemotherapy

• Monoclonal antibody, such as rituximab

• Radiation therapy

• Immunotherapy with CAR T-cell therapy or the immune checkpoint inhibitor pembrolizumab

Splenic marginal zone B-cell lymphoma. Because this type of indolent lymphoma is usually slow-growing, the initial management approach is often watchful waiting.

• Watchful waiting

• Monoclonal antibody, such as rituximab

• Chemotherapy

• Surgery to remove the spleen

Extranodal marginal zone B-cell lymphoma of MALT (mucosa-associated lymphoid tissue).

• Radiation therapy for disease only affecting 1 organ or site

• Monoclonal antibody, such as rituximab

• Chemotherapy

• Antibiotics for gastric MALT caused by the Helicobacter pylori bacteria

Nodal marginal zone B-cell lymphoma. In general, doctors treat this subtype of lymphoma similarly to follicular lymphoma (see above).

Lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia).

• Watchful waiting

• Chemotherapy

• Bruton's tyrosine kinase inhibitors

• Monoclonal antibodies

Learn more about the treatment of lymphoplasmacytic lymphoma and Waldenstrom macroglobulinemia.

Burkitt lymphoma/Burkitt cell leukemia. Burkitt lymphoma is often curable. Because it progresses and spreads quickly, it needs immediate treatment.

• Chemotherapy plus rituximab, when given over several days, and typically given in a hospital for at least the beginning treatment cycle, can lead to long-term remission in more than 80% of patients

Subtypes of T-cell and NK-cell lymphoma

Anaplastic large cell lymphoma, primary cutaneous type.

• Radiation therapy

• Chemotherapy

• Monoclonal antibody, such as brentuximab vedotin

Anaplastic large cell lymphoma, systemic type.

• Chemotherapy

• Monoclonal antibody, such as brentuximab vedotin

• Bone marrow/stem cell transplantation

• Radiation therapy

Breast implant-associated anaplastic large cell lymphoma.

• Surgical removal of the implant

• Chemotherapy in some cases

Peripheral T-cell lymphoma, not otherwise specified (NOS).

• Chemotherapy

• Bone marrow/stem cell transplantation

• Monoclonal antibody, such as brentuximab vedotin

• Radiation therapy

Angioimmunoblastic T-cell lymphoma.

• Chemotherapy

• Bone marrow/stem cell transplantation

Adult T-cell lymphoma/leukemia (human T-cell lymphotropic virus type I positive).

• Immunotherapy with interferon

• Zidovudine (Retrovir), an antiviral drug used to treat the human immunodeficiency virus (HIV)

• Chemotherapy

• Bone marrow/stem cell transplantation

Extranodal NK/T-cell lymphoma, nasal type. Radiation therapy in combination with chemotherapy is an important part of the treatment for disease that involves the nasal/sinus area.

• Radiation therapy

• Chemotherapy, usually including asparaginase (Elspar)

• Bone marrow/stem cell transplantation

Enteropathy-associated T-cell lymphoma.

• Chemotherapy

• Bone marrow/stem cell transplantation

Hepatosplenic T-cell lymphoma.

• Chemotherapy

• Bone marrow/stem cell transplantation

Primary cutaneous gamma/delta T-cell lymphoma. This is an aggressive disease treated similarly to hepatosplenic T-cell lymphoma.

Subcutaneous panniculitis-like T-cell lymphoma. This disease often follows an indolent course.

• Immunosuppressive medications, such as methotrexate (multiple brand names) or cyclosporine (multiple brand names)

• Chemotherapy

• Bone marrow/stem cell transplantation

Mycosis fungoides. Mycosis fungoides usually cannot be cured, but it is often manageable. In some centers, medical oncologists coordinate care with dermatologists and radiation oncologists to treat the disease and its related symptoms, which include rash and itching.

• Topical medications

• Radiation therapy

• Controlled exposure to ultraviolet light or radiation therapy

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Monoclonal antibodies, such as brentuximab vedotin and mogamulizumab (Poteligeo)

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Remission and the chance of recurrence

A complete remission is when lymphoma cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. Partial remission is when the lymphoma has regressed by more than 50% from its pretreatment state but can still be detected.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the disease returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the lymphoma does return. Learn more about coping with the fear of recurrence.

As explained in the Stages section, if the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. In most cases, another tissue biopsy is needed to prove that the lymphoma has not changed or transformed into a more aggressive subtype. After this testing is done, you and your doctor will talk about the treatment options.

Treatment for recurrent NHL depends on 3 factors:

• Where the cancer is and whether it has transformed into a more aggressive subtype

• Type(s) of treatment given before

• The patient’s overall health

Often the treatment plan will include the treatments described above, such as chemotherapy, radiation therapy, targeted therapy, immunotherapy, or bone marrow/stem cell transplantation. However, they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent NHL. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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Progressive NHL

Some people with NHL may not experience a complete remission and will have small amounts of residual disease that is stable. Or, they will have residual disease that is actively growing despite treatment. Indolent NHL may be observed with watchful waiting for a period or be treated with targeted therapy or other drugs. Radiation therapy to the local area may also be a possibility. These patients may have breaks from treatment, sometimes lasting many years. If the lymphoma begins to grow or spread, this is called progression of disease, and active treatment will begin again.

It is important to understand that remission is not always possible in some indolent lymphomas. However, some people can be safely monitored even if there is some remaining disease. This is possible as long as there are no symptoms and the lymphoma has not affected blood counts or other organs.

If there is residual disease that is growing despite active treatment, it is called refractory NHL.

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Refractory NHL

If standard treatments stop working well for NHL or the lymphoma comes back within 6 months after treatment, this is called refractory NHL. People with this diagnosis are encouraged to talk with doctors who are lymphoma experts to discuss options for the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the chosen treatment plan. This discussion may include clinical trials.

Treatment options for refractory NHL depend on 4 factors:

• Where the cancer is

• The lymphoma subtype

• The type of treatment given before

• The patient’s overall health

The doctor may suggest chemotherapy, immunotherapy, bone marrow/stem cell transplantation, or a clinical trial. Palliative and supportive care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of refractory NHL is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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If treatment does not work

Recovery from NHL is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced, terminal, or end stage.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, people with advanced NHL, especially those with indolent lymphoma, may continue to live for a long time after a diagnosis of advanced cancer. It is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about non-Hodgkin lymphoma (NHL) and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about NHL, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Genetic testing. Scientists are learning more about the genetics and the specific role that gene changes, called mutations, have in the development of cancer. As a result, they are better able to classify and diagnose subtypes of NHL. These gene profiling methods can help estimate the prognosis for people with certain types of lymphoma, and these tests are mostly used in lymphoma research. However, in the coming years, it is likely that treatments will be designed to target specific genetic changes.

• Immunotherapy. There is ongoing research to change healthy (not cancerous) T cells so that they recognize and eliminate lymphoma cells, called CAR (chimeric antigen receptor) T-cell therapy. As explained in Types of Treatment, there are several approved CAR T-cell therapies for the treatment of NHL, and others are being tested in clinical trials.

• Targeted therapies. As described in Types of Treatment, there are many targeted treatments approved to treat lymphoma. Many other targeted therapies are being studied in clinical trials. Those treatments include aurora kinase inhibitors.

• Vaccines. Several therapeutic vaccines have been studied in clinical trials, mostly for indolent lymphoma. These vaccines are not meant to prevent lymphoma but to lower the chance that a lymphoma will come back after treatment with chemotherapy or targeted therapy. So far, results from vaccine studies have not shown better results than other treatments, but research to improve vaccines is ongoing.

• Chemotherapy. Different combinations of chemotherapy and different chemotherapy schedules, sometimes including antibodies or radiolabeled antibodies, are being studied in clinical trials. Researchers are evaluating many new drugs that work differently from standard chemotherapy.

• Bone marrow transplantation/stem cell transplantation. The use of different types of bone marrow transplantation is being tested for people with newly diagnosed disease and for those who have had a recurrence after the first treatment. Those types include including allogeneic transplants or reduced-intensity transplants, also called mini-allogeneic or nonablative transplants. For many types of lymphoma, the best way to use transplantation is still uncertain and is being studied in clinical trials. Learn more about bone marrow transplantation.

• Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current NHL treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in NHL, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

• Review recent research and information on lymphoma on the Cancer.Net Blog.

• Listen to podcasts from an ASCO expert discussing highlights from the American Society of Hematology (ASH) Annual Meeting in 2022 and 2021.

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter.

• Visit the website of Conquer Cancer, the ASCO Foundation, to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about the late effects of treatment, which are side effects that can occur long after treatment for non-Hodgkin lymphoma (NHL) has ended. Use the menu to see other pages.

People who have been treated for lymphoma have an increased risk of developing other diseases or conditions later in life, called late effects. Late effects happen because cancer medications and radiation therapy can cause permanent damage to healthy parts of the body. Treatments have improved in the last 30 years, and now people who are treated for lymphoma recently are less likely to experience late effects. However, there is still some risk. Therefore, it is important for people to receive follow-up care to watch for the following late effects.

• People who have received radiation therapy to the pelvis, high doses of cyclophosphamide, and high-dose chemotherapy for bone marrow transplantation are at risk for infertility. Learn more about fertility concerns and preservation.

• All survivors of NHL have a higher risk of developing a secondary cancer. This increased risk continues for up to 20 years after treatment. The most common secondary cancers include cancer of the lung, brain, kidney, or bladder; melanoma; Hodgkin lymphoma; or leukemia.

• Women who received radiation therapy to the chest before age 35 have an increased risk of developing breast cancer.

• People who have received doxorubicin-based chemotherapy or radiation therapy to the chest may be at higher risk for developing heart problems, such as heart failure, valvular disease, pericarditis, and rhythm abnormalities.

• Adults who have received radiation therapy to the chest area may be at risk for lung damage and shortness of breath later in life.

• People who have received radiation therapy to the neck have an increased risk of having low levels of thyroid hormones later in life.

• People who have received a bone marrow/stem cell transplant or previous high-doses of chemotherapy may be at higher risk for myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML).

Learn more about the basics of late effects of cancer treatment.

The next section in this guide is Follow-up Care. It explains the importance of checkups after you finish cancer treatment. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

• Having no signs of cancer after finishing treatment.

• Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person’s life.

For some, the term “survivorship” itself does not feel right, and they may prefer to use different language to describe and define their experience. Sometimes long-term treatment will be used for months or years to manage or control non-Hodgkin lymphoma (NHL). Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

• Understanding the challenge you are facing

• Thinking through solutions

• Asking for and allowing the support of others

• Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from NHL are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

• ASCO Answers Guide to Cancer Survivorship: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

• Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.