Non Hodgkin lymphoma

All about non Hodgkin lymphoma (NHL)

Non Hodgkin lymphoma (NHL) describes over 80 different types of blood cancer. NHL starts in blood cells called lymphocytes, which live in our lymphatic system. NHL develops when lymphocytes grow in an uncontrolled way. They form tumours in lymph nodes and other parts of the body. It can affect anywhere that lymph tissue is found, which includes your:

• neck
• arm pits
• spleen
• chest (thymus, diaphragm)
• groin
• knee (back of)
• bone marrow.

The lymphatic system has three types of lymphocytes.

• B lymphocytes (B cells)
• T lymphocytes (T cells)
• natural killer cells (NK cells).

They are made in the bone marrow, then go to the lymph system and protect you from infection. Lymphoma can develop in any of the three cell types. Non Hodgkin lymphoma (NHL) is grouped into two types based on the kind of immune cell involved. Most people have B-cell lymphoma, while fewer people have T-cell lymphoma (including NK cell lymphoma). These lymphomas can also grow at different speeds. Some are indolent, which means they grow slowly and may not need treatment right away. Others are aggressive, meaning they grow quickly and need treatment soon.

Symptoms of non Hodgkin lymphoma

Symptoms of NHL vary depending on the subtype. People with indolent lymphomas may be diagnosed through a routine blood test. While others have symptoms that slowly get worse. Whereas aggressive lymphoma starts quickly and symptoms get worse fast.

The most common symptoms of non Hodgkin lymphoma

• painless swelling of lymph nodes in the neck, armpit or groin
• feeling tired for no reason
• fever
• night sweats
• itchy skin
• pain or full feeling in your abdomen.

B symptoms of non Hodgkin lymphoma

‘B’ symptoms can mean your lymphoma is more aggressive and grows quickly. They include:

• fever without infection
• drenching night sweats
• weight loss without trying.

Low blood counts

Lymphoma can cause low blood counts if it is affecting your bone marrow.

Anaemia is when your red blood cells (RBCs) or haemaglobin (Hb) is low. You might feel tired, have pale skin, be short of breath, feel lightheaded, and have a rapid or irregular heartbeat.

Neutropenia means you have a type of white blood cell (WBC) called neutrophils that are low. You may have frequent or severe infections.

Thrombocytopenia is the term used when your platelets are low. You might bruise or bleed easily if you cut yourself.

Causes of non Hodgkin lymphoma

In most cases, there is no cause of NHL. There are some risk factors that increase your risk of developing NHL, including:

• age with certain subtypes
• being male
• being of European origin
• a family history of NHL
• exposure to certain chemicals like pesticides, benzene and solvents
• a weak immune system
• some autoimmune diseases
• viruses like human immunodeficiency virus (HIV), hepatitis C and Epstein-Barr virus (EBV).
• long term infections.

Non Hodgkin lymphoma stages

Your NHL will be staged using the results of your diagnostic tests.  You will have either stage 1, 2, 3 or 4 disease.

Common subtypes of non Hodgkin lymphoma

Your NHL subtype is worked out by looking at your biopsy under a microscope and doing extra testing on it. Sometimes, it can be hard to clearly identify your subtype.

Subtypes are based on:

• the cell affected, B cell, T cell or NK cell
• what the lymphoma cell looks like under a microscope
• where the lymphoma cells are found in your body
• genetic or chromosome problems.

Your treatment team uses these results to recommend a treatment.

Diagnosis of non Hodgkin lymphoma

NHL is diagnosed with tests. You may need many of these depending on the suspected subtype.

Biopsy

The best test to diagnose NHL is a biopsy of a lymph node or a lump. This procedure is where a sample of tissue is taken from a swollen lymph node or lump and looked at under a microscope.

Other tests

• medical history and physical exam
• blood tests – full blood count, kidney and liver function, electrolytes, lactate dehydrogenase, protein electrophoresis, beta 2 microglobulin, hepatitis and human immunodeficiency virus (HIV).
• genetic tests.

Imaging tests help work out how far the disease has spread and what organs are affected. These tests include:

• computed tomography (CT) scan
• positron emission tomography (PET) scan
• ultrasound
• bone marrow biopsy
• lumbar puncture.

Treatment for non Hodgkin lymphoma

Treatment for NHL depends on:

• subtype
• if it is aggressive or indolent (slow growing)
• stage
• your age
• your general health.

Active monitoring

Active monitoring (watch and wait) involves regular tests and health checks. This is usually for indolent NHL. No treatment is needed unless you develop signs and symptoms which show the NHL is progressing.

Chemotherapy

Chemotherapy (chemo) is the most common treatment for NHL. The type of chemo recommended will depend on your subtype of NHL, the treatment goal, your age, and medical history. Chemo is often given in combination with immunotherapies.

Immunotherapy

Immunotherapies are a type of drug that use your own immune system to kill cancer cells. They are often given in combination with chemotherapy but can be given alone. There are several types of immunotherapies used to treat NHL.

Find out more about immunotherapies and targeted therapies.

Stem cell transplant

A bone marrow or blood stem cell transplant is a treatment that restores stem cells after high dose chemotherapy. Your treatment team might suggest a transplant if your NHL is aggressive, difficult to treat, or has come back after a period of remission. There are two types of transplants:

• An autologous stem cell transplant – your own stem cells are collected and then given back to you after high dose chemotherapy.
• An allogeneic stem cell transplant – you receive stem cells from a donor, often a blood relative.

It is more common to receive an autologous transplant for NHL. There are some situations where an allogeneic transplant may be recommended.

You can read about stem cell transplants on our stem cell transplants webpage.

Radiation therapy

Radiotherapy uses high energy x-rays to kill cancer cells. It can be used on its own to treat indolent (slow growing) lymphomas, or it can be given after high dose chemotherapy for aggressive lymphomas.

• Radiation therapy (RT) targets the areas in the body with NHL.
• It is given in small doses (fractions) over days to weeks.

Read more about radiation therapy on our webpage.

Clinical trials

Clinical trials may be available for some types of NHL. They often compare new or combination therapies with current treatments, including side effects.

Many are randomised, meaning some patients receive the new treatment, and others receive standard care. Trials help improve future treatments and may offer access to costly new therapies not on the Pharmaceutical Benefits Scheme (PBS) in Australia.

If you are considering a clinical trial, your doctor will explain:

• the possible risks and benefits
• how it compares to standard treatment
• what is involved.

You will need to give informed consent before taking part.

Trials are voluntary and run through hospitals and clinics. Read more about clinical trials.

Prognosis of non Hodgkin lymphoma

A prognosis is an estimate your haematologist will make of the likely course and outcome of your disease. Your prognosis is based on the subtype and stage of your disease. Some lymphomas have a poor prognosis without treatment. Other subtypes need very little treatment with some people living a normal life expectancy.

Your prognosis will depend on your:

• subtype and stage of NHL
• overall health
• age.

Your prognosis might change if your NHL comes back after treatment or changes to a different type of cancer.

Follow-up care

Follow up care for NHL includes regular checkups with your treatment team. This is to check for long term side effects. You will also have tests and scans to make sure the lymphoma hasn’t come back (relapsed/recurred). You will likely need more treatment if the lymphoma returns.

Living with non Hodgkin lymphoma

How NHL affects your everyday life depends on many factors. It could be that you are returning or managing work, trying to exercise or managing your nutrition. There are some helpful resources and information to guide you on our living well with blood cancer webpage.

Caring for someone with non Hodgkin lymphoma

We have a range of information and resources that may help when you are caring for someone with non-Hodgkin lymphoma.

Resources for non Hodgkin lymphoma

Booklets to download:

Optimal Care Pathway for low grade lymphoma

An Optimal Care Pathway for low grade lymphoma has been developed in association with the Cancer Council, Australia and you can access it below.

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References

• Non-Hodgkin lymphoma – Symptoms and causes – Mayo Clinic
• What Is Non-Hodgkin Lymphoma?| Types of Non-Hodgkin Lymphoma | American Cancer Society
• Non Hodgkin lymphoma subtypes – Blood Cancer United
• T Cells: Types and Function
• Types of lymphoma | Cancer Australia