Lymphoma

Introduction

A diagnosis of lymphoma — or even the suspicion of it during workup — raises many questions at once. What kind of lymphoma is it? How serious is it? What does treatment look like, and how long will it take? Will life return to normal afterward?

This guide is written for adults who have been diagnosed with lymphoma, are being investigated for it, or are supporting a family member through it. It explains what lymphoma is, the main types, how doctors stage and treat it, and what to expect during and after treatment. A separate section addresses lymphoma in children, because paediatric care follows different protocols.

Lymphoma is among the better-studied cancers, and many forms respond well to current treatment. The medical landscape has changed substantially over the past two decades with the addition of immunotherapy, targeted drugs, and cellular therapies. The aim of this article is to give you a clear picture of where things stand today so that conversations with your haematologist or oncologist feel less overwhelming.

What Is Lymphoma?

Lymphoma is a cancer that starts in lymphocytes, a type of white blood cell that is part of your body’s immune system. Lymphocytes circulate through the lymphatic system — a network of vessels, lymph nodes, and organs (including the spleen, thymus, tonsils, and parts of the bone marrow) that helps your body recognise and fight infection.

When a lymphocyte develops genetic changes that cause it to grow and divide uncontrollably, it can accumulate in lymph nodes and other tissues, forming a tumour. Because lymphocytes travel throughout the body, lymphoma can appear in many sites — sometimes in a single lymph node region, sometimes in several regions at once, and sometimes outside the lymphatic system entirely (for example in the stomach, skin, or brain).

Lymphoma is different from leukaemia, although both are blood cancers. Leukaemia generally starts in the bone marrow and spreads through the blood; lymphoma generally starts in lymph nodes or other lymphatic tissue. The two can overlap, and some conditions (such as chronic lymphocytic leukaemia and small lymphocytic lymphoma) are now understood to be the same disease behaving in different patterns.

Lymphoma is not contagious. You cannot catch it from another person or pass it to your family. It is also not caused by anything you did or did not do in your day-to-day life.

Types of Lymphoma

Lymphoma is divided into two broad categories that look different under the microscope and are treated differently:

• Hodgkin lymphoma (HL)
• Non-Hodgkin lymphoma (NHL)

Within each category there are many subtypes. The subtype matters because it determines how the lymphoma typically behaves and which treatments are most effective.

Hodgkin Lymphoma

Hodgkin lymphoma is identified by the presence of a particular abnormal cell called a Reed–Sternberg cell, seen on biopsy. It often starts in lymph nodes in the upper body — the neck, chest, or under the arms — and tends to spread in a predictable, stepwise pattern through neighbouring lymph node groups. The main subtypes are classical Hodgkin lymphoma (which has several variants) and nodular lymphocyte-predominant Hodgkin lymphoma. Hodgkin lymphoma is among the most responsive cancers to treatment, and cure is a realistic goal for many patients, particularly when caught at earlier stages.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma is a much larger and more diverse group — the World Health Organization classification lists dozens of distinct subtypes. They are usually grouped first by the cell of origin (B-cell or T-cell) and then by how quickly they grow.

Aggressive (fast-growing) B-cell lymphomas include:

• Diffuse large B-cell lymphoma (DLBCL) — the most common type of non-Hodgkin lymphoma. It grows quickly but responds well to combination chemoimmunotherapy.
• Burkitt lymphoma — very fast-growing but often curable with intensive chemotherapy.
• Mantle cell lymphoma — tends to behave more aggressively and often requires intensive initial treatment.
• Primary mediastinal B-cell lymphoma — appears as a mass in the chest, more common in young adults.

Indolent (slow-growing) B-cell lymphomas include:

• Follicular lymphoma — the most common slow-growing type.
• Marginal zone lymphoma — including MALT lymphoma, which can be associated with chronic inflammation or infection in certain organs.
• Small lymphocytic lymphoma (SLL) / chronic lymphocytic leukaemia (CLL) — two presentations of the same disease.
• Waldenström macroglobulinaemia (lymphoplasmacytic lymphoma).

T-cell and NK-cell lymphomas are less common overall and include peripheral T-cell lymphoma, anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma, cutaneous T-cell lymphomas (such as mycosis fungoides), and others. T-cell lymphomas often need different treatment regimens than B-cell lymphomas.

Indolent lymphomas grow slowly and may not need immediate treatment, though they can be difficult to fully eliminate. Aggressive lymphomas grow quickly and need prompt treatment but, paradoxically, often respond very well to it and can be cured.

Causes and Risk Factors

In most people with lymphoma, no single cause can be identified. Lymphoma develops because of genetic changes inside lymphocytes that occur over time. Several factors are linked to a higher risk, but most people with these factors never develop lymphoma, and many people with lymphoma have none of them.

Known associations include:

• Age. Most non-Hodgkin lymphomas become more common with age. Hodgkin lymphoma has a different pattern, with peaks in young adulthood and again later in life.
• Weakened immune system. People living with HIV, organ transplant recipients on immunosuppressive medication, and those with inherited immune deficiencies have higher risk.
• Autoimmune disease. Conditions such as rheumatoid arthritis, Sjögren’s syndrome, lupus, and coeliac disease have been associated with higher risk for certain lymphoma subtypes.
• Infections. Epstein–Barr virus (EBV), human T-lymphotropic virus (HTLV-1), hepatitis C, HIV, and Helicobacter pylori (linked to gastric MALT lymphoma) are connected to specific lymphoma types.
• Family history. A first-degree relative with lymphoma slightly increases risk, though most lymphoma is not inherited.
• Previous cancer treatment. Some patients treated with chemotherapy or radiation for an earlier cancer have a higher long-term risk of developing lymphoma.
• Chemical and occupational exposures. Long-term exposure to certain pesticides, solvents, and industrial chemicals has been studied as a possible factor.

Lifestyle factors play a smaller role in lymphoma than in many other cancers. Smoking and alcohol are not strongly linked to most lymphomas, although general health remains important during treatment.

Signs and Symptoms

If you have already been diagnosed, you may have noticed some of the symptoms below before your tests; if you are in the middle of investigation, this section will help you understand why certain features were considered concerning.

The most common feature of lymphoma is one or more painless swollen lymph nodes — usually in the neck, under the arms, or in the groin. Unlike infection-related swellings, lymphoma nodes tend to be firm, painless, and persistent over weeks.

Other features may include:

• Unexplained fevers, particularly recurring episodes without obvious infection
• Heavy drenching night sweats that require changing bedclothes
• Unintended weight loss (more than 10% of body weight over six months)
• Persistent fatigue not explained by sleep or activity
• Itching of the skin without rash
• A cough, shortness of breath, or chest discomfort if nodes in the chest are enlarged
• Abdominal swelling, early fullness when eating, or pain if abdominal nodes or the spleen are involved
• Skin nodules or rashes in cutaneous lymphomas

The combination of fever, night sweats, and weight loss is known as “B symptoms” and is recorded as part of staging, because their presence affects prognosis and treatment planning.

Diagnosis and Staging

Confirming a diagnosis of lymphoma and identifying its exact subtype takes several steps. Doctors avoid starting treatment until the subtype is clearly known, because treatments differ.

Biopsy

A lymph node biopsy is essential for diagnosis. Whenever possible, an entire lymph node (excisional biopsy) is removed rather than just a small sample, because pathologists need to study how the cells are arranged in the node, not only the cells themselves. In some situations a needle core biopsy is used, particularly when the suspicious node is deep inside the body.

The biopsy is examined under the microscope and tested with several specialised techniques:

• Immunohistochemistry and flow cytometry (immunophenotyping) — identify protein markers on the cell surface that classify the lymphoma as B-cell, T-cell, Hodgkin, or another type
• Cytogenetic and molecular tests — look for specific chromosome and gene changes that refine the diagnosis and may guide treatment

Staging Investigations

Once lymphoma is confirmed, the next step is to find out where it has spread. This is called staging and is usually done with:

• PET-CT scan — the most informative imaging test for most lymphomas, combining a CT scan with a metabolic scan that highlights active lymphoma tissue
• CT scans of the neck, chest, abdomen, and pelvis where PET is not used
• Bone marrow biopsy, taken from the back of the pelvis under local anaesthetic, used in selected cases to check whether the lymphoma involves the marrow
• Blood tests, including a full blood count, liver and kidney function, lactate dehydrogenase (LDH), and viral screening (hepatitis B and C, HIV)
• Heart function tests such as an echocardiogram, because some chemotherapy drugs affect the heart
• Lumbar puncture in selected aggressive lymphomas, to check for involvement of the fluid around the brain and spinal cord

The international system most commonly used to stage lymphoma is the Lugano classification, which assigns stage I to IV based on how many lymph node regions and which other organs are involved. The presence of B symptoms is noted as “B,” their absence as “A.” For some subtypes, additional scoring systems such as the International Prognostic Index (IPI for diffuse large B-cell lymphoma) or FLIPI (for follicular lymphoma) are used to estimate risk and guide treatment intensity.

Treatment Approach

Lymphoma treatment depends on the subtype, the stage, the speed of growth, age, overall health, and the patient’s own preferences after discussion with the care team. The same drug regimens are used worldwide, with national and international guidelines (such as those from the NCCN and ESMO) providing the framework.

Most patients are treated with a combination of approaches rather than a single therapy. The major treatment modalities are described below.

Active Surveillance (“Watch and Wait”)

For some slow-growing lymphomas — particularly low-volume follicular lymphoma, early-stage marginal zone lymphoma, and asymptomatic CLL/SLL — immediate treatment does not improve long-term outcomes. Studies have shown that starting treatment only when symptoms appear or the disease progresses is as effective as treating earlier, while sparing patients side effects. Active surveillance involves regular clinic visits, blood tests, and periodic imaging. Many patients find this approach emotionally difficult at first, and it takes time and trust to feel comfortable with it.

Chemotherapy

Chemotherapy is the foundation of treatment for most lymphomas. It uses combinations of drugs given through a vein (and sometimes by mouth) to destroy rapidly dividing cancer cells. Standard regimens are known by acronyms drawn from the drug names — for example, ABVD or BEACOPP for Hodgkin lymphoma, and CHOP (often combined with rituximab as R-CHOP) for many B-cell non-Hodgkin lymphomas. Treatment is given in cycles, with each cycle followed by a rest period of one to three weeks to allow the body to recover. A typical course involves four to eight cycles.

Immunotherapy

Immunotherapy uses the body’s own immune system to attack lymphoma cells. The most established form in lymphoma is the use of monoclonal antibodies — laboratory-made proteins that lock onto specific markers on lymphoma cells. Rituximab, which targets the CD20 protein on B-cells, is now combined with chemotherapy for nearly all B-cell lymphomas and has substantially improved outcomes since its introduction. Newer antibodies (such as obinutuzumab and bispecific antibodies that engage T-cells against lymphoma) are now part of treatment for selected patients.

A second class of immunotherapy, checkpoint inhibitors (such as nivolumab and pembrolizumab), releases the brakes on the immune system and is particularly effective in classical Hodgkin lymphoma that has come back after standard treatment.

Targeted Therapy

Targeted drugs are designed to interfere with specific molecules inside lymphoma cells. Examples include BTK inhibitors (ibrutinib, acalabrutinib, zanubrutinib) used in mantle cell lymphoma, CLL/SLL, and Waldenström’s, and BCL-2 inhibitors (venetoclax) used in selected B-cell lymphomas. Antibody-drug conjugates such as brentuximab vedotin deliver chemotherapy directly to cells carrying a specific marker and are used in Hodgkin lymphoma and certain T-cell lymphomas. Targeted therapies are often better tolerated than traditional chemotherapy but bring their own side effects and require careful monitoring.

Radiation Therapy

Radiation therapy uses focused high-energy beams to destroy lymphoma cells in a defined area. It plays a smaller role than it once did in lymphoma care, but it remains valuable for early-stage Hodgkin lymphoma (often combined with shorter chemotherapy), localised aggressive lymphomas, certain cutaneous lymphomas, and to control symptoms when a particular site of disease is causing pain or pressure. Modern radiation techniques use smaller fields and lower doses than in the past, which has reduced long-term side effects.

Stem Cell Transplant (Bone Marrow Transplant)

A stem cell transplant allows doctors to give very high doses of chemotherapy — high enough to destroy lymphoma but also high enough to destroy the bone marrow — and then rescue the patient with healthy stem cells that rebuild the blood and immune system. It is used when lymphoma has come back after initial treatment, when it has not responded well, or in selected high-risk situations.

Two main types are used:

• Autologous transplant — the patient’s own stem cells are collected before high-dose chemotherapy and returned afterwards. This is the more common transplant in lymphoma.
• Allogeneic transplant — stem cells come from a matched donor, often a sibling or an unrelated donor identified through a registry. Allogeneic transplants carry higher risks but offer an additional “graft-versus-lymphoma” effect and are used in selected aggressive or relapsed lymphomas.

CAR T-Cell Therapy

Chimeric antigen receptor (CAR) T-cell therapy is a newer form of cellular immunotherapy in which a patient’s own T-cells are collected, genetically modified in a laboratory to recognise lymphoma cells, and then infused back into the patient. It is approved for several aggressive B-cell lymphomas that have not responded to standard treatment or have relapsed, and it has produced durable remissions in patients who previously had few options. CAR T-cell therapy is offered at specialised centres and involves an intensive treatment and monitoring period.

Treatment by Lymphoma Type: A Summary

Treatment decisions are made individually, but some broad patterns are useful to understand.

• Hodgkin lymphoma: Most patients receive combination chemotherapy (such as ABVD), sometimes with radiation for early-stage disease. Response is monitored with interim PET-CT scans, and the regimen may be adjusted based on response. Brentuximab vedotin and checkpoint inhibitors are options for relapsed disease, often followed by autologous transplant.
• Diffuse large B-cell lymphoma: First-line treatment is usually R-CHOP or a similar regimen, given for six cycles. Most patients achieve remission with first-line treatment; for those who relapse, options include intensified chemotherapy followed by autologous transplant or CAR T-cell therapy.
• Follicular lymphoma: Asymptomatic patients with low-volume disease may be observed. When treatment is needed, options include rituximab alone, rituximab with chemotherapy, or targeted therapies. Multiple lines of treatment may be used over years.
• Mantle cell lymphoma: Intensive chemoimmunotherapy is common in younger fit patients, often followed by autologous transplant. BTK inhibitors are central to treatment of relapsed disease.
• Burkitt lymphoma: Treated with intensive, short-duration chemotherapy regimens that include treatment to protect the brain and spinal cord.
• CLL/SLL: Often observed when asymptomatic. When treatment is needed, BTK inhibitors and venetoclax-based regimens have largely replaced traditional chemotherapy for most patients.
• T-cell lymphomas: Treatment varies considerably by subtype; clinical trial participation is often considered because outcomes with standard chemotherapy are less predictable than for B-cell lymphomas.

Preparing for Treatment

The time between diagnosis and the first treatment cycle is usually used for preparation. This typically includes:

• Baseline tests of blood counts, kidney and liver function, and heart function
• Screening for viral infections (hepatitis B and C, HIV) because some treatments can reactivate dormant viruses
• Dental review to address infections that could cause problems during chemotherapy
• Vaccinations that can be given before treatment begins (live vaccines are usually avoided)
• Fertility preservation counselling — sperm banking, egg or embryo freezing, or ovarian tissue preservation, depending on age, sex, and the treatment planned. This is particularly important for younger patients and those receiving regimens with a higher risk of permanent infertility.
• Placement of a central venous catheter or port for repeated infusions, in many patients
• Nutritional and psychological assessment

This is also the time to ask your team practical questions: how often you will need to come in, what side effects to expect, when to call urgently, who to contact between appointments, and what support is available for family members.

Side Effects and How They Are Managed

Side effects depend on the specific drugs used. Some are common across many regimens; others are specific to particular drugs.

Common short-term side effects include:

• Fatigue, often the most persistent symptom during treatment
• Nausea and vomiting, which modern anti-nausea medications can largely prevent
• Hair loss, depending on the regimen
• Low blood counts: low white cells increase infection risk, low red cells cause tiredness and breathlessness, low platelets increase bruising and bleeding
• Mouth sores and changes in taste
• Constipation or diarrhoea
• Skin changes
• Numbness or tingling in hands and feet (peripheral neuropathy) with certain drugs

Drug-specific effects may include heart function changes (some anthracyclines), lung effects (bleomycin), kidney effects, allergic reactions during infusion (some monoclonal antibodies), or immune-related side effects (checkpoint inhibitors). CAR T-cell therapy carries unique risks including cytokine release syndrome and neurological effects, which is why it is delivered with intensive monitoring.

Long-term effects to monitor for include:

• Second cancers, including a small long-term risk after some lymphoma treatments
• Heart and lung effects from earlier therapies
• Thyroid dysfunction after radiation to the neck
• Reduced fertility
• Early menopause in women
• Bone thinning

Modern treatment regimens are designed to reduce these long-term risks while maintaining effectiveness. Survivorship clinics in many cancer centres provide structured follow-up to detect late effects early.

Response and Monitoring

During treatment, your team will assess how the lymphoma is responding. For many lymphomas, an interim PET-CT scan partway through chemotherapy gives important information about how the disease is responding and whether the regimen should be continued, intensified, or de-escalated.

At the end of treatment, response is classified using standardised criteria (the Lugano response criteria):

• Complete response — no detectable lymphoma on imaging and other tests
• Partial response — significant shrinkage but some disease remains
• Stable disease — little change
• Progressive disease — the lymphoma has grown despite treatment

After treatment ends, follow-up usually involves clinic visits every few months in the first two years, then less frequently. Imaging is used when symptoms or examination findings suggest the need, rather than on a fixed schedule for all patients. Most lymphoma recurrences happen in the first two to three years after treatment, although some indolent lymphomas can recur later.

Combining With Other Treatments and Clinical Trials

Lymphoma care often combines several modalities — chemotherapy with immunotherapy, chemoimmunotherapy followed by radiation to a specific site, or chemotherapy followed by transplant. The sequencing is planned by the care team based on subtype and stage.

Clinical trials have driven the major advances in lymphoma over recent decades. Many patients are offered the chance to take part in trials that test new drugs, new combinations, or new ways of giving existing treatments. Trial participation does not mean receiving experimental treatment instead of standard care — most trials compare a current standard with a possible improvement, and both groups receive close monitoring. Discussing trial availability with your haematologist is reasonable at any stage of treatment.

Living During and After Treatment

Treatment for lymphoma is demanding, but many patients continue to work, study, and care for their families during it, particularly between cycles. The first few days after each cycle are often the hardest; energy and appetite usually improve before the next cycle starts.

Practical points that many patients find useful:

• Infection precautions: handwashing, avoiding crowds during the period of lowest blood counts (usually around 7–14 days after each cycle), and contacting the team promptly for fever above 38°C
• Eating well: small frequent meals, food safety (avoiding undercooked meat, unpasteurised dairy, raw seafood), staying well hydrated
• Physical activity: gentle daily activity such as walking, increased as tolerated, helps reduce fatigue and maintain strength
• Mental health: anxiety and low mood are common; talking openly with the care team about emotional symptoms is as important as reporting physical ones. Counselling, peer support groups, and short courses of medication can all help.
• Sleep and rest: prioritising sleep helps the body recover between cycles
• Family and work conversations: many people benefit from arranging support in advance for the days after each cycle and being honest with employers about likely absences

After treatment ends, the transition to follow-up can be unexpectedly difficult emotionally. Many patients describe a mix of relief and anxiety as the regular reassurance of treatment visits gives way to longer gaps between appointments. This is a normal experience and worth raising with the care team.

Lymphoma in Children

Lymphoma is one of the more common cancers in children and adolescents, but childhood lymphoma differs from adult lymphoma in important ways, and it is treated by paediatric oncology teams using paediatric-specific protocols.

The main childhood lymphomas are:

• Hodgkin lymphoma — more common in older children and teenagers
• Burkitt lymphoma — an aggressive but highly treatable B-cell lymphoma
• Lymphoblastic lymphoma — closely related to acute lymphoblastic leukaemia and treated with similar regimens
• Diffuse large B-cell lymphoma
• Anaplastic large cell lymphoma — a T-cell lymphoma seen more often in children than adults

Childhood lymphomas tend to grow quickly but also respond very well to treatment, and cure rates are high. Paediatric chemotherapy protocols are often more intensive than adult regimens of the same name but are designed to minimise long-term effects on growth, development, fertility, and organ function.

Care for a child with lymphoma usually includes:

• A paediatric haematology-oncology team experienced in childhood lymphoma protocols
• A central venous catheter for repeated infusions, often used for the whole treatment course
• Schooling support, with hospital-based teaching during inpatient stays and a plan for gradual return to school
• Psychological support for the child and siblings
• Long-term follow-up clinics that monitor for late effects on heart, lungs, thyroid, fertility, growth, and second cancers, often for decades after treatment

Parents often find it useful to ask the paediatric team specifically about long-term follow-up planning, fertility considerations (which apply even to very young children), and how to talk to the child about their illness in age-appropriate ways.

Frequently Asked Questions

Is lymphoma curable?

Many lymphomas can be cured, particularly Hodgkin lymphoma and several aggressive B-cell lymphomas such as diffuse large B-cell lymphoma and Burkitt lymphoma. Slow-growing lymphomas such as follicular lymphoma are often not cured but can be controlled over many years, sometimes decades, with treatment when needed and observation in between. Cure or long-term control is realistic for the majority of patients today.

Will I definitely need chemotherapy?

Not always. Some indolent lymphomas are managed with observation, and some treatments rely mainly on immunotherapy, targeted drugs, or radiation. However, chemotherapy in some form is still part of the treatment plan for most aggressive lymphomas, usually combined with other modalities.

How long does treatment last?

Treatment length depends on the subtype and regimen. Aggressive lymphomas are often treated with three to six months of intensive therapy. Indolent lymphomas may be treated in shorter courses with longer maintenance, or in a series of courses over years. Stem cell transplant adds several weeks of intensive treatment and several months of recovery. Your care team will give you a specific timeline once the plan is set.

Can lymphoma come back?

Yes, relapse is possible, which is why follow-up is important. Most relapses occur in the first two to three years after treatment. When lymphoma relapses, further treatment is usually available, often including stem cell transplant or CAR T-cell therapy for suitable patients. Some patients who relapse can still achieve long-term remission with second-line treatment.

Will treatment affect my fertility?

Some lymphoma treatments — particularly higher-dose chemotherapy regimens, pelvic radiation, and stem cell transplant — can reduce fertility temporarily or permanently. Fertility preservation options should be discussed before treatment starts whenever possible. Younger patients and milder regimens often retain fertility, but this varies and should be discussed individually.

Is it safe to be vaccinated during lymphoma treatment?

Inactivated vaccines (such as flu and many COVID-19 vaccines) are generally safe and may be recommended, although the immune response may be reduced during treatment. Live vaccines are usually avoided during and for a period after treatment. Your care team will give specific advice for your situation.

Should family members be tested?

Most lymphoma is not inherited, and routine testing of family members is not recommended. A small number of lymphomas are linked to specific genetic syndromes, in which case a clinical geneticist may be involved.

How will I know if the lymphoma is coming back?

Possible signs of recurrence include new or returning swollen lymph nodes, recurrence of B symptoms (drenching night sweats, unexplained fevers, weight loss), or new persistent symptoms in the area where lymphoma was previously present. Any of these should be reported promptly to the haematology team rather than waited on until the next scheduled visit.

Conclusion

Lymphoma is a complex group of diseases, but it is also one of the cancers where treatment has improved most over the past generation. Modern care combines accurate diagnosis through advanced pathology, careful staging with PET-CT, treatment chosen for the specific subtype, and structured follow-up to detect any recurrence or long-term effects early.

Many patients reach long-term remission or cure; others live with lymphoma as a managed condition over many years. Understanding your subtype, the reasoning behind the treatment plan, and the rhythm of treatment cycles, scans, and follow-up visits can make the journey less disorienting. The conversations you have with your haematologist or oncologist remain the most important source of guidance specific to your situation — this article is intended to help those conversations feel more familiar and less daunting.