Non-Hodgkin lymphoma (all types)
Non-Hodgkin lymphoma is not one disease but a family of about sixty cancers of B cells, T cells or NK cells, from slow-growing follicular lymphoma to aggressive diffuse large B-cell and Burkitt lymphomas. This page is the map; each subtype has its own page with its own treatment.
Overview
Non-Hodgkin lymphoma (NHL) covers every lymphoma that is not Hodgkin lymphoma. Around 85 to 90% arise from B cells, the rest from T or NK cells. The WHO classification recognises dozens of subtypes, and treatment depends far more on the subtype than on the stage: aggressive B-cell lymphomas such as diffuse large B-cell lymphoma are treated to cure with R-CHOP or Pola-R-CHP and, at relapse, CAR-T or bispecific antibodies; indolent lymphomas such as follicular and marginal zone lymphoma are often watched and then controlled for years with rituximab-based therapy; mantle cell lymphoma and chronic lymphocytic leukaemia (the same disease as small lymphocytic lymphoma) are now largely managed with BTK and BCL2 inhibitors; T-cell lymphomas remain the hardest to treat. The subtype pages below carry the detail; this page exists so that a reader who has only been told 'lymphoma' can find the right one.
State of the art
Anatomy and lymph node drainage
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
- Bone marrow (leukaemia, MDS, MPN, myeloma)Diffuse large B-cell lymphoma · Chronic lymphocytic leukaemia / small lymphocytic lymphoma · Burkitt lymphoma · Waldenström macroglobulinaemia (lymphoplasmacytic lymphoma) · Peripheral T-cell lymphomas · Cutaneous T-cell lymphomas
- Lymph node germinal centre (lymphomas)Follicular lymphoma · Mantle cell lymphoma
- SpleenMarginal zone lymphoma
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sitesPrimary CNS lymphoma · Cutaneous T-cell lymphomas
- cervical
- axillary
- mediastinal
- para-aortic and mesenteric
- inguinal
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD)
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- About 544,000 new cases and 260,000 deaths worldwide in 2020 (GLOBOCAN); the commonest blood cancer, with some 60 subtypes ranging from slow-growing to very aggressive.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Curative immunochemotherapy (R-CHOP or Pola-R-CHP); CAR-T or bispecific antibodies at relapse. See the DLBCL page.
Watch and wait when asymptomatic; rituximab alone or with bendamustine or CHOP when treatment is needed; bispecifics and CAR-T for later relapses. See the follicular lymphoma page.
BTK inhibitors and venetoclax-based regimens have largely replaced chemotherapy. See the mantle cell and CLL pages.
CHOP-based chemotherapy, brentuximab vedotin for CD30-positive disease, transplant in first remission for fit patients. See the peripheral T-cell lymphoma page.
Subtypes & biomarkers
top- Diffuse large B-cell lymphoma
- Follicular lymphoma
- Marginal zone lymphoma
- Mantle cell lymphoma
- Chronic lymphocytic leukaemia / small lymphocytic lymphoma
- Burkitt lymphoma
- Waldenström macroglobulinaemia (lymphoplasmacytic lymphoma)
- Primary CNS lymphoma
- Peripheral T-cell lymphomas
- Cutaneous T-cell lymphomas
- HIV-associated lymphomas
- Immunophenotype (CD20, CD5, CD10, CD30 and others) that assigns the subtype
- MYC, BCL2 and BCL6 rearrangements (high-grade B-cell lymphoma)
- Ki-67 proliferation index
- Interim and end-of-treatment PET (Deauville score)
- Cell of origin (germinal centre versus activated B-cell) in DLBCL
How often this target appears
- 1997Rituximab approved, the first antibody for a cancer
Anti-CD20 rituximab for relapsed follicular lymphoma; added to CHOP it raised cure rates in diffuse large B-cell lymphoma.
- 2017First CAR-T for lymphoma
Axicabtagene ciloleucel approved for relapsed large B-cell lymphoma after two or more lines.
- 2023Bispecific antibodies approved
Glofitamab and epcoritamab, off-the-shelf CD20 x CD3 antibodies, approved for relapsed large B-cell lymphoma.
Open problems and what is being done
Relapsed T-cell lymphomas still lack effective options.
and how the field plans to fix it →What is being done about thisRecurrence and residual diseaseAvailable now- EpcoritamabApproved
- Obecabtagene autoleucelApproved
- Liquid biopsy (ctDNA)Standard of care
- MRD / molecular residual disease testingEstablished
- Multiparameter flow cytometry MRDStandard of care
- NGS-based MRD (clonoSEQ and molecular MRD)Standard of care
In trials- ADAURAPositive
- CAMBRIA-1 & CAMBRIA-2Active
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
- ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ)Emerging
- DYNAMICPositive
- IMvigor011Positive
Ideas and roadmaps- A blood test for the pre-metastatic niche
- A bone marrow niche on a chip to study human dormancy
- A dedicated clinic for people whose blood test says the cancer is back
- A drug screen that only rewards killing sleeping cancer cells
- A national platform trial that every ctDNA-positive patient can join
- A national residual-disease weather service: serial blood tests for every curatively treated patient, pooled
Background: Circulating tumour DNA (ctDNA), Disseminated tumour cells (DTCs), Late recurrence, Minimal / molecular residual disease (MRD), MRD negativity (myeloma, 10⁻⁵ / 10⁻⁶). Also on OnCo: Treatment journeys · Survivorship planner.
Access to CAR-T and bispecifics outside high-income countries.
and how the field plans to fix it →What is being done about thisCost and accessAvailable now- HPV & HBV vaccinationStandard of care
- ImatinibApproved
- Trastuzumab biosimilarsApproved
In trials- Gefitinib vs gefitinib plus pemetrexed-carboplatin in EGFR-mutant lung cancer (Tata Memorial)Positive
- IARC India HPV vaccine dose study (one, two or three doses)Positive
- IMAGINE (varnimcabtagene autoleucel, Immuneel)Positive
- Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial)Positive
- Low-dose olanzapine for cancer anorexia (Tata Memorial)Positive
- METRO PLUS (Tata Memorial Centre, Varanasi)Positive
Ideas and roadmaps- 90-day reliance approval for cancer drugs cleared by two stringent regulators
- A cheap old tablet to restore appetite
- A combination pricing rule so two-drug regimens are not priced as two monopolies
- A coordinated reserve and shared schedule for the world's medical isotope reactors
- A dedicated global financing window for cancer, modelled on the Global Fund
- A delinked market-entry reward paid by payers when a repurposed generic wins approval
Background: Accelerated approval, Biosimilar, Real-world evidence. Also on OnCo: Financial help · Coverage by country · HTA decisions.
Trials
topTrials recruiting now
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Expert centres
topExpert centres
- LYSA (The Lymphoma Study Association)Pierre-Bénite (Lyon), FRvia Glofitamab, Axicabtagene ciloleucel
- BC CancerVancouver, BC, CAvia Brentuximab vedotin
- German Hodgkin Study GroupCologne, DEvia Brentuximab vedotin
- HOVONRotterdam, NLvia Venetoclax
- via Glofitamab
- The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research InstituteColumbus, OH, USNCI comprehensivevia Ibrutinib
- Walter and Eliza Hall Institute of Medical ResearchMelbourne, AUvia Venetoclax
Questions to ask
topQuestions to ask your oncologist about Non-Hodgkin lymphoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Immunophenotypethat assigns the subtype, MYC, BCL2 and BCL6 rearrangements, Ki-67 proliferation index, Interim and end-of-treatment PET, Cell of originin DLBCL), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Diffuse large B-cell lymphoma, Follicular lymphoma, Marginal zone lymphoma.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Aggressive B-cell (DLBCL and related)
- For my situation (aggressive b-cell (dlbcl and related)), which of the standard options do you recommend and why?Why: Guideline options include: Curative immunochemotherapy (R-CHOP or Pola-R-CHP); CAR-T or bispecific antibodies at relapse. See the DLBCL page.
- Am I a candidate for Rituximab, Polatuzumab vedotin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Indolent B-cell (follicular, marginal zone)
- For my situation (indolent b-cell (follicular, marginal zone)), which of the standard options do you recommend and why?Why: Guideline options include: Watch and wait when asymptomatic; rituximab alone or with bendamustine or CHOP when treatment is needed; bispecifics and CAR-T for later relapses. See the follicular lymphoma page.
- Am I a candidate for Rituximab, Bendamustine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Mantle cell lymphoma and CLL
- For my situation (mantle cell lymphoma and cll), which of the standard options do you recommend and why?Why: Guideline options include: BTK inhibitors and venetoclax-based regimens have largely replaced chemotherapy. See the mantle cell and CLL pages.
- Am I a candidate for Ibrutinib, Venetoclax, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
T-cell lymphomas
- For my situation (t-cell lymphomas), which of the standard options do you recommend and why?Why: Guideline options include: CHOP-based chemotherapy, brentuximab vedotin for CD30-positive disease, transplant in first remission for fit patients. See the peripheral T-cell lymphoma page.
- Am I a candidate for Brentuximab vedotin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Glofitamab, Epcoritamab, Mosunetuzumab, Obecabtagene autoleucel?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Relapsed T-cell lymphomas still lack effective options”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Access to CAR-T and bispecifics outside high-income countries”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
6targets
6drugs
11companies
9Latest papers
topQuery for this cancer: (TITLE:"Non-Hodgkin lymphoma" OR ABSTRACT:"Non-Hodgkin lymphoma" OR TITLE:"all types" OR ABSTRACT:"all types" OR TITLE:"Non-Hodgkin Lymphoma" OR ABSTRACT:"Non-Hodgkin Lymphoma" OR TITLE:"NHL" OR ABSTRACT:"NHL" OR TITLE:"Non-Hodgkin's lymphoma" OR ABSTRACT:"Non-Hodgkin's lymphoma" OR TITLE:"Lymphoma non-Hodgkin" OR ABSTRACT:"Lymphoma non-Hodgkin") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Non-Hodgkin lymphoma (all types), not a curated reading list.
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