The first 60 days: 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. Below, week by week, is what OnCo's record of Non-Hodgkin lymphoma (all types) says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- Medical oncologistNamed in the standard of care for: Aggressive B-cell (DLBCL and related), Indolent B-cell (follicular, marginal zone), Mantle cell lymphoma and CLL, T-cell lymphomas.
- Transplant and cell therapy teamNamed in the standard of care for: Aggressive B-cell (DLBCL and related), Indolent B-cell (follicular, marginal zone), T-cell lymphomas.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?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?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?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?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?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?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?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?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?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?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?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?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?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?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?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- A Clinical Trial to Evaluate Efficacy, Safety, and Pharmacokinetics of Gamunex in Participants With Chronic Lymphocytic Leukemia, Multiple Myeloma, or Non-Hodgkin LymphomaPhase 3 · recruiting · NCT07582432An Open-label, Multi-Center, Single-arm Prospective Clinical Trial to Evaluate Efficacy, Safety, and Pharmacokinetics of Gamunex®-C Plus Standard Medical Treatment to Prevent Infections in Participants With Secondary Antibody Deficiency Associated With Chronic Lymphocytic Leukemia, Multiple Myeloma, or Non-Hodgkin Lymphoma
- A Study of Duvelisib Versus Gemcitabine or Bendamustine in Participants With Relapsed/Refractory Nodal T Cell Lymphoma With T Follicular Helper (TFH) PhenotypePhase 3 · recruiting · NCT06522737A Multicentre, Open-label, Phase 3, Randomised Controlled Trial of Duvelisib Versus Investigator's Choice of Gemcitabine or Bendamustine in Patients With Relapsed/Refractory Nodal T Cell Lymphoma With T Follicular Helper (TFH) Phenotype
- A Study of Nemtabrutinib Plus Venetoclax vs Venetoclax + Rituximab (VR) in Second-line (2L) + Relapsed/Refractory (R/R) Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) (MK-1026-010/BELLWAVE-010).Phase 3 · recruiting · NCT05947851A Phase 3, Open-label, Randomized Study to Compare the Efficacy and Safety of Nemtabrutinib (MK-1026) Plus Venetoclax Versus Venetoclax Plus Rituximab in Participants With Relapsed/Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Following at Least 1 Prior Therapy (BELLWAVE-010)
- A Study to Evaluate Efficacy, Safety, and PK of XEMBIFY®+Standard Medical Treatment (SMT) Compared to Placebo+SMT to Prevent Infections in Participants With HGG and Recurrent or Severe Infections Associated With B-cell Chronic Lymphocytic Leukemia, Multiple Myeloma, and Non-Hodgkin LymphomaPhase 3 · recruiting · NCT05645107A Randomized, Multi-Center, Parallel, Double-Blinded, Placebo-Controlled Clinical Trial to Evaluate Efficacy, Safety, and Pharmacokinetics of XEMBIFY® Plus Standard Medical Treatment Compared to Placebo Plus Standard Medical Treatment to Prevent Infections in Patients With Hypogammaglobulinemia and Recurrent or Severe Infections Associated With B-cell Chronic Lymphocytic Leukemia, Multiple Myeloma, and Non-Hodgkin Lymphoma
- A Study to Evaluate Glofitamab as a Single Agent vs. Investigator's Choice in Participants With Relapsed/Refractory Mantle Cell LymphomaPhase 3 · recruiting · NCT06084936A Phase III, Open-Label, Multicenter Randomized Study Evaluating Glofitamab as a Single Agent Versus Investigator's Choice in Patients With Relapsed/Refractory Mantle Cell Lymphoma
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Non-Hodgkin lymphoma (all types): the full pageNon-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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.