Non-Hodgkin lymphoma

Last revised by Mariam Piloyan on 24 Jan 2025

Non-Hodgkin lymphoma (NHL) is a neoplasm of the lymphoid tissues originating from B cell precursors, mature B cells, T cell precursors, and mature T cells. It includes all types of lymphomas apart from Hodgkin lymphoma.

See the WHO classification of haematolymphoid tumors for further information on subtypes. 

Up to two-thirds of patients present with peripheral lymphadenopathy. ~50% of patients develop extranodal disease (secondary extranodal disease) during the course of their disease, while between ~25% (range 10-35%) of patients have primary extranodal lymphoma at diagnosis.

Less common presenting symptoms include:

Symptoms of primary gastrointestinal (GI) tract lymphoma include:

  • nausea and vomiting

  • aversion to food

  • weight loss

  • fullness of the abdomen

  • early satiety

  • visceral obstruction-related symptoms

  • features of acute perforation and gastrointestinal bleeding

  • features of malabsorption syndrome

Symptoms of primary central nervous system (CNS) lymphoma include:

  • headaches

  • features of spinal cord compression

  • lethargy

  • focal neurologic deficits

  • seizures

  • paralysis

Management is highly variable depending on the exact type and staging of non-Hodgkin lymphoma, but generally, management options include:

  • chemoimmunotherapy

    • e.g. regimens such as R-CHOP (rituximab + cyclophosphamide + doxorubicin hydrochloride + vincristine + prednisolone) for some types of diffuse large B-cell lymphoma

    • e.g. regimens such as R-CODOX-M/IVAC (rituximab + cyclophosphamide + vincristine + doxorubicin + high-dose methotrexate, alternating with ifosfamide + etoposide + cytarabine) for some types of Burkitt lymphoma

  • radiation therapy, e.g. for early stage follicular lymphoma

  • hematopoietic stem cell transplantation: usually only in refractory disease

  • chimeric antigen receptor (CAR)-T cell therapy: usually only in refractory disease

Management options for non-Hodgkin lymphoma is a very dynamic field, with many new and trial/experimental therapies being utilized.

Non-Hodgkin lymphoma can be divided into two groups, "indolent" and "aggressive", based on the prognosis.

Indolent lymphoma:

Aggressive lymphoma:

  • often associated with non-specific B symptoms such as weight loss, night sweats, and fever, and can result in death within a few weeks if untreated

  • e.g. diffuse large B cell lymphoma (DLBCL), Burkitt lymphoma, precursor B and T cell lymphoblastic leukemia/lymphoma, adult T cell leukemia/lymphoma, and certain other peripheral T cell lymphomas

Cases and figures

  • Case 1
  • Case 2
  • Case 3a: ultrasound
  • Case 3b: MRI
  • Case 4: pleural involvement
  • Case 5
  • Case 6: retroperitoneal lymphoma
  • Case 7
  • Case 8
  • Case 9: relapsed
  • Case 10: multi-organ extranodal non-Hodgkin lymphoma
  • Case 11: multi-organ involvement
  • Case 12
  • Case 13
  • Case 14: multi-organ involvement
  • Case 15
  • Case 16: sandwich sign
:

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.