What is Non-Hodgkin Lymphoma?

Non-Hodgkin lymphoma (NHL) is a type of blood cancer that starts in the white blood cells known as lymphocytes. NHL develops in the lymphatic system, part of the immune system that carries lymph fluid throughout the body. Because the lymphatic system is so widespread, NHL can begin in many different places in the body.1,2

There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. The two types differ in their characteristics and how they are treated. There are also many subtypes of NHL, which are generally characterized as indolent (slower growing) or aggressive (faster growing). The exact subtype is important to know to help guide treatment decisions.1,2

What causes non-Hodgkin lymphoma?

Researchers have not determined the exact cause of NHL, but they know that cancers like NHL begin with changes (mutations) to the DNA of the cells. Mutations to the DNA may be inherited, although inherited mutations typically do not seem to be involved in NHL. Having a family member with NHL does not appear to increase a person’s risk of the disease, and NHL does not seem to run in families. The DNA mutations that occur in NHL may be spontaneous or as a result of exposure to certain environmental factors.1

How does non-Hodgkin lymphoma develop?

NHL can develop when mutations occur in lymphocytes. There are two main types of lymphocytes, B lymphocytes (or B cells) and T lymphocytes (or T cells). NHL may develop from either type of lymphocyte, although it is more commonly seen in B cells.1

The lymphocytes collect in the lymph system, which is made up of lymphatic vessels, lymph nodes, collecting ducts, and several organs, including the spleen, thymus, and tonsils.3 Different types of NHL can begin in different parts of the lymph system.1

What are the different types of non-Hodgkin lymphoma?

There are more than 60 types of NHL.4 They are classified by which type of lymphocyte they develop from (B cell or T cell), how the cells look under a microscope, the chromosomal features of the cells, the types of proteins found on the surface of the cells, and how slowly or quickly the cells replicate or grow.1,2

Approximately 85% of all NHL cases are B-cell lymphomas. Some of the more well-known types of B-cell NHL are:

  • Diffuse large B-cell lymphoma (DLBCL)
  • Follicular lymphoma
  • Chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL)
  • Mantle cell lymphoma (MCL)
  • Marginal zone lymphomas
  • Burkitt lymphoma
  • Hairy cell leukemia (may potentially be considered a lymphoma subtype)
  • Waldenstrom macroglobulinemia
  • Primary central nervous system lymphoma1,2

Approximately 15% of all NHL cases are T-cell lymphomas. Some of the more well-known types of T-cell NHL are:

  • Precursor T-lymphoblastic lymphoma
  • Cutaneous T-cell lymphoma (including mycosis fungoides and Sézary syndrome)
  • Adult T-cell leukemia/lymphoma1,2


The different subtypes of NHL are generally characterized as either indolent (slower growing) or aggressive (faster growing). Aggressive lymphomas account for approximately 60% of all NHL, with the most common type of aggressive lymphoma being DLBCL. The most common type of indolent NHL is follicular lymphoma. How quickly the cancer grows helps determine the treatment that is recommended. For some types of indolent NHL, doctors may recommend watching and waiting. Other indolent types or aggressive types of NHL may require more intensive treatment.2

Who gets non-Hodgkin lymphoma?

NHL can potentially occur at any age. It is one of the more common cancers seen in children and teenagers, but the risk of developing NHL increases with age. More than half of people with NHL are diagnosed at age 65 or older.1

What factors increase a person’s risk of developing non-Hodgkin lymphoma?

Risk factors that have been identified as potentially increasing a person’s chances of developing NHL include:

  • Having an immune deficiency, which may be due to an inherited condition, having human immunodeficiency virus (HIV), or due to medications like those used for organ transplant recipients
  • Having an autoimmune disease
  • Having certain chronic infections, including the Epstein-Barr virus (mononucleosis), hepatitis C, and the bacterium Helicobacter Pylori (H Pylori)1,2

People living in farming communities have a higher incidence of NHL, leading some researchers to look at herbicides and pesticides as potential risk factors. More research is needed to determine the association between these chemicals and the development of lymphoma.2

What are the common symptoms of non-Hodgkin lymphoma?

The symptoms of NHL can vary based on the subtype of lymphoma and where in the body it begins. Some common symptoms of NHL include:

How is non-Hodgkin lymphoma staged?

Non-Hodgkin lymphoma may be classified as Stage I, II, III, or IV. The staging may be further classified as A, B, or E.

  • A is defined as no symptoms.
  • B is defined as experiencing symptoms fever, weight loss, or night sweats.
  • E is defined as cancer found outside of the lymph system.1,2

What is the prognosis for non-Hodgkin lymphoma?

Survival rates for all types of blood cancer have been improving as new treatments become available. Survival rates are based on previous outcomes of people who survive a set amount of time after diagnosis. In cancer estimates, experts use the “five-year survival rate” as a marker. However, it is important to keep in mind that many people live beyond five years after diagnosis and the statistics are not necessarily predictive for any one individual. Based on data from 2007-2013 (the most recent data available), the National Cancer Institute has determined the five-year survival rate for all cases of non-Hodgkin lymphoma is 71.0%, although the survival rates vary for each subtype of NHL.1,5

Written by: Emily Downward | Last reviewed: February 2018
View References
  1. American Cancer Society. Available at https://www.cancer.org/cancer/non-hodgkin-lymphoma.html. Accessed 12/11/17.
  2. Leukemia & Lymphoma Society. Available at http://www.lls.org/lymphoma/non-hodgkin-lymphoma. Accessed 12/12/17.
  3. National Cancer Institute. Available at https://training.seer.cancer.gov/anatomy/lymphatic/components/. Accessed on 12/12/17.
  4. Lymphoma: Non-Hodgkin - Subtypes. Cancer.net. Available at https://www.cancer.net/cancer-types/lymphoma-non-hodgkin/subtypes. Accessed 12/19/17.
  5. SEER (Surveillance, Epidemiology and End Results) Cancer Statistics Review, National Cancer Institute. Available at https://seer.cancer.gov/statfacts/html/nhl.html. Accessed 12/12/17.