Non-Hodgkin lymphoma (NHL) is a type of cancer. It starts in a cell called a lymphocyte.

Healthy lymphocytes:

• Are part of the immune system
• Fight infections and illnesses
• Are often found in bean-sized lymph nodes or in other lymphoid tissues such as the spleen

It is normal for the lymph nodes to get bigger when the body is fighting an infection. The lymph nodes also get bigger with NHL. Some of the lymphocytes are no longer healthy and do not fight infection. Instead, the abnormal (cancerous) lymphocytes divide rapidly, crowding out the normal cells. NHL may spread to the bone marrow, central nervous system, liver, spleen, and reproductive organs.

Types of NHL include:

• Aggressive B-cell lymphomas, including Burkitt lymphoma, diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma (PMBCL)
• Lymphoblastic lymphoma (B cell or T cell)
• Anaplastic large cell lymphoma (ALCL)

Other types of NHL that are common in adults (such as follicular lymphoma) are rare in children.

Non-Hodgkin Lymphoma Causes

NHL develops when something changes the genetic code of a lymphocyte and makes it impossible for the lymphocyte to fight infection. Instead, the lymphocyte grows and divides rapidly, forming the malignant tumor. Doctors do not know what causes these genetic changes in most cases of NHL.

Non-Hodgkin Lymphoma Symptoms

The symptoms of NHL can depend on:

• The body part affected by the disease,
• How fast it is growing
• How far it has spread when it is found

A common symptom is painless swelling of the lymph nodes in the neck, armpit or groin.

An enlarged lymph node in the chest or abdomen may not be noticed until it is large enough to cause problems.

• A cough, difficulty breathing, fatigue and shortness of breath can develop from lymph nodes in the chest.
• Pain, vomiting, diarrhea, constipation or weight loss may develop from lymph nodes in the abdomen.

Non-Hodgkin Lymphoma Diagnosis

The diagnosis of NHL is made by biopsy. This is a surgery that removes part or all of the abnormal lymph node. Doctors examine the lymph node under the microscope to look for cancer cells that are typical of the disease.

Doctors also do tests to determine the extent of disease and to see if it has spread to other parts of the body. These tests can include:

• Blood tests
• A chest X-ray to see if there are enlarged lymph nodes in the chest.
• A CT scan to check for lymphoma in the chest and abdomen.
• A PET scan can see if the disease has spread to the liver, bones, bone marrow or spleen.
• A spinal tap (also called a lumbar puncture) is sometimes done to find out if the NHL has spread to the fluid that surrounds the brain and spinal cord.
• A bone marrow biopsy, if doctors are concerned that the lymphoma has spread to the bone marrow.

Non-Hodgkin Lymphoma Treatment

The treatment of NHL is related to the location of the tumor and how far the disease has spread.

The primary treatment is chemotherapy. If the disease is in one area of your body or localized, treatment may consist of surgery and a short, less intensive course of chemotherapy. If the disease is more advanced, the treatment usually includes high-dose chemotherapy.

Some patients also require radiation therapy. Cincinnati Children’s is one of only a few children’s hospitals that offers proton therapy. This type of radiation therapy uses a highly precise proton beam. This beam treats the tumor but avoids healthy tissue in the body. Proton therapy can help avoid some short-term side effects and long-term complications of traditional radiation therapy.

In many patients with advanced disease, there is a large tumor mass when the diagnosis is made. The first treatment with chemotherapy may cause kidney damage from the breakdown of so many tumor cells. Giving fluids and certain medicines can help protect the kidneys from damage.

Other therapies are available if the NHL doesn’t respond to treatment or returns after a time of remission. These therapies can include intensive chemotherapy in combination with hematopoietic stem cell transplantation (HSCT) or novel therapies.

For example, a novel therapy for children and young adults with treatment-resistant or relapsed B-cell NHL is an immunotherapy called chimeric antigen receptor T-cell (CAR-T) therapy. Cincinnati Children’s is one of the first pediatric hospitals certified to provide this groundbreaking treatment.

Non-Hodgkin Lymphoma Prognosis

Currently, the overall survival rate for NHL in countries with advanced medical care is about 90%, depending on type and stage of lymphoma. Children with localized disease have a better prognosis than those with advanced or widespread disease.

Cincinnati Children's is an international referral center for the treatment of children and young adults with high-risk and relapsed NHL. Our doctors lead national efforts in the development of new targeted therapies, immunological approaches, and stem cell transplantation.