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The Leukemia/Bone Marrow Transplant Program of BC


Non-Hodgkin's Lymphoma (NHL)

What Is NHL?

Non-Hodgkin's Lymphoma (NHL) is a cancer usually affecting the lymph glands but the disease may involve any body organ, particularly the liver, spleen, bone or bone marrow.

Symptoms & Types of NHL

Patients may complain of an enlarged lymph gland and/or weight loss, fever or night sweats. These are referred to as "B" symptoms.

Staging of NHL - Stage I to IV - is based upon the number of areas where the lymph glands are enlarged and whether there is involvement of a major body organ.

There are many subtypes of NHL and the subtype generally determines the treatment recommended and the success expected. While there are numerous systems for classifying NHL, it is most useful to approach this from the growth rate of the NHL.

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Indolent (Low-Grade) NHL

Indolent or "low-grade" NHL grows relatively slowly although it is almost always present at multiple sites (Stage III/IV) at the time of diagnosis.

While indolent NHL may respond well to standard chemotherapy and is associated with an average survival of 8-10 years, very few patients are cured with this chemotherapy approach.

In the uncommon circumstance where low-grade NHL is found to be localised to one area, radiotherapy may cure a significant proportion of patients.

Some types of indolent NHL follow a more aggressive course and are treated with more intensive therapies.

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Aggressive (Intermediate-Grade) NHL

Aggressive or "intermediate-grade" NHL may be localised (Stage I) or may be present at multiple sites (Stage II to IV) at the time of diagnosis. The most frequent example of this grade of NHL is diffuse large cell lymphoma.

Stage I disease is usually treated with brief chemotherapy and local radiation and is associated with a high cure rate in 80% of patients.

Stage II-IV intermediate-grade NHL is treated with multi-drug chemotherapy, which results in a complete remission rate of 80% and a cure rate of 50% for patients younger than 60 years old.

Aside from patient age, results in individual patients are dependent upon the disease stage, the general health condition of the patient at the time of diagnosis and the blood "lactate dehydrogenase" (LDH) level. As a result, therapy may be "tailored" to each patient according to how many of these "risk" factors are present.

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High-Grade Lymphomas

"High-grade" NHL has a rapid growth rate and includes lymphoblastic, Burkitt's and Burkitt's-like lymphomas. These types of lymphoma require prompt, intensive therapy in order to cure a reasonable percentage of patients.

"Mantle cell" lymphoma is a recently described NHL that behaves in a particularly aggressive fashion. Although it is not a "high-grade" NHL per se, several centres are treating mantle cell lymphoma with high-dose therapy and bone marrow transplant early in the course of the disease.


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