Lymphomas

Common Forms of Lymphoma

Following are many variations of lymphoma, along with typical characteristics and treatment options. Common treatments are listed, but options may depend on the stage of your cancer, your treatment history and your general health. Talk with your doctor about the option that might be best for you. Additionally, ask your doctor if you are a candidate for clinical trials, which offer access to new therapies and regimens that are currently being evaluated.

Cancer Type	Description	Treatment
Non-Hodgkin Lymphoma (NHL)
B-cell lymphomas (NHLs)
Diffuse large B-cell lymphoma (DLBCL)	• Most common type of NHL in adults in the United States (about 1 of every 3 cases) • Fast-growing • Average age at diagnosis, mid-60s	• R-CHOP: rituximab (Rituxan), cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone • EPOCH-R: etoposide (Etopophos), prednisone, vincristine (Oncovin), cyclophosphamide and doxorubicin (Adriamycin) + rituximab (Rituxan) • Immunotherapy: axicabtagene ciloleucel (Yescarta), rituximab (Rituxan), rituximab and hyaluronase human (Rituxan Hycela) • High-dose chemotherapy and stem cell transplantation
Primary mediastinal B-cell lymphoma (subtype of DLBCL)	• Most likely to occur in women in their 30s • Fast-growing but typically responds well to treatment	• R-CHOP: rituximab (Rituxan), cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone • EPOCH-R: etoposide (Etopophos), prednisone, vincristine (Oncovin), cyclophosphamide and doxorubicin (Adriamycin) + rituximab (Rituxan) • Immunotherapy: rituximab (Rituxan) • High-dose chemotherapy and stem cell transplantation
Intravascular large B-cell lymphoma (subtype of DLBCL)	• Rare • Lymphoma cells found only inside blood vessels	• R-CHOP: rituximab (Rituxan), cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone • EPOCH-R: etoposide (Etopophos), prednisone, vincristine (Oncovin), cyclophosphamide and doxorubicin (Adriamycin) + rituximab (Rituxan) • Immunotherapy: rituximab (Rituxan) • High-dose chemotherapy and stem cell transplantation
Follicular lymphoma	• Slow-growing and responds well to treatment but hard to cure • Found in lymph node sites and bone marrow • Called follicular for the circular pattern in which the cancer cells grow in the lymph nodes • Average age at diagnosis, 60	• BR: bendamustine (Bendeka, Treanda) + rituximab (Rituxan) • R-CHOP: rituximab (Rituxan), cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone • Bendamustine (Bendeka, Treanda) and lenalidomide (Revlimid) • R-CVP: rituximab (Rituxan), cyclophosphamide, vincristine (Oncovin) and prednisone • Chemotherapy: chlorambucil (Leukeran) • Immunotherapy: obinutuzumab (Gazyva), rituximab (Rituxan), rituximab and hyaluronidase human (Rituxan Hycela) • Radioimmunotherapy: ibritumomab (Zevalin) • High-dose chemotherapy and stem cell transplantation • Targeted therapy: copanlisib (Aliqopa), idelalisib (Zydelig) • Radiation therapy • Watchful waiting (for indolent [slow-growing] disease)
Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)	• CLL cancer cells found mainly in blood and bone marrow • SLL cancer cells found mainly in lymph nodes and spleen • Slow-growing	• Chemotherapy: bendamustine (Bendeka, Treanda), chlorambucil (Leukeran), cyclophosphamide, doxorubicin, fludarabine, mechlorethamine (Mustargen), methotrexate (Trexall), venetoclax (Venclexta), vincristine • Immunotherapy: alemtuzumab (Campath, Lemtrada), obinutuzumab (Gazyva), ofatumumab (Arzerra), rituximab (Rituxan), rituximab and hyaluronidase human (Rituxan Hycela) • Targeted therapy: ibrutinib (Imbruvica), idelalisib (Zydelig) • Radiation therapy • Watchful waiting
Mantle cell lymphoma	•Affects more men than women •Average age at diagnosis, early 60s •Usually found in lymph nodes, bone marrow and spleen	•Hyper-CVAD: cyclophosphamide, vincristine (Oncovin), doxorubicin (Adriamycin) and dexamethasone, alternating with high-dose methotrexate (Trexall) plus cytarabine + rituximab (Rituxan) •R-CHOP: rituximab (Rituxan), cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone •BR: bendamustine (Treanda) + rituximab (Rituxan) •Immunotherapy: lenalidomide (Revlimid), rituximab (Rituxan) •High-dose chemotherapy and stem cell transplantation
Marginal zone B-cell lymphomas	•Cells look small under a microscope •Three subtypes: 1. Extranodal (also known as mucosa-associated lymphoid tissue [MALT] lymphomas) 2. Nodal 3. Splenic	Extranodal (MALT) •R-CHOP: rituximab (Rituxan), cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone •CVP: cyclophosphamide, vincristine (Oncovin), prednisone •BR: bendamustine (Treanda) + rituximab (Rituxan) •Chemotherapy: chlorambucil (Leukeran), fludarabine •Immunotherapy: rituximab (Rituxan) •Antibiotics •Radiation therapy •Surgery •Targeted therapy: ibrutinib (Imbruvica) Nodal •Watchful waiting •Radiation therapy •Chemotherapy Splenic •Surgery •Radiation therapy •Immunotherapy •Chemotherapy
Burkitt lymphoma	•Rare and fast-growing •Nearly 90% of patients are male •Average age at diagnosis, 30	Intensive chemotherapy and treatment for the central nervous system to prevent metastasis to the brain: •Hyper-CVAD: cyclophosphamide, vincristine (Oncovin), doxorubicin (Adriamycin) and dexamethasone, alternating with high-dose methotrexate (Trexall) and cytarabine + rituximab (Rituxan) •CODOX-M/IVAC: cyclophosphamide, vincristine (Oncovin), doxorubicin (Adriamycin) and intrathecal methotrexate (Trexall), and cytarabine followed by high-dose systemic methotrexate + rituximab (Rituxan) •EPOCH-R: etoposide (Etopophos), prednisone, vincristine (Oncovin), cyclophosphamide and doxorubicin (Adriamycin) + rituximab (Rituxan)
Lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)	•Rare •Found mainly in bone marrow, lymph nodes and spleen	•Chemotherapy •Immunotherapy: rituximab (Rituxan) •Radiation therapy •Targeted therapy: ibrutinib (Imbruvica) •Watchful waiting •High-dose chemotherapy and stem cell transplantation •Plasma exchange
Hairy cell leukemia	•Rare and slow-growing •Can be considered a lymphoma despite its name •More common in men •Average age at diagnosis, 50	•Watchful waiting •Chemotherapy: chlorambucil (Leukeran), cladribine (Leustatin), pentostatin (Nipent), prednisone •Immunotherapy: interferon alfa, rituximab (Rituxan)
Primary central nervous system (CNS) lymphoma	•Usually involves the brain but may also be found in the spinal cord and in tissues around the spinal cord and eye •Rare, but more common in people with immune system problems	•Radiation therapy •Chemotherapy: cytarabine, methotrexate (Trexall) •Immunotherapy: rituximab (Rituxan) •Corticosteroids •High-dose chemotherapy and stem cell transplantation
T-cell lymphomas (NHLs)
Precursor T-lymphoblastic lymphoma/leukemia	•Can be considered a leukemia or lymphoma, depending on how much bone marrow is involved •Most often affects young adults (men more than women) •Fast-growing •Often starts in the thymus gland, where T-cells are made	•Chemotherapy
Peripheral T-cell lymphomas	•Rare •Develop from mature forms of T-cells •Many subtypes	•CHOP: cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone •Chemotherapy: belinostat (Beleodaq), pralatrexate (Folotyn) •Radiation therapy •High-dose chemotherapy and stem cell transplantation •Targeted therapy
Cutaneous T-cell lymphomas	•Start in the skin	Skin-directed treatments: •Radiation therapy •Phototherapy •Topical medicines Systemic treatments: •Photopheresis •Chemotherapy •Targeted therapy •High-dose chemotherapy and stem cell transplantation
Adult T-cell leukemia/lymphoma	•Rare in the United States •Caused by an infection with the HTLV-1 virus, commonly found in Japan, the Caribbean and Africa •Four subtypes: smoldering, chronic, acute and lymphoma	•Immunotherapy: interferon alfa •Chemotherapy: cyclophosphamide, doxorubicin hydrochloride, prednisone, vincristine sulfate •High-dose chemotherapy and stem cell transplantation
Angioimmunoblastic T-cell lymphoma	•More common in older adults •Involves lymph nodes, spleen or liver •Fast-growing	•Corticosteroids •Chemotherapy •High-dose chemotherapy and stem cell transplantation
Extranodal natural killer/T-cell lymphoma, nasal type	•Rare •Often involves upper airway passages but can invade the skin and digestive tract •Most common in parts of Asia and South America	•Chemotherapy •Radiation therapy
Enteropathy-associated intestinal T-cell lymphoma (EATL)	•Rare and fast-growing •Occurs in lining of the intestine •Can cause a blockage or hole in the intestine •Two subtypes: 1. Type 1 occurs in people with celiac disease, celiac sprue or sprue 2. Type 2 (less common than Type 1) is not linked to sprue and the cells looks different under the microscope	•Surgery •Chemotherapy •High-dose chemotherapy and stem cell transplantation
Anaplastic large cell lymphoma (ALCL)	•More common in young people, but does occur in people in their 50s and 60s •Usually starts in lymph nodes •Can spread to skin •Fast-growing but curable •Two subtypes: 1. Primary cutaneous 2. Systemic	• Radiation therapy • Chemotherapy • High-dose chemotherapy and stem cell transplantation • Targeted therapy: brentuximab vedotin (Adcetris)
Peripheral T-cell lymphoma, unspecified	• Involves lymph nodes but can affect skin, bone marrow, liver and GI tract • Fast-growing • Average age at diagnosis, 60s • Includes several subtypes	• CHOP: cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone • Radiation therapy • High-dose chemotherapy and stem cell transplantation • Targeted therapy: belinostat (Beleodaq), romidepsin (Istodax)
Hodgkin lymphoma
Classical Hodgkin lymphoma (CHL)	•Accounts for about 95% of all Hodgkin cases in developed countries, such as the United States •Cancer cells are Reed-Sternberg cells, which are much larger than normal lymphocytes	• ABVD: doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban) and dacarbazine (DTIC-Dome) • BEACOPP: bleomycin (Blenoxane), etoposide (Etopophos), doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine (Matulane) and prednisone • Stanford V: doxorubicin (Adriamycin), mechlorethamine (Mustargen), vincristine (Oncovin), bleomycin (Blenoxane), etoposide (Etopophos), prednisone • ChlVPP: chlorambucil (Leukeran), vinblastine (Velban), procarbazine (Matulane) and prednisone • Radiation therapy • High-dose chemotherapy and stem cell transplantation • Immunotherapy: nivolumab (Opdivo), pembrolizumab (Keytruda), rituximab (Rituxan) • Targeted therapy: brentuximab vedotin (Adcetris)
Nodular sclerosis Hodgkin lymphoma	• Highly curable • Most common in teens and young adults, but can occur in people of any age • Tends to start in lymph nodes in the neck or chest	• Chemotherapy • Radiation therapy • High-dose chemotherapy and stem cell transplantation • Immunotherapy
Mixed cellularity classical Hodgkin lymphoma	• Fast-growing but highly curable • Occurs mostly in older adults but can occur at any age • Most often develops in the upper half of the body	• Chemotherapy • Radiation therapy • High-dose chemotherapy and stem cell transplantation • Immunotherapy
Lymphocyte-rich classical Hodgkin lymphoma	• Usually occurs in the upper half of the body • Rarely found in more than a few lymph nodes	• Chemotherapy • Radiation therapy • High-dose chemotherapy and stem cell transplantation • Immunotherapy
Lymphocyte-depleted classical Hodgkin lymphoma	• Occurs mostly in older adults • More likely to be advanced when first found in lymph nodes or in the abdomen, spleen, liver and bone marrow	• Chemotherapy • Radiation therapy • High-dose chemotherapy and stem cell transplantation • Immunotherapy
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)	• Slow-growing • Cancer cells are called popcorn cells because of how they look • Cancer cells are variants of Reed-Sternberg cells	• Chemotherapy • Radiation therapy • Immunotherapy