Non-Hodgkin's Lymphoma

Topic Overview

What is non-Hodgkin's lymphoma?

Non-Hodgkin's lymphoma (NHL) is cancer of the lymphatic system, which is part of the immune system. The lymphatic system is found throughout the body. When you have this disease, cells in the lymphatic system either grow without control or do not die as cells normally do.

There are many types of NHL. Sometimes they are grouped as:

  • Aggressive lymphomas, which are also called intermediate-grade and high-grade lymphomas. These cancers tend to grow and spread quickly and cause severe symptoms.
  • Nonaggressive lymphomas, which are also called indolent or low-grade lymphomas. These tend to grow and spread quite slowly and cause few symptoms.

Non-Hodgkin's lymphoma is different from Hodgkin's lymphoma.

NHL can start almost anywhere in the body. It may start in a single lymph node, a group of lymph nodes, or an organ such as the spleen. NHL can spread to almost any part of the body, including the liver and bone marrow.

Treatment can cure some people and may allow others to live for years. How long you live depends on the type of NHL you have and how early it’s diagnosed. About 81 out of 100 people diagnosed with non-Hodgkin's lymphoma are alive 1 year after the disease is diagnosed. About 63 out of 100 people with the disease are alive at 5 years, and 49 out of 100 at 10 years.1

What causes non-Hodgkin's lymphoma?

The cause of NHL is not known. The abnormal cell changes may be triggered by an infection or exposure to something in the environment. It is not contagious.

What are the symptoms?

Symptoms of NHL include:

  • A painless swelling of the lymph nodes in the neck, underarm, or groin. This is the most common symptom.
  • Fever not caused by another health problem.
  • Night sweats.
  • Extreme fatigue.
  • Weight loss you can't explain.
  • Itchy skin.
  • Reddened patches on the skin.
  • A cough or shortness of breath.
  • Pain in the belly or back.

How is non-Hodgkin's lymphoma diagnosed?

Your doctor will do a physical exam and ask you questions about your health. The exam includes checking the size of your lymph nodes in your neck, underarm, and groin.

Your doctor will take a piece of body tissue (biopsy) to diagnose NHL. The tissue usually is taken from a lymph node. Your doctor also may do other test, including tests to see what kind of NHL you have.

How is it treated?

Your treatment depends on the type of lymphoma you have, the stage of the disease, your age, and your general health. You may not need treatment until you have symptoms. The treatment options are:

  • Watchful waiting , which is being under your doctor’s care but not yet getting treatment.
  • Radiation therapy , which is using high-dose X-rays to kill cancer cells.
  • Chemotherapy , which is using medicine to kill cancer cells.
  • Monoclonal antibody therapy , which can boost your body's natural defenses against disease, slow how fast the cancer grows, and carry radiation or medicines that kill cancer cells.
  • Stem cell transplant plus chemotherapy. A stem cell transplant replaces damaged bone marrow cells with healthy stem cells.

How do you deal with your emotions?

When you have cancer, you may feel confused, alone, and scared. Your loved ones may feel this way too. You are not alone. Others are facing the same struggles, and they know what you are going through. Many of them are feeling the same way.

To help yourself:

  • Get the support you need. Spend time with people who care about you, and let them help you. Talk to your hospital social worker if you need help with bills or have other worries. Your local American Cancer Society also may be helpful.
  • Take good care of yourself. Get plenty of rest, eat healthy meals, and get regular exercise.
  • Talk about your feelings, and find a support group. Other people who have NHL can help you, and your experience can help them.
  • Do everything you can to stay positive. Set a goal each day to do something special for yourself or someone else.

If your emotions are too much to handle, be sure to tell your doctor. You may be able to get counseling or other types of help.

Frequently Asked Questions

Learning about non-Hodgkin's lymphoma:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with non-Hodgkin's lymphoma:

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Cause

The cause of non-Hodgkin's lymphoma (NHL) is unknown. The incidence of NHL has continued to increase over the years. When a person has non-Hodgkin's lymphoma, abnormal rapid cell growth occurs. This abnormal growth may need a "trigger" to start, such as an infection or exposure to something in your environment. NHL is not contagious and is not caused by injury.2

Symptoms

Symptoms of non-Hodgkin's lymphoma (NHL) depend on the area of the body affected by the disease. The most common symptom is a painless swelling of the lymph nodes in the neck, underarm, or groin. Other symptoms may include:

  • Unexplained fever.
  • Night sweats.
  • Extreme fatigue.
  • Unexplained weight loss.
  • Itchy skin.
  • Reddened patches on the skin.
  • Cough or shortness of breath.
  • Pain in the abdomen or back.

What Happens

In non-Hodgkin's lymphoma (NHL), either abnormal cells in the lymphatic system divide and grow without order or control or old cells do not die normally. Lymphatic tissue is present in many areas of the body, so non-Hodgkin's lymphoma can start almost anywhere in the body.

Non-Hodgkin's lymphoma may occur in a single lymph node, a group of lymph nodes, or an organ. And it can spread to almost any part of the body, including the liver, bone marrow, and spleen. Doctors classify NHL into stages based on where the lymphoma is growing in the body.

Over time, lymphoma cells may replace the normal cells in the bone marrow. Bone marrow failure results in the inability to produce red blood cells that carry oxygen, white blood cells that fight infection, and platelets that stop bleeding.

Long-term survival depends on the type of non-Hodgkin's lymphoma and the stage of the disease when it is diagnosed. Approximately 81 out of 100 people diagnosed with non-Hodgkin's lymphoma are alive 1 year after the disease is diagnosed. That number drops to about 63 out of 100 at 5 years and 49 out of 100 at 10 years.1

What Increases Your Risk

No one knows exactly what increases your risk of getting non-Hodgkin's lymphoma (NHL). Experts do agree that the disease is not caused by injury and is not contagious. The following risk factors may increase your chances of having the disease. But most people with these risk factors do not ever have non-Hodgkin's lymphoma, and many people who have non-Hodgkin's lymphoma do not have any of these risk factors.2

  • Being male. NHL is more common in men than in women.
  • Age. The likelihood of getting NHL increases as you get older.
  • Impaired immune system. NHL is most common among those who have an impaired immune system, an autoimmune disease, or HIV or AIDS. It also occurs among those who take immunosuppressant medicines, such as medicines following an organ transplant.
  • Viral infection. A viral infection, such as Epstein-Barr virus, increases the risk of developing NHL.
  • Bacterial infection. Infection with Helicobacter pyloriincreases the risk of lymphoma involving the stomach.
  • Environmental exposure. Exposure to agricultural pesticides or fertilizers, solvents and other chemicals, rubber processing, asbestos, and arsenic increases the risk of developing NHL.

When To Call a Doctor

Call your doctor to schedule an appointment if you have had any symptoms for longer than 2 weeks, such as:

  • Painless swelling in the lymph nodes in the neck, underarm, or groin.
  • Unexplained fever.
  • Drenching night sweats.
  • Extreme fatigue.
  • Unexplained weight loss in the past 6 months.
  • Itchy skin.
  • Cough or shortness of breath.
  • Pain in the abdomen or back.

Watchful Waiting

Watchful waiting (surveillance) is a period after the diagnosis of some types of non-Hodgkin's lymphoma (NHL) when little or no treatment is used. Watchful waiting is not appropriate for aggressive or high-grade lymphoma. Watchful waiting does not mean that your doctor is giving up or refusing to give you treatment. During this time you will:

  • Have regularly scheduled appointments with your doctor.
  • Receive periodic medical tests, including scans and blood tests.
  • Be told which symptoms to report to your doctor immediately.

Watchful waiting is often as effective as immediate aggressive treatment for some types of NHL. People with advanced low-grade, indolent lymphomas often live a long time without symptoms.3, 4

Watchful waiting ends when one of the following occurs:

  • Symptoms develop.
  • Lymphoma tumor size is larger than 2 in. (5.1 cm) and growing.
  • Organs do not function normally.

Who To See

Doctors who can help diagnose non-Hodgkin's lymphoma (NHL) include:

When NHL is suspected, a tissue sample (biopsy) is needed to make a diagnosis. A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well. A surgeon will remove a sample of tissue so that a pathologist can examine it under a microscope to check for cancer cells.

Non-Hodgkin's lymphoma is usually treated by a medical oncologist or a hematologist. If you require radiation therapy, you will also see a radiation oncologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

If non-Hodgkin's lymphoma (NHL) is suspected, your doctor will ask about your medical history and perform a physical examination. This exam includes checking for enlarged lymph nodes in your neck, underarm, and groin.

A tissue sample (biopsy) is needed to make a diagnosis. A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well.

A bone marrow aspiration and biopsy will be done to find out if lymphoma cells are present in the bone marrow.

Your doctor may also order other tests, including:

  • Blood tests, such as a chemistry screen to measure the levels of several substances in the blood and a CBC (complete blood count) to provide information about the kinds and numbers of cells in the blood.
  • A chest X-ray to provide a picture of organs and structures within the chest, including the heart and lungs, the blood vessels of the chest, and the thin sheet of muscle (diaphragm) that separates the chest cavity from the abdominal cavity.
  • A CT scan (computed tomography) or MRI (magnetic resonance imaging) to provide detailed pictures of the organs and structures in the chest, abdomen, and pelvis.
  • PET scan (positron emission tomography) to show areas of increased metabolic activity. Metabolic activity refers to all of the chemical processes that take place in the body, such as using sugars for energy. Metabolic activity is generally high in cancer cells.
  • Flow cytometry, which checks the types of cells in a biopsy sample. This test helps your doctor find out the type of lymphoma.
  • Lumbar puncture (also called a spinal tap) to find out whether lymphoma cells are in the fluid (cerebrospinal fluid, or CSF) surrounding your brain and spinal cord.
  • Multigated acquisition (MUGA) scan, which is a type of cardiac blood pool scan. A cardiac blood pool scan shows how well your heart is pumping blood to the rest of your body. A MUGA scan can show whether your heart is strong enough to tolerate certain types of chemotherapy, like doxorubicin.

Early Detection

At this time, there are no special tests recommended for early detection of non-Hodgkin's lymphoma. The best strategy for early diagnosis is to see your doctor if you develop signs or symptoms of NHL.

Treatment Overview

Different types of treatment are used for different types of non-Hodgkin's lymphoma (NHL). Treatment of NHL depends on:

  • The stage of the disease.
  • The type of lymphoma. The kind of treatment you have will depend on whether you have B-cell or T-cell lymphoma and whether it is fast-growing or slow-growing.
  • The size of the tumor and whether it is greater than 10 cm (3.9 in.). It also matters where the lymphoma is located and what organs are involved.
  • Your general health.
  • Whether you have had lymphoma in the past (recurrent disease). Although lymphoma that has come back (recurred) may be controlled, it often is not curable.

Initial treatment

Treatment recommendations that may be appropriate when you are first diagnosed with non-Hodgkin's lymphoma include:

  • Watchful waiting (surveillance), a period of time after the diagnosis of some types of NHL when little or no other treatment is used. Watchful waiting gives as good or better results than more aggressive treatment for some types of NHL. Your doctor may discuss watchful waiting with you if you have an advanced, low-grade (indolent) lymphoma.3, 4 Watchful waiting is not appropriate for aggressive lymphoma or less aggressive lymphoma that has gotten larger or is causing symptoms.
  • Radiation therapy, which is often the treatment of choice for early-stage, indolent NHL. Radiation therapy may be used alone or combined with other treatment options for more advanced NHL.
  • Medicines, such as chemotherapy or monoclonal antibody therapy, which often cure NHL. Even when cure is not possible, treatment with medicines may allow you to live a long time without symptoms.

If you have recently been diagnosed with non-Hodgkin's lymphoma, you may experience a wide variety of emotions. Most people experience some denial, anger, and grief. Other people may have fewer emotions. There is no "normal" or "right" way to react to a diagnosis of lymphoma. There are many steps you can take to help with your emotional reactions. You may find that talking with family and friends helps you with your emotions. Some people may find that spending time alone is what they need.

If your reaction is interfering with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.

You may use home treatment to help you manage the side effects that may happen with NHL or its treatment.

Ongoing treatment

Schedule regular follow-up examinations with your doctor after you have been treated for non-Hodgkin's lymphoma. Follow-up care is an important part of the overall treatment plan. During regular follow-up care:

  • You will probably be seen every 3 to 4 months for the first 2 years and then every 6 months until it has been 5 years since your diagnosis. After that, you will only need annual checkups if you have had no relapse.
  • Changes in health can be discussed with your doctor. To monitor your health, your doctor may obtain lab tests, such as a chemistry screen and CBC, and imaging tests, such as a chest X-ray or CT scan.

Report to your doctor any problems you have, as soon as they appear. If you are having a problem, you may need to make some new appointments.

Treatment if the condition gets worse

You may be offered the following treatment options if your disease progresses:

  • Radiation therapy may be used alone or in combination with other treatments if non-Hodgkin's lymphoma (NHL) recurs. Targeted radiation therapy uses monoclonal antibodies to deliver radiation directly to lymphoma cells.
  • Chemotherapy often effectively treats recurrent NHL. Sometimes a person may take one type of chemotherapy for several cycles and later be switched to different medicines if the first medicines are no longer working.
  • Stem cell transplant (bone marrow transplant) is often used to treat recurrent lymphoma. Stem cell transplant may be offered as part of standard treatment or in a clinical trial. Talk with your doctor to see if a clinical trial may be available for your type of recurrent disease.
  • Biological therapy may be used to treat recurrent lymphoma.

What to think about

Survival rates have improved as a result of clinical trials. Clinical trials provide evidence about new medicines and treatments that may help people who have non-Hodgkin's lymphoma live longer and have a better quality of life. If you are interested in taking part in a clinical trial, check with your doctor to see if there are any clinical trials available in your area.

Your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people with non-Hodgkin's lymphoma are successfully treated, the term remission is used because cancer can return. It is important to discuss the possibility of recurrence with your doctor.

Even after effective treatment for NHL, you may be at slightly higher risk for other types of cancer, especially melanoma, lung, brain, kidney, and bladder cancers. Be watchful for any symptoms of cancer.

For more information about specific treatments, see the following topics:

Prevention

There is no known way to prevent non-Hodgkin's lymphoma (NHL). Most people with NHL do not have known risk factors.

Home Treatment

During treatment for any stage of non-Hodgkin's lymphoma (NHL), you can use home treatment to help manage the side effects that may accompany NHL or its treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

  • Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Your doctor also may prescribe medicines to control nausea and vomiting. For more information on how to deal with these side effects, see:
    Click here to view an Actionset.Cancer: Controlling nausea and vomiting from chemotherapy.
  • Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.
  • Home treatment for constipation includes gentle exercise along with adequate intake of fluids and a diet that is high in fruits, vegetables, and fiber. Check with your doctor before using a laxative for your constipation.
  • Home treatment for fatigue includes making sure you get extra rest while you are receiving chemotherapy or radiation therapy. Let your symptoms be your guide. You may be able to stick to your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.
  • Home treatment for a sore mouth includes changing your diet, rinsing your mouth with liquid medicines, and putting a baking soda paste or nonprescription medicine on mouth sores.

Other issues that may arise include:

  • Hair loss. This can be emotionally distressing. Not all chemotherapy medicines cause hair loss, and some people have only mild thinning that is noticeable only to them. Talk to your doctor about whether hair loss is an expected side effect with the medicines you will take.
  • Sleep problems. If you find you have trouble sleeping, having a regular bedtime, getting some exercise during the day, avoiding naps, and using other tips to relieve sleep problems may help you sleep more easily.

Many people with lymphoma face emotional issues because of their disease or its treatment.

  • The diagnosis of any type of cancer and the need for treatment can be very stressful. You may be able to reduce your stress by expressing your feelings to others. Learning relaxation techniques may also help you reduce your stress.
  • Your feelings about your body may change following a diagnosis of cancer and the need for treatment. Adapting to your body image changes may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to organizations that can offer additional support and information.
  • To prevent weight loss and conserve your strength, it is important to eat well during treatment for cancer.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many treatments are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. You may use home treatment for pain to improve your physical and mental well-being. Be sure to discuss any home treatment you use for pain with your doctor.

Medications

Your doctor may prescribe medicines that will affect the growth of non-Hodgkin's lymphoma and relieve your symptoms. Treatment depends on:

  • The stage of the disease.
  • The type of lymphoma. The kind of treatment you have will depend on whether you have B-cell or T-cell lymphoma and whether it is fast-growing or slow-growing.
  • The size of the tumor and whether it is greater than 10 cm (3.9 in.). It also matters where the lymphoma is located and what organs are involved.
  • Your general health.
  • Whether you have had lymphoma in the past (recurrent disease). While lymphoma that has come back (recurred) may be controlled, it often is not curable.

For more information about medication treatments, see the following topics:

Medication Choices

Chemotherapy often cures aggressive forms of non-Hodgkin's lymphoma. Even when cure is not possible, such as with indolent lymphoma, chemotherapy may allow you to live a long time without symptoms. A combination of chemotherapy medicines is generally more effective than a single drug. The most commonly used combination is called CHOP, which combines cyclophosphamide, doxorubicin, vincristine, and prednisone.

Your doctor may recommend that you try treatment with a medicine known as a monoclonal antibody (such as rituximab). This medicine is used with CHOP for B-cell lymphomas and helps you live a long time without symptoms.5

Other medicine combinations include:

What To Think About

Depending on the type and the stage of the lymphoma, chemotherapy may be used alone or in combination with radiation therapy.

Sometimes a person may take one chemotherapy combination for several cycles and later switch to a different one if the first treatment combination does not seem to be working.

Chemotherapy causes many side effects. These side effects are usually temporary and go away when treatment is stopped. Your doctor may prescribe medicines to control nausea and vomiting from chemotherapy. Older adults may find side effects more difficult to tolerate. Side effects may also cause more problems if you have other diseases, such as diabetes, chronic lung disease, or coronary artery disease. You may not be able to become pregnant or father a child after chemotherapy treatment. Discuss fertility issues with your doctor before starting treatment. Chemotherapy medicines can also cause birth defects. If you are pregnant or wish to father a child, discuss the risk of birth defects with your doctor before using any chemotherapy medicine.

Survival rates have improved as a result of clinical trials. Clinical trials provide evidence about new medicines and treatments that may help people who have non-Hodgkin's lymphoma live longer and have a better quality of life. If you are interested in taking part in a clinical trial, check with your doctor to see if there are any clinical trials available in your area.

Your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people with non-Hodgkin's lymphoma are successfully treated, doctors use the term remission because cancer can return. It is important to discuss the possibility of recurrence with your doctor.

Surgery

Surgery is not used to treat non-Hodgkin's lymphoma.

What to think about

Because of recent improvements in body scans (such as the CT scan, MRI, and PET scan), exploratory surgery is rarely used to stage NHL.

Other Treatment

Radiation therapy is often the treatment of choice for early-stage or nonaggressive (indolent) non-Hodgkin's lymphoma (NHL). Radiation therapy may be used alone or combined with other treatment options, such as chemotherapy, for later or more advanced NHL.

Stem cell transplant (also called bone marrow transplant) is used to treat relapsed aggressive NHL. One study showed that stem cell transplant improved survival rates in people with aggressive NHL.6

A growth factor called G-CSF may be used along with chemotherapy for newly diagnosed NHL. G-CSF is a protein that is produced naturally in the body. G-CSF can help you tolerate chemotherapy better and have less risk for serious infections.

What to think about

Radiation therapy often cures early-stage or nonaggressive (indolent) non-Hodgkin's lymphoma.

Survival rates have improved as a result of clinical trials. Clinical trials provide evidence about new medicines and treatments that may help people who have non-Hodgkin's lymphoma live longer and have a better quality of life. If you are interested in taking part in a clinical trial, check with your doctor to see if there are any clinical trials available in your area.

Your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people with non-Hodgkin's lymphoma are successfully treated, doctors use the term remission because cancer can return. It is important to discuss the possibility of recurrence with your doctor.

Palliative care

If your non-Hodgkin's lymphoma gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit. Some people combine palliative care with curative care.

Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term illness, make future plans around your medical care, or help your family better understand your illness and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

Non-Hodgkin's lymphoma is often a progressive condition. If you have been diagnosed with NHL, you may wish to discuss with your family and your doctor the health care and other legal issues that arise near the end of life.

A time may come when your goals or the goals of your loved ones may change from treating or curing an illness to maintaining comfort and dignity. You may find it helpful and comforting to state your health care choices in writing (with an advance directive or living will) while you are still able to make and communicate these decisions. Think about your treatment options and which kind of treatment will be best for you. You may wish to choose a health care agent to make and carry out decisions about your care if you become unable to speak for yourself. For more information, see the topic Care at the End of Life.

Other Places To Get Help

Organizations

Leukemia and Lymphoma Society
1311 Mamaroneck Avenue
White Plains, NY  10605
Phone: 1-800-955-4572
(914) 949-5213
Fax: (914) 949-6691
Web Address: http://www.leukemia.org
 

The Leukemia and Lymphoma Society is the world's largest voluntary health organization dedicated to funding blood cancer research, education, and patient services. The Society's mission is to cure leukemia, lymphoma, Hodgkin's lymphoma, and myeloma and to improve the quality of life for patients and their families.


American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
TDD: 1-866-228-4327 toll-free
Web Address: www.cancer.org
 

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.


Cancer.Net
Phone: 1-888-651-3036
(571) 483-1300
Fax: (571) 366-9530
E-mail: foundation@asco.org
Web Address: www.cancer.net
 

Cancer.Net is the information Web site of the American Society of Clinical Oncology (ASCO) for people living with cancer and for those who care for them. ASCO is the world's leading professional organization representing physicians of all oncology subspecialties. Cancer.Net provides current oncologist-approved information on living with cancer.


National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD: 1-800-332-8615
E-mail: cancergovstaff@mail.nih.gov
Web Address: www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


References

Citations

  1. American Cancer Society (2005). Cancer Facts and Figures 2005, pp. 1–21. Atlanta: American Cancer Society. Also available online: http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf.
  2. Fisher RI, et al. (2005). Non-Hodgkin's lymphomas. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., pp. 1957–1997. Philadelphia: Lippincott Williams and Williams.
  3. Evans LS, Hancock BW (2003). Non-Hodgkin lymphoma. Lancet, 362(9378): 139–146.
  4. Ardeshna KM, et al. (2003). Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: A randomised controlled trial. Lancet, 362(9383): 516–522.
  5. Coiffier B, et al. (2002). CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. New England Journal of Medicine, 346(4): 235–242.
  6. Milpied N, et al. (2004). Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. New England Journal of Medicine, 350(13): 1287–1295.

Other Works Consulted

  • American Joint Committee on Cancer (2002). Lymphoid neoplasms. AJCC Cancer Staging Manual, 6th ed., pp. 393–406. New York: Springer-Verlag.
  • Bierman PJ, et al. (2008). Non-Hodgkin’s lymphomas. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., pp. 1408–1419. Philadelphia: Saunders Elsevier.
  • Copson ER, Kerr JP (2006). Non-Hodgkin’s lymphoma (diffuse large B cell lymphoma), search date April 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  • Foon KA, Fisher RI (2006). The non-Hodgkin lymphomas. In MA Lichtman et al., eds., Williams Hematology, 7th ed., pp. 1407–1459. New York: McGraw-Hill.

Credits

Author Bets Davis, MFA
Editor Maria Essig
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Douglas A. Stewart, MD - Medical Oncology
Last Updated April 22, 2008

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