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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65899_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65899_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65899_"><span class="title" itemprop="name">Adult Non-Hodgkin Lymphoma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: August 3, 2016.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062958__450">This PDQ cancer information summary has current information about the treatment of adult non-Hodgkin lymphoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062958__451">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000062958__129"><h2 id="_CDR0000062958__129_">General Information About Adult Non-Hodgkin Lymphoma</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062958__130">Adult non-Hodgkin lymphoma is a disease in which malignant
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(cancer) cells form in the lymph system.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__136">The major types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__376">Non-Hodgkin lymphoma can be indolent or aggressive.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__140">Age, gender, and a weakened immune system can affect the risk of
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adult non-Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__145">Signs and symptoms of adult non-Hodgkin lymphoma include swelling in the lymph nodes, fever,
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night sweats, weight loss, and fatigue. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__149">Tests that examine the body and lymph system are used to
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help detect (find) and diagnose adult non-Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__155">Certain factors affect prognosis (chance
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of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000062958__130"><h3>Adult non-Hodgkin lymphoma is a disease in which malignant
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(cancer) cells form in the lymph system.</h3><p id="CDR0000062958__132"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">Non-Hodgkin lymphoma</a> is a type of
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that forms in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, which is part of the body's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>. The immune system protects the body from foreign substances, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>, and diseases. The lymph system is
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made up of the following:</p><ul id="CDR0000062958__133"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046305/" class="def">Lymph</a>: Colorless, watery <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> that carries <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045765/" class="def">lymphocytes</a> through the lymph system. Lymphocytes protect the body against infection and the growth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>. There are three types of lymphocytes:<ul id="CDR0000062958__401"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044953/" class="def">B lymphocytes</a> that make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to help fight infection. Also called B cells. Most types of non-Hodgkin lymphoma begin in B lymphocytes.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T lymphocytes</a> that help B lymphocytes make the antibodies that help fight infection. Also called T cells.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044062/" class="def">Natural killer cells</a> that attack cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045941/" class="def">viruses</a>. Also called NK cells.</div></li></ul></div><div class="half_rhythm">Non-Hodgkin lymphoma can begin in B lymphocytes, T lymphocytes, or natural killer cells. Lymphocytes can also be found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and also collect in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046616/" class="def">thymus</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">Lymph vessels</a>: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.</div></li><li class="half_rhythm"><div class="half_rhythm">Lymph nodes:
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Small, bean-shaped structures that filter lymph and store white blood cells that help fight
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infection and disease. Lymph nodes are located along the network of lymph vessels
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found throughout the body. Clusters of lymph nodes are found in the neck, underarm,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>. </div></li><li class="half_rhythm"><div class="half_rhythm">Spleen: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> that makes lymphocytes, filters the
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blood, stores blood cells, and destroys old blood cells. It is on the
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left side of the abdomen near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>.</div></li><li class="half_rhythm"><div class="half_rhythm">Thymus: An organ in which lymphocytes grow and multiply. The
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thymus is in the chest behind the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046618/" class="def">Tonsils</a>: Two small masses of lymph <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> at the back of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>. The
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tonsils make lymphocytes.</div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">Bone marrow</a>: The soft, spongy tissue in the center of
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large bones. Bone marrow makes white blood cells, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a>, and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a>.</div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958297" co-legend-rid="figlgndCDR0000062958297"><a href="/books/NBK65899.6/figure/CDR0000062958__297/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958297" rid-ob="figobCDR0000062958297"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000533339.gif" src-large="/books/NBK65899.6/bin/CDR0000533339.jpg" alt="Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958297"><h4 id="CDR0000062958__297"><a href="/books/NBK65899.6/figure/CDR0000062958__297/?report=objectonly" target="object" rid-ob="figobCDR0000062958297">Figure</a></h4><p class="float-caption no_bottom_margin">Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes <a href="/books/NBK65899.6/figure/CDR0000062958__297/?report=objectonly" target="object" rid-ob="figobCDR0000062958297">(more...)</a></p></div></div><p id="CDR0000062958__134">Lymph tissue is also found in other parts of the body such as the stomach, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044751/" class="def">thyroid gland</a>, brain, and skin. Cancer can spread to the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.</p><p id="CDR0000062958__274">Non-Hodgkin lymphoma during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666677/" class="def">pregnancy</a> is rare. Non-Hodgkin lymphoma in pregnant women is the same as the disease in nonpregnant women of childbearing age. However, treatment is different for pregnant women. This summary includes information on the treatment of non-Hodgkin lymphoma during pregnancy (see the <a href="#CDR0000062958__354">Treatment Options for Non-Hodgkin Lymphoma During Pregnancy</a> section for more information).</p><p id="CDR0000062958__135">
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Non-Hodgkin lymphoma can occur in both adults and children. Treatment for adults is different than treatment for children.
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(See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000258002/">Childhood
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Non-Hodgkin Lymphoma Treatment</a> for more information.)
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</p></div><div id="CDR0000062958__136"><h3>The major types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.</h3><p id="CDR0000062958__138"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">Lymphomas</a> are divided into two general types: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a> and non-Hodgkin lymphoma. This summary is about the treatment of adult non-Hodgkin lymphoma. </p><p id="CDR0000062958__404">For information about certain types of lymphoma, see the following PDQ summaries: </p><ul id="CDR0000062958__139"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000257989/">Adult Acute Lymphoblastic Leukemia Treatment</a> (lymphoblastic lymphoma)</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000257991/">Adult Hodgkin Lymphoma Treatment</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000257993/">AIDS-Related Lymphoma Treatment</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258005/">Chronic Lymphocytic Leukemia Treatment</a> (small lymphocytic lymphoma)</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258022/">Mycosis Fungoides and the Sézary Syndrome Treatment</a> (cutaneous T-cell lymphoma)</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000258030/">Primary CNS Lymphoma Treatment</a></div></li></ul></div><div id="CDR0000062958__376"><h3>Non-Hodgkin lymphoma can be indolent or aggressive.</h3><p id="CDR0000062958__378">Non-Hodgkin lymphoma grows and spreads at different rates and can be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046355/" class="def">indolent</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046053/" class="def">aggressive</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045735/" class="def">Indolent lymphoma</a> tends to grow and spread slowly, and has few <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">Aggressive lymphoma</a> grows and spreads quickly, and has signs and symptoms that can be severe. The treatments for indolent and aggressive lymphoma are different.</p><p id="CDR0000062958__397">This summary is about the following types of non-Hodgkin lymphoma:</p><p id="CDR0000062958__453"><b><div class="milestone-start" id="CDR0000062958__379"></div>Indolent non-Hodgkin lymphomas</b></p><ul id="CDR0000062958__398" class="simple-list"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000428287/" class="def">Follicular lymphoma</a>.</b> Follicular lymphoma is the most common type of indolent non-Hodgkin lymphoma. It is a very slow-growing type of non-Hodgkin lymphoma that begins in B lymphocytes. It affects the lymph nodes and may spread to the bone marrow or spleen. Most patients with follicular lymphoma are age 50 years and older when they are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>. Follicular lymphoma may go away without treatment. The patient is closely watched for signs or symptoms that the disease has come back. Treatment is needed if signs or symptoms occur after the cancer disappeared or after initial cancer treatment. Sometimes follicular lymphoma can become a more aggressive type of lymphoma, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000428286/" class="def">diffuse large B-cell lymphoma</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409750/" class="def">Lymphoplasmacytic lymphoma</a>.</b> In most cases of lymphoplasmacytic lymphoma, B lymphocytes that are turning into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046230/" class="def">plasma cells</a> make large amounts of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000411378/" class="def">monoclonal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045725/" class="def">immunoglobulin</a> M (IgM) antibody. High levels of IgM antibody in the blood cause the blood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045839/" class="def">plasma</a> to thicken. This may cause signs or symptoms such as trouble seeing or hearing, heart problems, shortness of breath, headache, dizziness, and numbness or tingling of the hands and feet. Sometimes there are no signs or symptoms of lymphoplasmacytic lymphoma. It may be found when a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000688783/" class="def">blood test</a> is done for another reason. Lymphoplasmacytic lymphoma often spreads to the bone marrow, lymph nodes, and spleen. It is also called Waldenström macroglobulinemia.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000543124/" class="def">Marginal zone lymphoma</a>.</b> This type of non-Hodgkin lymphoma begins in B lymphocytes in a part of lymph tissue called the marginal zone. There are five different types of marginal zone lymphoma. They are grouped by the type of tissue where the lymphoma formed: <ul id="CDR0000062958__400"><li class="half_rhythm"><div><b>Monocytoid <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444967/" class="def">B cell lymphoma</a>.</b> Monocytoid B-cell lymphoma forms in lymph nodes. This type of non-Hodgkin lymphoma is rare. It is also called nodal marginal zone lymphoma.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046770/" class="def">Gastric</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044437/" class="def">mucosa-associated lymphoid tissue (MALT) lymphoma</a>.</b> Gastric MALT lymphoma usually begins in the stomach. This type of marginal zone lymphoma forms in cells in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257213/" class="def">mucosa</a> that help make antibodies. Patients with gastric MALT lymphoma may also have <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045706/" class="def">Helicobacter</a></i>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330169/" class="def">gastritis</a> or an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045604/" class="def">autoimmune disease</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000658010/" class="def">Hashimoto thyroiditis</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455423/" class="def">Sjögren syndrome</a>. </div></li><li class="half_rhythm"><div><b>Extragastric MALT lymphoma.</b> Extragastric MALT lymphoma begins outside of the stomach in almost every part of the body including other parts of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046189/" class="def">gastrointestinal tract</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">salivary glands</a>, thyroid, lung, skin, and around the eye. This type of marginal zone lymphoma forms in cells in the mucosa that help make antibodies. Extragastric MALT lymphoma may come back many years after treatment.</div></li><li class="half_rhythm"><div><b>Mediterranean <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> lymphoma.</b> This is a type of MALT lymphoma that occurs in young adults in eastern Mediterranean countries. It often forms in the abdomen and patients may also be infected with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">bacteria</a> called <i>Campylobacter jejuni</i>. This type of lymphoma is also called immunoproliferative small intestinal disease.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000467863/" class="def">Splenic</a> marginal zone lymphoma.</b> This type of marginal zone lymphoma begins in the spleen and may spread to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046011/" class="def">peripheral blood</a> and bone marrow. The most common sign of this type of splenic marginal zone lymphoma is a spleen that is larger than normal.</div></li></ul></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748354/" class="def">Primary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046112/" class="def">cutaneous</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045552/" class="def">anaplastic large cell lymphoma</a>.</b> This type of non-Hodgkin lymphoma is in the skin only. It can be a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045614/" class="def">benign</a> (not cancer) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044502/" class="def">nodule</a> that may go away on its own or it can spread to many places on the skin and need treatment.<div class="milestone-end"></div></div></li></ul><p id="CDR0000062958__454"><b><div class="milestone-start" id="CDR0000062958__392"></div>Aggressive non-Hodgkin lymphomas</b></p><ul id="CDR0000062958__399" class="simple-list"><li class="half_rhythm"><div class="half_rhythm"><b>Diffuse large B-cell lymphoma.</b> Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma. It grows quickly in the lymph nodes and often the spleen, liver, bone marrow, or other organs are also affected. Signs and symptoms of diffuse large B-cell lymphoma may include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">fever</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> night sweats, and weight loss. These are also called B symptoms.</div><div class="half_rhythm">Primary mediastinal large B-cell lymphoma is a type of diffuse large B-cell lymphoma.<ul id="CDR0000062958__408"><li class="half_rhythm"><div><b>Primary mediastinal large B-cell lymphoma.</b> This type of non-Hodgkin lymphoma is marked by the overgrowth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000344349/" class="def">fibrous</a> (scar-like) lymph tissue. A tumor most often forms behind the breastbone. It may press on the airways and cause coughing and trouble breathing. Most patients with primary mediastinal large B-cell lymphoma are women who are age 30 to 40 years.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044238/" class="def">Follicular large cell lymphoma</a>, stage III.</b> Follicular large cell lymphoma, stage III, is a very rare type of non-Hodgkin lymphoma. It is more like diffuse large B-cell lymphoma than other types of follicular lymphoma.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Anaplastic large cell lymphoma.</b> Anaplastic large cell lymphoma is a type of non-Hodgkin lymphoma that usually begins in T lymphocytes. The cancer cells also have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">marker</a> called CD30 on the surface of the cell. </div><div class="half_rhythm">There are two types of anaplastic large cell lymphoma:<ul id="CDR0000062958__410"><li class="half_rhythm"><div><b>Cutaneous anaplastic large cell lymphoma.</b> This type of anaplastic large cell lymphoma mostly affects the skin, but other parts of the body may also be affected. Signs of cutaneous anaplastic large cell lymphoma include one or more bumps or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390317/" class="def">ulcers</a> on the skin.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045921/" class="def">Systemic</a> anaplastic large cell lymphoma.</b> This type of anaplastic large cell lymphoma begins in the lymph nodes and may affect other parts of the body. Patients may have a lot of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045591/" class="def">anaplastic</a> lymphoma <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641114/" class="def">kinase</a> (ALK) protein inside the lymphoma cells. These patients have a better <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> than patients who do not have extra ALK protein. Systemic anaplastic large cell lymphoma is more common in children than adults. (See the PDQ summary on <a href="/books/n/pdqcis/CDR0000258002/">Childhood Non-Hodgkin Lymphoma Treatment</a> for more information.)</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000539104/" class="def">Extranodal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044439/" class="def">NK</a>-/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045924/" class="def">T-cell lymphoma</a>.</b> Extranodal NK-/T-cell lymphoma usually begins in the area around the nose. It may also affect the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000518299/" class="def">paranasal sinus</a> (hollow spaces in the bones around the nose), roof of the mouth, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046623/" class="def">trachea</a>, skin, stomach, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestines</a>. Most cases of extranodal NK-/T-cell lymphoma have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045684/" class="def">Epstein-Barr virus</a> in the tumor cells. Sometimes hemophagocytic <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045090/" class="def">syndrome</a> occurs (a serious <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> in which there are too many active histiocytes and T cells that cause severe <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> in the body). Treatment to suppress the immune system is needed. This type of non-Hodgkin lymphoma is not common in the United States. </div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045766/" class="def">Lymphomatoid granulomatosis</a>.</b> Lymphomatoid granulomatosis mostly affects the lungs. It may also affect the paranasal sinuses (hollow spaces in the bones around the nose), skin, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidneys</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a>. In lymphomatoid granulomatosis, cancer invades the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> and kills tissue. Because the cancer may spread to the brain, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the brain is given.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346464/" class="def">Angioimmunoblastic T-cell lymphoma</a>.</b> This type of non-Hodgkin lymphoma begins in T cells. Swollen lymph nodes are a common sign. Other signs may include a skin rash, fever, weight loss, or night sweats. There may also be high levels of gamma globulin (antibodies) in the blood. Patients may also have opportunistic infections because their immune systems are weakened.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000405873/" class="def">Peripheral T-cell lymphoma</a>.</b> Peripheral T-cell lymphoma begins in mature T lymphocytes. This type of T lymphocyte matures in the thymus <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046386/" class="def">gland</a> and travels to other lymphatic sites in the body such as the lymph nodes, bone marrow, and spleen. There are three subtypes of peripheral T-cell lymphoma:<ul id="CDR0000062958__412"><li class="half_rhythm"><div><b>Hepatosplenic T-cell lymphoma.</b> This is an uncommon type of peripheral T-cell lymphoma that occurs mostly in young men. It begins in the liver and spleen and the cancer cells also have a T-cell <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044958/" class="def">receptor</a> called gamma/delta on the surface of the cell. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045914/" class="def">Subcutaneous</a> panniculitis-like T-cell lymphoma.</b> Subcutaneous panniculitis-like T-cell lymphoma begins in the skin or mucosa. It may occur with hemophagocytic syndrome (a serious condition in which there are too many active histiocytes and T cells that cause severe inflammation in the body). Treatment to suppress the immune system is needed.</div></li><li class="half_rhythm"><div><b>Enteropathy-type <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044046/" class="def">intestinal</a> T-cell lymphoma.</b> This type of peripheral T-cell lymphoma occurs in the small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> of patients with untreated <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000377726/" class="def">celiac disease</a> (an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune response</a> to gluten that causes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046014/" class="def">malnutrition</a>). Patients who are diagnosed with celiac disease in childhood and stay on a gluten-free <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a> rarely develop enteropathy-type intestinal T-cell lymphoma.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"><b>Intravascular large B-cell lymphoma.</b> This type of non-Hodgkin lymphoma affects blood vessels, especially the small blood vessels in the brain, kidney, lung, and skin. Signs and symptoms of intravascular large B-cell lymphoma are caused by blocked blood vessels. It is also called intravascular lymphomatosis.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045203/" class="def">Burkitt lymphoma</a>.</b> Burkitt lymphoma is a type of B-cell non-Hodgkin lymphoma that grows and spreads very quickly. It may affect the jaw, bones of the face, bowel, kidneys, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>, or other organs. There are three main types of Burkitt lymphoma (endemic, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000339347/" class="def">sporadic</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046357/" class="def">immunodeficiency</a> related). Endemic Burkitt lymphoma commonly occurs in Africa and is linked to the Epstein-Barr virus, and sporadic Burkitt lymphoma occurs throughout the world. Immunodeficiency-related Burkitt lymphoma is most often seen in patients who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045950/" class="def">AIDS</a>. Burkitt lymphoma may spread to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> and treatment to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a> its spread may be given. Burkitt lymphoma occurs most often in children and young adults (See the PDQ summary on <a href="/books/n/pdqcis/CDR0000258002/">Childhood Non-Hodgkin Lymphoma Treatment</a> for more information.) Burkitt lymphoma is also called diffuse small noncleaved-cell lymphoma.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597158/" class="def">Lymphoblastic lymphoma</a>.</b> Lymphoblastic lymphoma may begin in T cells or B cells, but it usually begins in T cells. In this type of non-Hodgkin lymphoma, there are too many <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302475/" class="def">lymphoblasts</a> (immature white blood cells) in the lymph nodes and the thymus gland. These lymphoblasts may spread to other places in the body, such as the bone marrow, brain, and spinal cord. Lymphoblastic lymphoma is most common in teenagers and young adults. It is a lot like <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a> (lymphoblasts are mostly found in the bone marrow and blood). (See the PDQ summary on <a href="/books/n/pdqcis/CDR0000257989/">Adult Acute Lymphoblastic Leukemia Treatment</a> for more information.)</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269410/" class="def">Adult T-cell leukemia/lymphoma</a>.</b> Adult T-cell leukemia/lymphoma is caused by the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269420/" class="def">human T-cell leukemia virus type 1</a> (HTLV-1). Signs include bone and skin lesions, high blood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045632/" class="def">calcium</a> levels, and lymph nodes, spleen, and liver that are larger than normal. </div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445048/" class="def">Mantle cell lymphoma</a>.</b> Mantle cell lymphoma is a type of B-cell non-Hodgkin lymphoma that usually occurs in middle-aged or older adults. It begins in the lymph nodes and spreads to the spleen, bone marrow, blood, and sometimes the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>, stomach, and intestines. Patients with mantle cell lymphoma have too much of a protein called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000729820/" class="def">cyclin-D1</a>or a certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> change in the lymphoma cells. In some patients who do not have signs or symptoms of lymphoma delaying the start of treatment does not affect the prognosis.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468786/" class="def">Posttransplantation lymphoproliferative disorder</a>.</b> This disease occurs in patients who have had a heart, lung, liver, kidney, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046254/" class="def">pancreas</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a> and need lifelong <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045728/" class="def">immunosuppressive therapy</a>. Most posttransplant lymphoproliferative disorders affect the B cells and have Epstein-Barr virus in the cells. Lymphoproliferative disorders are often treated like cancer. </div></li><li class="half_rhythm"><div class="half_rhythm"><b>True <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373019/" class="def">histiocytic lymphoma</a>.</b> This is a rare, very aggressive type of lymphoma. It is not known whether it begins in B cells or T cells. It does not respond well to treatment with standard <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455144/" class="def">Primary effusion lymphoma</a>.</b> Primary effusion lymphoma begins in B cells that are found in an area where there is a large build-up of fluid, such as the areas between the lining of the lung and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest wall</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045843/" class="def">pleural effusion</a>), the sac around the heart and the heart (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045825/" class="def">pericardial effusion</a>), or in the abdominal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a>. There is usually no tumor that can be seen. This type of lymphoma often occurs in patients who have AIDS.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Plasmablastic lymphoma.</b> Plasmablastic lymphoma is a type of large B-cell non-Hodgkin lymphoma that is very aggressive. It is most often seen in patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044985/" class="def">HIV</a> infection.<div class="milestone-end"></div></div></li></ul></div><div id="CDR0000062958__140"><h3>Age, gender, and a weakened immune system can affect the risk of
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adult non-Hodgkin lymphoma.</h3><p id="CDR0000062958__142">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. </p><p id="CDR0000062958__413">These and other risk factors may increase the risk of certain types of adult
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non-Hodgkin lymphoma:</p><ul id="CDR0000062958__143"><li class="half_rhythm"><div>Being older, male, or white.</div></li><li class="half_rhythm"><div>Having one of the following medical conditions:<dl id="CDR0000062958__144" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">inherited</a> immune <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407758/" class="def">disorder</a> (such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455335/" class="def">hypogammaglobulinemia</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000539110/" class="def">Wiskott-Aldrich syndrome</a>).</p></dd><dt>-</dt><dd><p class="no_top_margin">An autoimmune disease (such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455398/" class="def">rheumatoid arthritis</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044219/" class="def">psoriasis</a>, or Sjögren syndrome).</p></dd><dt>-</dt><dd><p class="no_top_margin">HIV/AIDS.</p></dd><dt>-</dt><dd><p class="no_top_margin">Human T-lymphotrophic virus type I or Epstein-Barr virus infection.</p></dd><dt>-</dt><dd><p class="no_top_margin"><i>Helicobacter pylori</i> infection.</p></dd></dl></div></li><li class="half_rhythm"><div>Taking <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045727/" class="def">immunosuppressant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> after an organ transplant.</div></li></ul></div><div id="CDR0000062958__145"><h3>Signs and symptoms of adult non-Hodgkin lymphoma include swelling in the lymph nodes, fever,
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night sweats, weight loss, and fatigue. </h3><p id="CDR0000062958__147">These signs and symptoms may be caused by adult non-Hodgkin
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lymphoma or by other conditions. Check with your doctor if you have any of the
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following:</p><ul id="CDR0000062958__148"><li class="half_rhythm"><div>Swelling in the lymph nodes in the neck, underarm,
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groin, or stomach.</div></li><li class="half_rhythm"><div>Fever for no known reason.</div></li><li class="half_rhythm"><div>Recurring night sweats.</div></li><li class="half_rhythm"><div>Feeling very tired.</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Skin rash or itchy skin.</div></li><li class="half_rhythm"><div>Pain in the chest, abdomen, or bones for no known reason.</div></li></ul><p id="CDR0000062958__411">When fever, night sweats, and weight loss occur together, this group of symptoms is called B symptoms. </p><p id="CDR0000062958__415">Other signs and symptoms of adult non-Hodgkin lymphoma may occur and depend on the following:
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</p><ul id="CDR0000062958__416"><li class="half_rhythm"><div>Where the cancer forms in the body.</div></li><li class="half_rhythm"><div>The size of the tumor.</div></li><li class="half_rhythm"><div>How fast the tumor grows.
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</div></li></ul></div><div id="CDR0000062958__149"><h3><div class="milestone-start" id="CDR0000062958__150"></div>Tests that examine the body and lymph system are used to
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help detect (find) and diagnose adult non-Hodgkin lymphoma.<div class="milestone-end"></div></h3><p id="CDR0000062958__151">The following tests and procedures may be used:</p><ul id="CDR0000062958__152"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335066/" class="def">Flow cytometry</a></b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor markers</a> on the cell surface. The cells are stained with a light-sensitive dye, placed in a fluid, and passed in a stream before a laser or other type of light. The measurements are based on how the light-sensitive dye reacts to the light.
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This test is used to diagnose lymphoplasmacytic lymphoma.</div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of bone marrow and a small piece of bone by inserting a needle into the hipbone or breastbone. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the bone marrow and bone under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for signs of cancer.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958310" co-legend-rid="figlgndCDR0000062958310"><a href="/books/NBK65899.6/figure/CDR0000062958__310/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958310" rid-ob="figobCDR0000062958310"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000554337.gif" src-large="/books/NBK65899.6/bin/CDR0000554337.jpg" alt="Bone marrow aspiration and biopsy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958310"><h4 id="CDR0000062958__310"><a href="/books/NBK65899.6/figure/CDR0000062958__310/?report=objectonly" target="object" rid-ob="figobCDR0000062958310">Figure</a></h4><p class="float-caption no_bottom_margin">Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope. </p></div></div></div></li><li class="half_rhythm"><div><b> Lymph node biopsy</b>: The
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removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done: <dl id="CDR0000062958__154" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046411/" class="def">Excisional
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biopsy</a></b>: The removal of an entire lymph node. </p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046698/" class="def">Incisional
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biopsy</a></b>: The removal of part of a lymph node.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045657/" class="def">Core biopsy</a></b>: The removal of part of a lymph node using a wide needle. </p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045691/" class="def">Fine-needle aspiration</a> (FNA) biopsy</b>: The removal of tissue or fluid using a thin needle.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045556/" class="def">Laparoscopy</a></b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgical</a> procedure to look at the organs inside the abdomen to check for signs of disease. Small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incisions</a> (cuts) are made in the wall of the abdomen and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044360/" class="def">laparoscope</a> (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to take tissue samples to be checked under a microscope for signs of disease.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045747/" class="def">Laparotomy</a></b>: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. Tissue samples are taken and checked under a microscope for signs of disease.</p></dd></dl></div></li></ul><p id="CDR0000062958__319">If cancer is found, the following tests may be done to study the cancer cells:
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</p><ul id="CDR0000062958__320"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000653117/" class="def">Immunohistochemistry</a></b>: A test that uses antibodies to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> in a sample of tissue. The antibody is usually linked to a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270737/" class="def">Cytogenetic analysis</a></b>: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosomes</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000460228/" class="def">FISH</a> (fluorescence in situ hybridization)</b>: A laboratory test used to look at genes or chromosomes in cells and tissues. Pieces of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA attach to certain genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. This type of test is used to look for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046129/" class="def">genetic markers</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000341450/" class="def">Immunophenotyping</a></b>: A process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose specific types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> and lymphoma by comparing the cancer cells to normal cells of the immune system.</div></li></ul><p id="CDR0000062958__417">Other tests and procedures may be done depending on the signs and symptoms seen and where the cancer forms in the body.</p></div><div id="CDR0000062958__155"><h3>Certain factors affect prognosis (chance
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of recovery) and treatment options.</h3><p id="CDR0000062958__260">The prognosis (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend on the following:</p><ul id="CDR0000062958__261"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer.</div></li><li class="half_rhythm"><div>The type of non-Hodgkin lymphoma. </div></li><li class="half_rhythm"><div>The amount of lactate dehydrogenase (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354465/" class="def">LDH</a>) in the blood.</div></li><li class="half_rhythm"><div>Whether there are certain changes in the genes.</div></li><li class="half_rhythm"><div>The patient’s age and
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general health.</div></li><li class="half_rhythm"><div>Whether the lymphoma has just been diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a> (come back).</div></li></ul><p id="CDR0000062958__275">For non-Hodgkin lymphoma during pregnancy, the treatment options also depend on:</p><ul id="CDR0000062958__276"><li class="half_rhythm"><div>The wishes of the patient.</div></li><li class="half_rhythm"><div>Which trimester of pregnancy the patient is in.</div></li><li class="half_rhythm"><div>Whether the baby can be delivered early.</div></li></ul><p id="CDR0000062958__277">Some types of non-Hodgkin lymphoma spread more quickly than
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others do. Most non-Hodgkin lymphomas that occur during pregnancy are
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aggressive. Delaying treatment
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of aggressive lymphoma until after the baby is born may lessen the mother's chance of survival. Immediate
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treatment is often recommended, even during pregnancy. </p></div></div><div id="CDR0000062958__158"><h2 id="_CDR0000062958__158_">Stages of Adult Non-Hodgkin Lymphoma</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062958__159">After adult non-Hodgkin lymphoma has been diagnosed, tests are done to find out
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if cancer cells have spread within the lymph
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system or to other parts of the body.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__302">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__31">Stages of adult non-Hodgkin lymphoma may include
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E and S.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__164">The following stages are used for adult non-Hodgkin
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lymphoma:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__182">Adult non-Hodgkin lymphomas may be grouped for treatment according to whether the cancer is indolent or aggressive and whether affected lymph nodes are next to each other in the body.</a></div></li></ul></div><div id="CDR0000062958__159"><h3>After adult non-Hodgkin lymphoma has been diagnosed, tests are done to find out
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if cancer cells have spread within the lymph
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system or to other parts of the body.
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</h3><p id="CDR0000062958__161">The process used to find out the type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and if cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>
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have spread within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a> or to other parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The
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information gathered from the staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the
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disease. It is important to know the stage of the disease in order to plan treatment. The results of the <a href="#CDR0000062958__150">tests and procedures</a> done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> are used to help make decisions about treatment.</p><p id="CDR0000062958__418">The following tests and procedures may also be used in the staging
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process:</p><ul id="CDR0000062958__163"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000729979/" class="def">Complete blood count (CBC) with differential</a></b>: A procedure in which a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> is drawn and checked for the following:<dl id="CDR0000062958__321" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">
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The number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">The number and type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> that carries <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a>) in the red blood cells.</p></dd><dt>-</dt><dd><p class="no_top_margin">The portion of the blood sample made up of red blood cells.
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</p></dd></dl><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958351" co-legend-rid="figlgndCDR0000062958351"><a href="/books/NBK65899.6/figure/CDR0000062958__351/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958351" rid-ob="figobCDR0000062958351"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000526546.gif" src-large="/books/NBK65899.6/bin/CDR0000526546.jpg" alt="Complete blood count (CBC)" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958351"><h4 id="CDR0000062958__351"><a href="/books/NBK65899.6/figure/CDR0000062958__351/?report=objectonly" target="object" rid-ob="figobCDR0000062958351">Figure</a></h4><p class="float-caption no_bottom_margin">Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used <a href="/books/NBK65899.6/figure/CDR0000062958__351/?report=objectonly" target="object" rid-ob="figobCDR0000062958351">(more...)</a></p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the body. An unusual (higher or lower than normal) amount of a substance can be a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">sign</a> of disease.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>:
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A procedure that makes a series of detailed pictures of areas inside the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron
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emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> cells in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic
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resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). </div></li><li class="half_rhythm"><div>
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<b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> and a small piece of bone by inserting a needle into the hipbone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the bone marrow and bone under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to look for signs of cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046303/" class="def">Lumbar puncture</a></b>: A procedure used to collect <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF) from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396787/" class="def">spinal column</a>. This is done by placing a needle between two bones in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> and into the CSF around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs that the cancer has spread to the brain and spinal cord. This procedure is also called an LP or spinal tap. <div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958322" co-legend-rid="figlgndCDR0000062958322"><a href="/books/NBK65899.6/figure/CDR0000062958__322/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958322" rid-ob="figobCDR0000062958322"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000503953.gif" src-large="/books/NBK65899.6/bin/CDR0000503953.jpg" alt="Lumbar puncture" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958322"><h4 id="CDR0000062958__322"><a href="/books/NBK65899.6/figure/CDR0000062958__322/?report=objectonly" target="object" rid-ob="figobCDR0000062958322">Figure</a></h4><p class="float-caption no_bottom_margin">Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). <a href="/books/NBK65899.6/figure/CDR0000062958__322/?report=objectonly" target="object" rid-ob="figobCDR0000062958322">(more...)</a></p></div></div></div></li></ul><p id="CDR0000062958__284">For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666677/" class="def">pregnant</a> women with non-Hodgkin lymphoma, staging tests and procedures that protect the baby from the harms of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> are used. These tests and procedures include MRI, bone marrow aspiration and biopsy, lumbar puncture, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">ultrasound</a>. An ultrasound exam is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. </p></div><div id="CDR0000062958__302"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000062958__302_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000062958__302_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000062958__31"><h3>Stages of adult non-Hodgkin lymphoma may include
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E and S.</h3><p id="CDR0000062958__33">Adult non-Hodgkin lymphoma may be described as
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follows:</p><ul id="CDR0000062958__34"><li class="half_rhythm"><div>E: "E" stands for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000539104/" class="def">extranodal</a> and means the cancer is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymphatic</a>
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areas.</div></li><li class="half_rhythm"><div>S: "S" stands for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a> and means the cancer is found in the spleen.</div></li></ul></div><div id="CDR0000062958__164"><h3>The following stages are used for adult non-Hodgkin
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lymphoma:</h3><div id="CDR0000062958__166"><h4>Stage I</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958313" co-legend-rid="figlgndCDR0000062958313"><a href="/books/NBK65899.6/figure/CDR0000062958__313/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958313" rid-ob="figobCDR0000062958313"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000614643.gif" src-large="/books/NBK65899.6/bin/CDR0000614643.jpg" alt="Stage I adult non-Hodgkin lymphoma" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958313"><h4 id="CDR0000062958__313"><a href="/books/NBK65899.6/figure/CDR0000062958__313/?report=objectonly" target="object" rid-ob="figobCDR0000062958313">Figure</a></h4><p class="float-caption no_bottom_margin">Stage I adult non-Hodgkin lymphoma. Cancer is found in one lymphatic area (lymph nodes, tonsils, thymus, or spleen). In stage IE (not shown), cancer is found in one organ or area outside the lymph nodes. </p></div></div><p id="CDR0000062958__168">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045906/" class="def">Stage I</a> adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> is divided into stage I and stage IE.</p><ul id="CDR0000062958__169"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045906/" class="def">Stage I</a>: Cancer is found in one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymphatic</a> area (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> group, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046618/" class="def">tonsils</a> and nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046616/" class="def">thymus</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045906/" class="def">Stage IE</a>: Cancer is found in one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</div></li></ul></div><div id="CDR0000062958__170"><h4>Stage II</h4><p id="CDR0000062958__172">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045907/" class="def">Stage II</a> adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> is divided into stage II and stage IIE.</p><ul id="CDR0000062958__173"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045907/" class="def">Stage II</a>: Cancer is found in two or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups either above or below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>
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(the thin muscle below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> that helps breathing and separates the chest
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from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>).<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958314" co-legend-rid="figlgndCDR0000062958314"><a href="/books/NBK65899.6/figure/CDR0000062958__314/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958314" rid-ob="figobCDR0000062958314"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000614648.gif" src-large="/books/NBK65899.6/bin/CDR0000614648.jpg" alt="Stage II adult non-Hodgkin lymphoma" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958314"><h4 id="CDR0000062958__314"><a href="/books/NBK65899.6/figure/CDR0000062958__314/?report=objectonly" target="object" rid-ob="figobCDR0000062958314">Figure</a></h4><p class="float-caption no_bottom_margin">Stage II adult non-Hodgkin lymphoma. Cancer is found in two or more lymph node groups, and both are either above (a) or below (b) the diaphragm. </p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045907/" class="def">Stage IIE</a>: Cancer is found in one or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups either above or below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>. Cancer is also found outside the lymph nodes in one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area on the same side of the diaphragm as the affected lymph nodes.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958315" co-legend-rid="figlgndCDR0000062958315"><a href="/books/NBK65899.6/figure/CDR0000062958__315/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958315" rid-ob="figobCDR0000062958315"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000614650.gif" src-large="/books/NBK65899.6/bin/CDR0000614650.jpg" alt="Stage IIE adult non-Hodgkin lymphoma" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958315"><h4 id="CDR0000062958__315"><a href="/books/NBK65899.6/figure/CDR0000062958__315/?report=objectonly" target="object" rid-ob="figobCDR0000062958315">Figure</a></h4><p class="float-caption no_bottom_margin">Stage IIE adult non-Hodgkin lymphoma. Cancer is found in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in an organ or area on the same side of the diaphragm as the lymph nodes with cancer (a). </p></div></div></div></li></ul></div><div id="CDR0000062958__174"><h4>Stage III</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958316" co-legend-rid="figlgndCDR0000062958316"><a href="/books/NBK65899.6/figure/CDR0000062958__316/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958316" rid-ob="figobCDR0000062958316"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000614684.gif" src-large="/books/NBK65899.6/bin/CDR0000614684.jpg" alt="Stage III adult non-Hodgkin lymphoma" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958316"><h4 id="CDR0000062958__316"><a href="/books/NBK65899.6/figure/CDR0000062958__316/?report=objectonly" target="object" rid-ob="figobCDR0000062958316">Figure</a></h4><p class="float-caption no_bottom_margin">Stage III adult non-Hodgkin lymphoma. Cancer is found in one or more lymph node groups above and below the diaphragm (a). In stage IIIE, cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or <a href="/books/NBK65899.6/figure/CDR0000062958__316/?report=objectonly" target="object" rid-ob="figobCDR0000062958316">(more...)</a></p></div></div><p id="CDR0000062958__176">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045908/" class="def">Stage III</a> adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> is divided into stage III, stage IIIE, stage IIIS, and stage IIIE+S.</p><ul id="CDR0000062958__177"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045908/" class="def">Stage III</a>: Cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> (the thin muscle below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> that helps breathing and separates the chest from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045908/" class="def">Stage IIIE</a>: Cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>
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and outside the lymph nodes in a nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045908/" class="def">Stage IIIS</a>: Cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>, and in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045908/" class="def">Stage IIIE+S</a>: Cancer is found in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> groups above and below the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>, outside the lymph nodes in a nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a> or area, and in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li></ul></div><div id="CDR0000062958__178"><h4>Stage IV</h4><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958317" co-legend-rid="figlgndCDR0000062958317"><a href="/books/NBK65899.6/figure/CDR0000062958__317/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958317" rid-ob="figobCDR0000062958317"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000629626.gif" src-large="/books/NBK65899.6/bin/CDR0000629626.jpg" alt="Stage IV adult non-Hodgkin lymphoma" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958317"><h4 id="CDR0000062958__317"><a href="/books/NBK65899.6/figure/CDR0000062958__317/?report=objectonly" target="object" rid-ob="figobCDR0000062958317">Figure</a></h4><p class="float-caption no_bottom_margin">Stage IV adult non-Hodgkin lymphoma. Cancer is found throughout one or more organs that are not part of a lymphatic area (lymph nodes, tonsils, thymus, or spleen) (a); or in one organ that is not part of a lymphatic area and has spread to lymph nodes <a href="/books/NBK65899.6/figure/CDR0000062958__317/?report=objectonly" target="object" rid-ob="figobCDR0000062958317">(more...)</a></p></div></div><p id="CDR0000062958__180">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045909/" class="def">stage IV</a> adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a>, the cancer: </p><ul id="CDR0000062958__181"><li class="half_rhythm"><div>is found throughout one or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> that are not part of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymphatic</a> area (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a> group, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046618/" class="def">tonsils</a> and nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046616/" class="def">thymus</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>), and may be in lymph nodes near those organs; or</div></li><li class="half_rhythm"><div>is found in one organ that is not part of a lymphatic area and has spread to organs or lymph nodes far away from that organ; or</div></li><li class="half_rhythm"><div>is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>, cerebrospinal fluid (CSF), or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> (other than cancer that has spread to the lungs from nearby areas).</div></li></ul></div></div><div id="CDR0000062958__182"><h3>Adult non-Hodgkin lymphomas may be grouped for treatment according to whether the cancer is indolent or aggressive and whether affected lymph nodes are next to each other in the body.</h3><p id="CDR0000062958__414">See the <a href="#CDR0000062958__376">General Information</a> section for more information on the types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045735/" class="def">indolent</a> (slow-growing) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">aggressive</a> (fast-growing) non-Hodgkin lymphoma.</p><p id="CDR0000062958__186">Non-Hodgkin lymphoma can also be described as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350356/" class="def">contiguous</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350357/" class="def">noncontiguous</a>:</p><ul id="CDR0000062958__187"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350356/" class="def">Contiguous lymphomas</a>: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">Lymphomas</a> in which the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> with cancer are next
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to each other.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350357/" class="def">Noncontiguous lymphomas</a>: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">Lymphomas</a> in which the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> with cancer
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are not next to each other, but are on the same side of the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>.</div></li></ul></div></div><div id="CDR0000062958__188"><h2 id="_CDR0000062958__188_">Recurrent Adult Non-Hodgkin Lymphoma</h2><p id="CDR0000062958__189"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> is
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back)
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after it has been treated. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">lymphoma</a> may come back
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in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a> or in other parts of the body. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045735/" class="def">Indolent lymphoma</a> may come back as
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">aggressive lymphoma</a>. Aggressive
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lymphoma may come back as indolent lymphoma.</p></div><div id="CDR0000062958__190"><h2 id="_CDR0000062958__190_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062958__191">There are different types of treatment for patients with non-Hodgkin lymphoma. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__62">Patients with non-Hodgkin lymphoma should have their treatment
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planned by a team of health care providers who are experts in treating lymphomas.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__362">Patients may develop late effects that appear months or years after their treatment for non-Hodgkin lymphoma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__195">Nine types of standard treatment are used:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__206">New types of treatment are being tested in clinical
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trials. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__304">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__306">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062958__308">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000062958__191"><h3>There are different types of treatment for patients with non-Hodgkin lymphoma. </h3><p id="CDR0000062958__193">Different types of treatment are available for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some
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are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.
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A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help
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improve current treatments or obtain information on new treatments for patients
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with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is better than the
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standard treatment, the new
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treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.</p><p id="CDR0000062958__285">For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666677/" class="def">pregnant</a> women with non-Hodgkin lymphoma, treatment is carefully chosen to protect the baby. Treatment decisions are based on the mother’s wishes, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the non-Hodgkin lymphoma, and the age of the baby. The treatment plan may change as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a>, cancer, and pregnancy change. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
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</p></div><div id="CDR0000062958__62"><h3>Patients with non-Hodgkin lymphoma should have their treatment
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planned by a team of health care providers who are experts in treating lymphomas.</h3><p id="CDR0000062958__64">Treatment will be overseen by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046290/" class="def">medical
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oncologist</a>, a doctor who specializes in treating cancer, or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046370/" class="def">hematologist</a>, a doctor who specializes in treating <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000733834/" class="def">blood cancers</a>. The
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medical oncologist may refer you to other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">health care providers</a> who have experience and
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are experts in treating adult non-Hodgkin lymphoma and who specialize in certain
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areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These may include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000062958__65"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046269/" class="def">Neurosurgeon</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046267/" class="def">Neurologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation
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oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046439/" class="def">Endocrinologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li><li class="half_rhythm"><div>Other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045434/" class="def">oncology</a> specialists.</div></li></ul></div><div id="CDR0000062958__362"><h3>Patients may develop late effects that appear months or years after their treatment for non-Hodgkin lymphoma.</h3><p id="CDR0000062958__364"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">Side effects</a> from cancer treatment that begin during or after treatment and continue for months or years are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> for non-Hodgkin lymphoma may increase the risk of late effects. </p><p id="CDR0000062958__405">Late effects of cancer treatment may include the following: </p><ul id="CDR0000062958__395"><li class="half_rhythm"><div>Heart problems.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046348/" class="def">Infertility</a> (inability to have children).</div></li><li class="half_rhythm"><div>Loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407755/" class="def">bone density</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046041/" class="def">Neuropathy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">nerve</a> damage that causes numbness or trouble walking).</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">second cancer</a>, such as:<ul id="CDR0000062958__396"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">Lung cancer</a>.</div></li><li class="half_rhythm"><div>Brain cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444995/" class="def">Kidney cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444968/" class="def">Bladder cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045135/" class="def">Melanoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">Myelodysplastic syndrome</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">Acute myeloid leukemia</a>.</div></li></ul></div></li></ul><p id="CDR0000062958__250">Some late effects may be treated or controlled. It is important to talk with your doctor about the effects cancer treatment can have on you. Regular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> to check for late effects is important.</p></div><div id="CDR0000062958__195"><h3>Nine types of standard treatment are used:</h3><div id="CDR0000062958__197"><h4>Radiation therapy
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</h4><p id="CDR0000062958__199">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> or keep them from growing. There are two types of radiation therapy:</p><ul id="CDR0000062958__462"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000062958__452">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">Total-body irradiation</a> is a type of external radiation therapy that is given to the entire body. It may be given before a stem cell transplant.</p><p id="CDR0000062958__463">The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat adult non-Hodgkin lymphoma, and may also be used as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve symptoms and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</p><p id="CDR0000062958__294">For pregnant women with non-Hodgkin lymphoma, radiation therapy should be given after delivery, if possible, to avoid any risk to the baby. If treatment is needed right away, pregnant women may decide to continue the pregnancy and receive radiation therapy. However, lead used to shield the baby may not protect it from scattered radiation that could possibly cause cancer in the future.</p></div><div id="CDR0000062958__200"><h4>Chemotherapy </h4><p id="CDR0000062958__202">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal chemotherapy</a>), an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> is treatment using two or more anticancer drugs. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046601/" class="def">Steroid drugs</a> may be added, to lessen
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> and lower the body's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune response</a>.</p><p id="CDR0000062958__448">The way the chemotherapy is given depends on the type and stage of the cancer being treated. </p><p id="CDR0000062958__263">Intrathecal chemotherapy may also be used in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">lymphoma</a> that first forms in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641960/" class="def">sinuses</a> (hollow areas) around the nose, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000428286/" class="def">diffuse large B-cell lymphoma</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045203/" class="def">Burkitt lymphoma</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597158/" class="def">lymphoblastic lymphoma</a>, and some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046053/" class="def">aggressive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045924/" class="def">T-cell lymphomas</a>. It is given to lessen the chance that lymphoma cells will spread to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>. This is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046472/" class="def">CNS prophylaxis</a>.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958455" co-legend-rid="figlgndCDR0000062958455"><a href="/books/NBK65899.6/figure/CDR0000062958__455/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958455" rid-ob="figobCDR0000062958455"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000539773.gif" src-large="/books/NBK65899.6/bin/CDR0000539773.jpg" alt="Intrathecal chemotherapy" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958455"><h4 id="CDR0000062958__455"><a href="/books/NBK65899.6/figure/CDR0000062958__455/?report=objectonly" target="object" rid-ob="figobCDR0000062958455">Figure</a></h4><p class="float-caption no_bottom_margin">Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to <a href="/books/NBK65899.6/figure/CDR0000062958__455/?report=objectonly" target="object" rid-ob="figobCDR0000062958455">(more...)</a></p></div></div><p id="CDR0000062958__295">In pregnant women, the baby is exposed to chemotherapy when the mother is treated, and some anticancer drugs cause birth defects.
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Because anticancer drugs are passed to the baby through the mother, both must be watched closely when chemotherapy is given.</p><p id="CDR0000062958__324">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/non-hodgkin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Non-Hodgkin Lymphoma</a> for more information.</p></div><div id="CDR0000062958__457"><h4>Immunotherapy</h4><p id="CDR0000062958__157"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.</p><p id="CDR0000062958__458"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739791/" class="def">Immunomodulators</a> are a type of immunotherapy. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393761/" class="def">Lenalidomide</a> is an immunomodulator used to treat adult non-Hodgkin lymphoma.</p><p id="CDR0000062958__461">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/non-hodgkin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Non-Hodgkin Lymphoma</a> for more information.</p></div><div id="CDR0000062958__208"><h4>Targeted therapy</h4><p id="CDR0000062958__318"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal
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antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393541/" class="def">proteasome inhibitor</a> therapy, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750798/" class="def">kinase inhibitor</a> therapy are types of targeted therapy used to treat adult non-Hodgkin lymphoma.</p><p id="CDR0000062958__267">Monoclonal
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antibody therapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> made in the laboratory from a single type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or radioactive material directly to cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045525/" class="def">Rituximab</a> is a monoclonal antibody used to treat many types of non-Hodgkin lymphoma. Monoclonal antibodies that have been joined to radioactive material are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045857/" class="def">radiolabeled</a> monoclonal antibodies. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046020/" class="def">Yttrium-90-labeled ibritumomab tiuxetan</a> is an example of a radiolabeled monoclonal antibody. Monoclonal antibodies are given by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. </p><p id="CDR0000062958__350">Proteasome inhibitor therapy blocks the action of proteasomes in cancer cells and may prevent the growth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>.</p><p id="CDR0000062958__449">Kinase inhibitor therapy, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763267/" class="def">idelalisib</a>, blocks certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a>, which may help keep lymphoma cells from growing and may kill them. It is used to treat indolent lymphoma. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000754851/" class="def">Ibrutinib</a>, a type of Bruton's tyrosine kinase inhibitor therapy, is used to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409750/" class="def">lymphoplasmacytic lymphoma</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445048/" class="def">mantle cell lymphoma</a>.</p><p id="CDR0000062958__325">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/non-hodgkin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Non-Hodgkin Lymphoma</a> for more information.</p></div><div id="CDR0000062958__343"><h4>Plasmapheresis</h4><p id="CDR0000062958__345">If the blood becomes thick with extra antibody proteins and affects <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476484/" class="def">circulation</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045483/" class="def">plasmapheresis</a> is done to remove extra <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045839/" class="def">plasma</a> and antibody proteins from the blood. In this procedure, blood is removed from the patient and sent through a machine that separates the plasma (the liquid part of the blood) from the blood cells. The patient's plasma contains the unneeded antibodies and is not returned to the patient. The normal blood cells are returned to the bloodstream along with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donated</a> plasma or a plasma replacement. Plasmapheresis does not keep new antibodies from forming. </p></div><div id="CDR0000062958__203"><h4>Watchful waiting
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</h4><p id="CDR0000062958__205"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a> is
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closely <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454803/" class="def">monitoring</a> a patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> without giving any treatment until
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signs or symptoms appear or change. </p></div><div id="CDR0000062958__366"><h4>Antibiotic therapy</h4><p id="CDR0000062958__368"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">Antibiotic</a> therapy is a treatment that uses drugs to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infections</a> and cancer caused by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">bacteria</a> and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044059/" class="def">microorganisms</a>.</p><p id="CDR0000062958__403">See <a href="http://www.cancer.gov/about-cancer/treatment/drugs/non-hodgkin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Non-Hodgkin Lymphoma</a> for more information.</p></div><div id="CDR0000062958__369"><h4>Surgery</h4><p id="CDR0000062958__371"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> may be used to remove the lymphoma in certain patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045735/" class="def">indolent</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">aggressive</a> non-Hodgkin lymphoma.</p><p id="CDR0000062958__374">The type of surgery used depends on where the lymphoma formed in the body:</p><ul id="CDR0000062958__375"><li class="half_rhythm"><div>Local <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269459/" class="def">excision</a> for certain patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044437/" class="def">mucosa-associated lymphoid tissue (MALT) lymphoma</a>, PTLD, and small bowel T-cell lymphoma.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046594/" class="def">Splenectomy</a> for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000543124/" class="def">marginal zone lymphoma</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li></ul><p id="CDR0000062958__372">Patients who have a heart, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidney</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046254/" class="def">pancreas</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a> usually need to take drugs to suppress their immune system for the rest of their lives. Long-term <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045727/" class="def">immunosuppression</a> after an organ transplant can cause a certain type of non-Hodgkin lymphoma called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468786/" class="def">post-transplant lymphoproliferative disorder</a> (PLTD).</p><p id="CDR0000062958__373">Small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> surgery is often needed to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000377726/" class="def">celiac disease</a> in adults who develop a type of T-cell lymphoma.</p></div><div id="CDR0000062958__213"><h4>Stem cell transplant</h4><p id="CDR0000062958__215">Stem cell transplant is a method of giving high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of chemotherapy and/or total-body irradiation and then replacing blood-forming cells destroyed by the cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> of the patient (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270733/" class="def">autologous transplant</a>) or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270732/" class="def">allogeneic transplant</a>) and are frozen and stored. After the chemotherapy and/or radiation therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000062958456" co-legend-rid="figlgndCDR0000062958456"><a href="/books/NBK65899.6/figure/CDR0000062958__456/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000062958456" rid-ob="figobCDR0000062958456"><img class="small-thumb" src="/books/NBK65899.6/bin/CDR0000765030.gif" src-large="/books/NBK65899.6/bin/CDR0000765030.jpg" alt="Stem cell transplant" /></a><div class="icnblk_cntnt" id="figlgndCDR0000062958456"><h4 id="CDR0000062958__456"><a href="/books/NBK65899.6/figure/CDR0000062958__456/?report=objectonly" target="object" rid-ob="figobCDR0000062958456">Figure</a></h4><p class="float-caption no_bottom_margin">Stem cell transplant. (Step 1): Blood is taken from a vein in the arm of the donor. The patient or another person may be the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in <a href="/books/NBK65899.6/figure/CDR0000062958__456/?report=objectonly" target="object" rid-ob="figobCDR0000062958456">(more...)</a></p></div></div></div></div><div id="CDR0000062958__206"><h3>New types of treatment are being tested in clinical
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trials. </h3><p id="CDR0000062958__301">This summary section describes treatments that are being studied in
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clinical trials. It may not mention every new treatment being studied.
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Information about clinical trials is available from the
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<a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000062958__268"><h4>Vaccine therapy</h4><p id="CDR0000062958__270"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386223/" class="def">Vaccine therapy</a> is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045617/" class="def">biologic therapy</a>. Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Vaccine therapy can also be a type of targeted therapy.</p></div></div><div id="CDR0000062958__304"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000062958__304_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000062958__304_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000062958__304_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000062958__306"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000062958__306_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000062958__306_30">Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </p></div><div id="CDR0000062958__308"><h3>Follow-up tests may be needed.</h3><p id="CDR0000062958__308_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000062958__308_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000062958__419"><h2 id="_CDR0000062958__419_">Treatment Options for Indolent Non-Hodgkin Lymphoma</h2><p id="CDR0000062958__420">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046355/" class="def">indolent</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045906/" class="def">stage I</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350356/" class="def">contiguous</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045907/" class="def">stage II</a> adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> may include
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the following:</p><ul id="CDR0000062958__421"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a>.</div></li></ul><p id="CDR0000062958__422">If the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is too large to be treated with radiation therapy, the treatment options for indolent, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350357/" class="def">noncontiguous</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045907/" class="def">stage II</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045908/" class="def">III</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045909/" class="def">IV</a> adult
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non-Hodgkin lymphoma will be used.</p><p id="CDR0000062958__425">Treatment of indolent, noncontiguous stage II, III, or IV adult
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non-Hodgkin lymphoma may include the following:</p><ul id="CDR0000062958__426"><li class="half_rhythm"><div>Watchful waiting for patients who do not have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a>.</div></li><li class="half_rhythm"><div>Monoclonal
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antibody therapy with or without chemotherapy.</div></li><li class="half_rhythm"><div>Chemotherapy with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046601/" class="def">steroids</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750798/" class="def">Kinase inhibitor</a> therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045857/" class="def">Radiolabeled</a> monoclonal antibody
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therapy.</div></li><li class="half_rhythm"><div>Monoclonal antibody therapy after treatment with combination chemotherapy. </div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">high-dose chemotherapy</a> with or without
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a> or radiolabeled monoclonal antibody therapy, followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270733/" class="def">autologous</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270732/" class="def">allogeneic stem cell transplant</a>.</div></li><li class="half_rhythm"><div>A clinical trial of chemotherapy with or without
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386223/" class="def">vaccine therapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of new types of monoclonal antibodies.</div></li><li class="half_rhythm"><div> A clinical trial of radiation therapy that includes nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, for patients who have stage III disease.</div></li><li class="half_rhythm"><div>A clinical trial of low-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> radiation therapy, to relieve symptoms and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li></ul><p id="CDR0000062958__427">After initial treatment with the monoclonal antibody <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045525/" class="def">rituximab</a> with or without chemotherapy, more treatment with rituximab may be given. </p><p id="CDR0000062958__423">Other treatments for indolent non-Hodgkin lymphoma depend on the type of non-Hodgkin lymphoma. Treatment may include the following:</p><ul id="CDR0000062958__424"><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000428287/" class="def">follicular lymphoma</a>, treatment may be within a clinical trial of new monoclonal antibody therapy, new chemotherapy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a>, or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409750/" class="def">lymphoplasmacytic lymphoma</a>, Bruton's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">tyrosine kinase inhibitor</a> therapy and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045483/" class="def">plasmapheresis</a> (if needed to make the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> thinner) is used. Other treatments that are like those used for follicular lymphoma may also be given.</div></li><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046770/" class="def">gastric</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044437/" class="def">mucosa-associated lymphoid tissue (MALT) lymphoma</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">antibiotic</a> therapy to treat <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045706/" class="def">Helicobacter pylori</a></i>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> is given first. For tumors that do not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">respond</a> to antibiotic therapy, treatment is radiation therapy, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>, or rituximab with or without chemotherapy. </div></li><li class="half_rhythm"><div>For extragastric MALT lymphoma of the eye and Mediterranean <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">lymphoma</a>, antibiotic therapy is used to treat infection.</div></li><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000467863/" class="def">splenic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000543124/" class="def">marginal zone lymphoma</a>, rituximab with or without chemotherapy and B-cell receptor therapy is used as initial treatment. If the tumor does not respond to treatment, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046594/" class="def">splenectomy</a> may be done.</div></li></ul></div><div id="CDR0000062958__428"><h2 id="_CDR0000062958__428_">Treatment Options for Aggressive Non-Hodgkin Lymphoma</h2><p id="CDR0000062958__429">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">aggressive</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045906/" class="def">stage I</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350356/" class="def">contiguous</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045907/" class="def">stage II</a> adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> may include the following:</p><ul id="CDR0000062958__430"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> is given later.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a> of monoclonal antibody therapy and combination chemotherapy.</div></li></ul><p id="CDR0000062958__431">Treatment of aggressive, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350357/" class="def">noncontiguous</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045907/" class="def">stage II</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045908/" class="def">III</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045909/" class="def">IV</a> adult
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non-Hodgkin lymphoma may include the following:</p><ul id="CDR0000062958__432"><li class="half_rhythm"><div>Monoclonal antibody therapy with combination chemotherapy.</div></li><li class="half_rhythm"><div>Combination chemotherapy.
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</div></li><li class="half_rhythm"><div>A clinical trial of monoclonal antibody therapy with combination chemotherapy followed by radiation therapy.</div></li></ul><p id="CDR0000062958__433">Other treatments depend on the type of aggressive non-Hodgkin lymphoma. Treatment may include the following:</p><ul id="CDR0000062958__434"><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000539104/" class="def">extranodal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044439/" class="def">NK</a>-/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045924/" class="def">T-cell lymphoma</a>, radiation therapy that may be followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046472/" class="def">CNS prophylaxis</a>. </div></li><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468786/" class="def">posttransplantation lymphoproliferative disorder</a>, treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044041/" class="def">immunosuppressive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> may be stopped. If this does not work or cannot be done, monoclonal antibody therapy alone or with chemotherapy may be given. For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> that has not spread, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove the cancer or radiation therapy may be used.</div></li><li class="half_rhythm"><div>For plasmablastic lymphoma, treatments are like those used for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597158/" class="def">lymphoblastic lymphoma</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045203/" class="def">Burkitt lymphoma</a>.</div></li></ul><p id="CDR0000062958__435">For information on the treatment of lymphoblastic lymphoma, see <a href="#CDR0000062958__436">Treatment Options for Lymphoblastic Lymphoma</a> and for information on the treatment of Burkitt lymphoma, see <a href="#CDR0000062958__439">Treatment Options for Burkitt Lymphoma</a>.</p></div><div id="CDR0000062958__436"><h2 id="_CDR0000062958__436_">Treatment Options for Lymphoblastic Lymphoma</h2><p id="CDR0000062958__437">Treatment of adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597158/" class="def">lymphoblastic lymphoma</a> may include the
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following:</p><ul id="CDR0000062958__438"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046472/" class="def">CNS prophylaxis</a>. Sometimes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> is also given to shrink a large <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> after initial treatment.</div></li></ul></div><div id="CDR0000062958__439"><h2 id="_CDR0000062958__439_">Treatment Options for Burkitt Lymphoma</h2><p id="CDR0000062958__440">Treatment of adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045203/" class="def">Burkitt lymphoma</a>
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may include the following:</p><ul id="CDR0000062958__441"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046472/" class="def">CNS prophylaxis</a>.</div></li></ul></div><div id="CDR0000062958__442"><h2 id="_CDR0000062958__442_">Treatment Options for Recurrent Non-Hodgkin Lymphoma</h2><p id="CDR0000062958__443">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046355/" class="def">indolent</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> adult
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> may include
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the following:</p><ul id="CDR0000062958__444"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> with one
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or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045857/" class="def">Radiolabeled</a> monoclonal antibody therapy.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> as
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of
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life</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270733/" class="def">autologous</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270732/" class="def">allogeneic stem cell transplant</a>.</div></li></ul><p id="CDR0000062958__445">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">aggressive</a>,
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recurrent adult non-Hodgkin lymphoma may include the following:</p><ul id="CDR0000062958__446"><li class="half_rhythm"><div>Chemotherapy with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li><li class="half_rhythm"><div>Monoclonal antibody therapy with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> followed by autologous stem cell transplant.</div></li><li class="half_rhythm"><div>Radiation therapy as
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palliative therapy to relieve symptoms and improve quality of
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life.</div></li><li class="half_rhythm"><div>Radiolabeled monoclonal antibody therapy.</div></li><li class="half_rhythm"><div>For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445048/" class="def">mantle cell lymphoma</a>, treatment may include the following:<ul id="CDR0000062958__459"><li class="half_rhythm"><div>Bruton's tyrosine kinase inhibitor therapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393761/" class="def">Lenalidomide</a>.</div></li><li class="half_rhythm"><div>A clinical trial of lenalidomide with monoclonal antibody therapy.</div></li><li class="half_rhythm"><div>A clinical trial comparing lenalidomide to other therapy.</div></li></ul></div></li><li class="half_rhythm"><div> A clinical trial of autologous or allogeneic stem cell transplant.</div></li></ul><p id="CDR0000062958__447">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045735/" class="def">indolent
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lymphoma</a> that comes back as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">aggressive lymphoma</a> depends on the type of non-Hodgkin lymphoma and may include radiation therapy as palliative therapy to relieve symptoms and improve quality of life. Treatment of aggressive lymphoma that comes back as indolent lymphoma may include chemotherapy.</p></div><div id="CDR0000062958__354"><h2 id="_CDR0000062958__354_">Treatment Options for Non-Hodgkin Lymphoma During Pregnancy</h2><div id="CDR0000062958__357"><h3>Indolent Non-Hodgkin Lymphoma During Pregnancy</h3><p id="CDR0000062958__292">
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Women who have
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046355/" class="def">indolent</a> (slow-growing)
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666677/" class="def">pregnancy</a> may be treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">watchful waiting</a> until after they give birth. (See the <a href="#CDR0000062958__419">Treatment Options for Indolent Non-Hodgkin Lymphoma</a> section for more information.)</p></div><div id="CDR0000062958__358"><h3>Aggressive Non-Hodgkin Lymphoma During Pregnancy</h3><p id="CDR0000062958__359">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045588/" class="def">aggressive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a> during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666677/" class="def">pregnancy</a> may include the following:</p><ul id="CDR0000062958__360"><li class="half_rhythm"><div>Treatment given right away based on the type of non-Hodgkin lymphoma to increase the mother's chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survival</a>. Treatment may include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045525/" class="def">rituximab</a>.</div></li><li class="half_rhythm"><div>Early delivery of the baby followed by treatment based on the type of non-Hodgkin lymphoma.</div></li><li class="half_rhythm"><div>If in the first trimester of pregnancy, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046290/" class="def">medical oncologists</a> may advise ending the pregnancy so that treatment may begin. Treatment depends on the type of non-Hodgkin lymphoma.</div></li></ul></div></div><div id="CDR0000062958__271"><h2 id="_CDR0000062958__271_">To Learn More About Adult Non-Hodgkin Lymphoma</h2><p id="CDR0000062958__272">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about adult non-Hodgkin lymphoma, see the following: </p><ul id="CDR0000062958__326"><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/lymphoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Non-Hodgkin Lymphoma Home Page</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/wyntk-non-hodgkin-lymphoma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">What You Need to Know About™ Non-Hodgkin Lymphoma</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/drugs/non-hodgkin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Non-Hodgkin Lymphoma</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/treatment/types/immunotherapy/bio-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Biological Therapies for Cancer</a></div></li></ul><p id="CDR0000062958__271_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000062958__271_41"><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="http://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000062958__AboutThis_1"><h2 id="_CDR0000062958__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062958__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062958__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="http://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062958__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062958__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062958__AboutThis_6">This PDQ cancer information summary has current information about the treatment of adult non-Hodgkin lymphoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062958__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062958__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000062958__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062958__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062958__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000062958__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062958__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062958__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062958__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062958__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Adult Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389337]</p><p id="CDR0000062958__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000062958__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062958__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062958__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062958__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65899</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389337" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389337</a></span></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65899.6/?report=reader">PubReader</a></li><li><a href="/books/NBK65899.6/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65899" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65899" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Adult Non-Hodgkin Lymphoma Treatment (PDQ®): Patient Version. 2016 Aug 3. 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2015</li><li><span class="bk_col_itm"><a href="/books/NBK65899.1/">NBK65899.1</a></span> April 25, 2014</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062958__129" ref="log$=inpage&link_id=inpage">General Information About Adult Non-Hodgkin Lymphoma</a></li><li><a href="#CDR0000062958__158" ref="log$=inpage&link_id=inpage">Stages of Adult Non-Hodgkin Lymphoma</a></li><li><a href="#CDR0000062958__188" ref="log$=inpage&link_id=inpage">Recurrent Adult Non-Hodgkin Lymphoma</a></li><li><a href="#CDR0000062958__190" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000062958__419" ref="log$=inpage&link_id=inpage">Treatment Options for Indolent Non-Hodgkin Lymphoma</a></li><li><a href="#CDR0000062958__428" ref="log$=inpage&link_id=inpage">Treatment Options for Aggressive Non-Hodgkin Lymphoma</a></li><li><a href="#CDR0000062958__436" ref="log$=inpage&link_id=inpage">Treatment Options for Lymphoblastic Lymphoma</a></li><li><a href="#CDR0000062958__439" ref="log$=inpage&link_id=inpage">Treatment Options for Burkitt Lymphoma</a></li><li><a href="#CDR0000062958__442" ref="log$=inpage&link_id=inpage">Treatment Options for Recurrent Non-Hodgkin Lymphoma</a></li><li><a href="#CDR0000062958__354" ref="log$=inpage&link_id=inpage">Treatment Options for Non-Hodgkin Lymphoma During Pregnancy</a></li><li><a href="#CDR0000062958__271" ref="log$=inpage&link_id=inpage">To Learn More About Adult Non-Hodgkin Lymphoma</a></li><li><a href="#CDR0000062958__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66057/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389294" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Non-Hodgkin Lymphoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Non-Hodgkin Lymphoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389245" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hodgkin Lymphoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hodgkin Lymphoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389274" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Primary CNS Lymphoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Primary CNS Lymphoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389358" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> AIDS-Related Lymphoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> AIDS-Related Lymphoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389388" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Melanoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389337" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=26389337" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a 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