Non-Hodgkin Lymphoma (NHL)

Non-Hodgkin lymphoma (NHL) is a type of blood cancer that affects the lymphatic system, a vital part of the immune system responsible for fighting infections and diseases. In NHL, the body produces abnormal lymphocytes—white blood cells that help protect against illness. These unhealthy cells can grow uncontrollably and form tumors in areas rich in lymph tissue, such as the lymph nodes in the neck, armpits and groin. NHL can also impact organs that produce blood cells, including the liver, spleen and bone marrow, potentially affecting the body's ability to fight infections and maintain healthy blood cell levels.

NHL is categorized based on the type of lymphocytes affected and the rate at which the disease progresses. The specific type of NHL a person develops can influence treatment options and help determine the overall severity of the condition.

NHL can affect different types of lymphocytes, which are essential components of the immune system. Identifying the affected cell type helps determine the classification of NHL.

• B lymphocytes (B cells) - Defend the body by producing antibodies to help fight infections.
• T lymphocytes (T cells) - Serve different functions within the immune system. Some T cells regulate immune responses, while others attack infected or abnormal cells.
• Natural Killer (NK) Cells - Regulate and destroy infected or cancerous cells without prior activation

Lymphomas can also be classified based on how quickly they grow and spread to other parts of the body. 

• Indolent lymphomas - Grow slowly, often without noticeable symptoms for months or even years. Some cases may not require immediate treatment.
• Aggressive lymphomas - Grow rapidly, spreading quickly throughout the body and require immediate treatment.

There are over 30 different types of NHL. The most common forms include:

• Diffuse large B-cell lymphoma (DLBCL) - An aggressive form that affects B cells, often developing in the lymph nodes, spleen, liver and bone marrow.
• Follicular lymphoma - A slow-growing form of NHL that originates in B cells. In some cases, it may go away without treatment. Most diagnoses occur in people over age 50.
• Mantle cell lymphoma -Typically affects middle-aged or older adults and arises in B cells. It commonly spreads to the spleen, bone marrow and blood, and can also involve the digestive track.

A blood or marrow transplant (BMT), also called a bone marrow transplant or blood stem cell transplant, replaces unhealthy bone marrow with healthy blood-forming cells from a donor. For some people, transplant can cure their NHL.

For NHL, doctors can use two  types of transplant:

• Autologous transplant - Uses the patient’s own blood-forming cells, which are collected and stored. Then, they’re given back after chemotherapy (chemo) or radiation. This is the most common form of transplant used for NHL.
• Allogeneic transplant - Uses healthy blood-forming cells from a family member, unrelated donor or umbilical cord blood. An allogeneic transplant is only used if the NHL relapses after chemo or after an autologous transplant.

In addition to autologous and allogeneic transplants, one emerging form of treatment for NHL called Chimeric antigen receptor T-cell (CAT-T) therapy, is currently in clinical trials and doctors believe it can help the immune system find and destroy cancer cells.

Although each person’s journey is unique, bone marrow transplantation for non-Hodgkin lymphoma typically follows a series of distinct phases. From the initial therapy to the infusion of donor cells and ongoing recovery, here’s how the transplant process generally works:

• Preparation: You’ll begin with chemotherapy (and sometimes radiation) to destroy the unhealthy marrow. This step, called conditioning therapy, makes room for new, healthy blood-forming cells.
• Transplant: Next, healthy donor cells are delivered through an intravenous (IV) catheter, often referred to as a stem cell infusion. These cells travel to the inside of your bones and begin producing new blood cells.
• Recovery: Full recovery can take several months to a year. From the start of conditioning to leaving the hospital can take weeks to months. You’ll then spend additional time recovering near the transplant center and at home. During this period, your transplant team carefully monitors you, helping prevent any side effects or complications.

If you have follicular lymphoma, see a transplant doctor if:

• It doesn’t get better with initial treatment
• The initial remission (no signs of disease) lasts less than 1 year
• It comes back a 2nd time
• It turns into a more aggressive lymphoma

If you have DLBCL, you should see a transplant doctor if:

• It comes back after initial treatment
• The initial chemo doesn’t lead to remission

If you have mantle cell lymphoma or other high-risk lymphomas, you should see a transplant doctor right away.

Scheduling an appointment with a doctor to discuss your NHL diagnosis is the first step to finding a cure. At your first appointment, the transplant doctor will:

• Review your medical history
• Talk with you about NHL treatment options
• Discuss the risks and benefits of BMT transplant
• Recommend the best time for you to get a transplant, the best type of transplant, and help you prepare for treatment

Patients that come from ethnically diverse backgrounds will often have a harder time finding a matching bone marrow donor. This is because of genes called human leukocyte antigens (HLAs), which are the codes inside your body doctors use to help find a match. HLAs are inherited, which means it will be easier to find a match using a patient and donor that share the same ancestry.

Unfortunately, not all ethnicities are equally represented on the registry.

Learn more about the importance of diversity

Ask questions so you can best understand the  treatment options available for your non-Hodgkin lymphoma. Questions you may want to ask include:

• What are my chances of curing NHL or entering long-term remission if I get a transplant? If I don’t get a transplant?
• What are the risks of waiting or trying other NHL treatments before a transplant?
• Does my current health or age affect how well transplant might work for me?
• What are the possible side effects of a bone marrow or blood stem cell transplant? How can they be reduced?
• How might my quality of life change over time due to NHL, with or without transplant?

By asking these questions, you can better understand your options and plan the next steps in your treatment journey.

Learn more about planning for transplant