Intended for healthcare professionals

Practice Clinical updates

Non-Hodgkin lymphoma

BMJ 2018; 362 doi: (Published 22 August 2018) Cite this as: BMJ 2018;362:k3204
  1. Anna Bowzyk Al-Naeeb, consultant clinical oncologist1,
  2. Thankamma Ajithkumar, consultant clinical oncologist2,
  3. Sarah Behan, haematology clinical nurse specialist3,
  4. Daniel James Hodson, consultant haematologist and MRC clinician scientist3 4
  1. 1Department of Oncology, Bedford Hospital, Bedford, UK
  2. 2Department of Oncology, Cambridge University Hospitals NHS Trust, Cambridge, UK
  3. 3Department of Haematology, Cambridge University Hospitals NHS Trust, Cambridge, UK
  4. 4Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
  1. Correspondence to: D J Hodson djh1002{at}

What you need to know

  • A clinical or radiological finding of enlarged lymph nodes may raise suspicion of lymphoma, but a diagnosis cannot be made without tissue biopsy

  • Refer patients with unexplained persistent (>6 weeks), progressive, or generalised lymphadenopathy to the team most appropriate to arrange biopsy as directed by local referral pathways.

  • The commonest high grade lymphoma is diffuse large B cell lymphoma—an aggressive malignancy that is curable in 60-70% of patients with combined immunochemotherapy

  • The commonest low grade (indolent) lymphoma is follicular lymphoma—generally considered incurable, it follows a relapsing-remitting course with treatment required intermittently

  • The relapsing and remitting nature of indolent lymphomas can present unique mental health challenges for patients and requires patient education and emotional support

Non-Hodgkin lymphoma are malignant disorders arising from cells of the immune system, and manifest predominantly as lymphadenopathy or solid tumours. The classification of non-Hodgkin lymphoma is complex and ever-evolving, with more than 50 different subtypes listed in the latest World Health Organization classification.1 For non-specialists, however, they can most usefully be categorised as low grade (indolent) or high grade (aggressive) lymphoma since this broad distinction determines the likely natural course and management of the disease. In this clinical update we discuss the principles of diagnosis and management that are of particular relevance to non-specialist physicians, who may encounter patients with non-Hodgkin lymphoma during their initial presentation, therapy, and follow-up.

Sources and selection criteria

We searched PubMed using the key words “non-Hodgkin lymphoma,” “diffuse large B cell lymphoma,” and “follicular lymphoma” to identify reviews and major studies published since 2000. This was supplemented by a review of management guidelines (listed in the “Further educational resources” box), by personal experience of the authors, and by feedback from patients.

How common is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma is the sixth commonest malignancy in the UK with 13 000 new cases diagnosed annually (fig 1).34 The International …

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