Yes; many people with lymphoma (cancer of the lymph nodes) are cured, but the chance of cure depends on the type of lymphoma. Of every 10 people newly diagnosed with Hodgkin lymphoma, up to 9 are cured [3], and in fast-growing (aggressive) non-Hodgkin lymphomas, more than 7 of every 10 people are cured too [4]. Slow-growing lymphomas such as follicular lymphoma usually do not go away completely when they are advanced, but they can often be controlled for many years; half of people with follicular lymphoma live for 8 to 15 years or more [4].
Key points
- Lymphoma is a cancer that starts in the lymph system (the lymph nodes and other tissues of the immune system); so it is always malignant [1, 2].
- Hodgkin lymphoma: up to 9 of every 10 newly diagnosed people are cured; even at an advanced stage, about 9 of every 10 people in a large study were alive 6 years later [3, 5].
- Fast-growing non-Hodgkin lymphomas, such as diffuse large B-cell lymphoma (the commonest type of non-Hodgkin lymphoma): more than 7 of every 10 people are cured [2, 4].
- Slow-growing lymphomas, such as follicular lymphoma: they usually do not go away completely, but they are controlled for many years; if you have no symptoms, regular monitoring alone may be all you need for a while [4].
- Even if lymphoma comes back, there is treatment: further chemotherapy and a stem cell transplant, and newer treatments such as CAR-T cell therapy [3, 8].
What is lymphoma (cancer of the lymph nodes), and what types are there?
Lymphoma is a cancer that starts in the lymph system [1, 2]. The lymph system is part of the immune system and includes the lymph nodes, spleen, tonsils, thymus and bone marrow [1]. Most non-Hodgkin lymphomas start in B lymphocytes, a type of white blood cell that makes antibodies [2].
Lymphoma has two main groups: Hodgkin lymphoma and non-Hodgkin lymphoma [1]. A pathologist tells the two apart under the microscope: in Hodgkin lymphoma, special cancer cells called "Reed-Sternberg cells" are seen [1]. Non-Hodgkin lymphoma itself has two groups [2]:
- Fast-growing (aggressive): grows quickly; its commonest type, diffuse large B-cell lymphoma, is also the commonest type of non-Hodgkin lymphoma [2].
- Slow-growing (indolent): grows slowly; its commonest type is follicular lymphoma [2].
To understand how lymphoma differs from leukaemia and myeloma, read: Leukaemia, lymphoma and myeloma: what is the difference? and for symptoms: What are the symptoms of lymphoma?
Is Hodgkin lymphoma curable?
Yes; most people with Hodgkin lymphoma are cured: up to 9 of every 10 newly diagnosed people are cured with chemotherapy, with or without radiotherapy [3]. It is most common in young adults aged 20 to 39 and in people aged 65 and over, and if it is found and treated early, it can usually be cured [1].
Even at an advanced stage (stage 3 and 4), about 9 of every 10 people in a large study were alive 6 years later; in that study, adding the targeted medicine brentuximab to chemotherapy improved the chance of survival [5]. In a newer study, combining the immunotherapy medicine nivolumab with chemotherapy kept the disease under control even better, and this is now the preferred treatment for advanced-stage disease [3]. If the disease comes back, more than half of patients stay free of the disease for a long time, or are even cured, with further chemotherapy and a stem cell transplant [3].
Read more: Treatment of Hodgkin lymphoma.
Is non-Hodgkin lymphoma curable?
It depends on the type [4]:
- Fast-growing lymphomas are more dangerous in the short term, but with combination chemotherapy more than 7 of every 10 patients are cured [4]. In diffuse large B-cell lymphoma, the standard treatment is chemotherapy with the medicine rituximab (the R-CHOP regimen). In a large study of patients at intermediate to high risk, about 6 of every 10 people were alive without their lymphoma growing 5 years after this treatment; the newer medicine polatuzumab improved this figure slightly [6]. Read more: Treatment of diffuse large B-cell lymphoma.
- Slow-growing lymphomas have a fairly good long-term outlook and are often controlled for many years, sometimes for about 20 years; but at advanced stages they usually do not go away completely [4]. If the disease is only in one area, the aim of treatment is cure [4].
Read about other types of lymphoma on the lymphoma page.
Follicular lymphoma and other slow-growing lymphomas: why is treatment sometimes not started?
Follicular lymphoma is the commonest slow-growing lymphoma [2]. Half of patients, even at an advanced stage, live for 8 to 15 years or more [4]. In a large study of patients who had chemotherapy with rituximab, about 8 of every 10 people were alive 10 years later [10].
If you have no symptoms and only a small amount of disease, your doctor may suggest "watch and wait" (regular monitoring); this means treatment is put off until the disease causes symptoms [4]. In three studies that compared watch and wait with starting chemotherapy straight away, survival was no different [4]. In one study, almost half of the patients who were only monitored still did not need treatment 3 years later; rituximab injections made this time longer [9].
Sometimes a slow-growing lymphoma changes into a fast-growing type; in a large study, this happened to 1 in every 7 patients over about 7 years [4]. If a lump suddenly grows quickly or you get a new symptom, tell your doctor soon [4]. Read more: Follicular lymphoma.
Is Hodgkin or non-Hodgkin lymphoma more dangerous?
In general, Hodgkin lymphoma has a better chance of cure [3]. Non-Hodgkin lymphoma is a large group of diseases, and the chance of cure differs by type: fast-growing lymphomas are more dangerous in the short term but most are cured, while slow-growing lymphomas grow slowly but usually do not go away completely [4]. So which is "more dangerous" depends on the exact type of lymphoma, not just on whether it is called Hodgkin or non-Hodgkin.
| Type of lymphoma | Aim of treatment | Results of treatment today |
|---|---|---|
| Hodgkin lymphoma | Cure | Up to 9 of every 10 newly diagnosed people are cured [3] |
| Fast-growing non-Hodgkin lymphomas (such as diffuse large B-cell lymphoma) | Cure | More than 7 of every 10 people are cured [4] |
| Slow-growing non-Hodgkin lymphomas (such as follicular lymphoma) | Long-term control; cure when the disease is limited to one area | Half of people with follicular lymphoma live for 8 to 15 years or more [4] |
| Lymphoma that has come back | Further treatment; sometimes cure | In Hodgkin lymphoma, more than half stay free of the disease for a long time after a transplant [3]; in large B-cell lymphoma that had not responded to the first treatment or had come back early, more than half were alive 4 years after CAR-T cell therapy [8] |
These figures are averages from large numbers of patients; each person's chance depends on the exact type of lymphoma, the stage, age and test results [2].
What affects the chance of cure?
Besides the type of lymphoma, these factors matter [2]:
- Age and general health
- Stage: stage 3 and 4, meaning more widespread disease
- The LDH blood test: a high level is a sign of more active disease
- "B symptoms": unexplained fever, unexplained weight loss and drenching night sweats
Doctors combine these factors into scores that estimate the risk. But a high score does not mean there is no hope: in diffuse large B-cell lymphoma, even in the highest-risk group, more than half of patients were alive 4 years later [7]; and in advanced Hodgkin lymphoma, more than 7 of every 10 of the highest-risk patients were alive 5 years later [3].
The response to treatment also matters: your doctor uses a PET scan to check how the lymphoma is responding [11] (What is a PET scan?).
When should I contact my doctor?
Before a diagnosis: have a lump in the neck, armpit or groin that is growing or has lasted for several weeks, unexplained fever, drenching night sweats, unexplained weight loss, severe tiredness or long-lasting itching checked by a doctor soon [2] (Swollen lymph nodes: when should you worry?).
During or after treatment, contact your care team straight away or go to the emergency department if you have:
- a temperature of 38°C or higher, or shivering (low blood counts and infection)
- shortness of breath, or sudden swelling of the face and neck
- confusion, a seizure or difficulty speaking, especially in the days and weeks after CAR-T cell therapy
- a lump that grows again after treatment
In an emergency, call your local emergency number.
Frequently asked questions
Is lymphoma fatal?
Lymphoma is a serious disease, but many patients are cured: up to 9 of every 10 people with Hodgkin lymphoma [3] and more than 7 of every 10 people with fast-growing lymphomas [4]. Slow-growing lymphomas can also often be controlled for many years [4]. What matters is that the exact type of lymphoma is confirmed with a biopsy and the right treatment is started promptly.
What does "malignant lymph node cancer" mean?
"Malignant" means cancerous. Lymphoma is always malignant, because it means cancer cells are forming in the lymph system [1, 2]. But not every swollen lymph node is lymphoma; to make the diagnosis, the doctor takes a sample (biopsy) of the lymph node [2]. Read: Swollen lymph nodes: when should you worry?
Is stage 4 lymphoma curable?
Yes; in lymphoma, stage 4 does not mean it cannot be cured. For example, in stage 3 and 4 Hodgkin lymphoma, about 9 of every 10 people in a large study were alive 6 years later [5]. In practice, doctors mainly divide lymphoma into "limited" (stage 1 and 2) and "advanced" (stage 3 and 4) disease and choose treatment on that basis [11].
If lymphoma comes back, can it still be treated?
Yes. In Hodgkin lymphoma, more than half of patients stay free of the disease for a long time, or are cured, with further chemotherapy and a stem cell transplant [3]. In diffuse large B-cell lymphoma that does not respond to the first treatment or comes back early, the usual treatment is further chemotherapy and a transplant of the patient's own stem cells; in a large study, CAR-T cell therapy did better than this, and more than half of patients were alive 4 years later [8]. Read: Blood stem cell transplant.
After my treatment ends, do I need regular scans?
Usually not. If the lymphoma has responded completely to treatment, routine scans without symptoms are not recommended [11]; follow-up appointments and telling your doctor about any new symptom matter more.
Can I have children after lymphoma treatment?
Hodgkin lymphoma is common in young adults [1]; before treatment starts, talk to your doctor about protecting your fertility. Read: Fertility and sex during cancer treatment.
Is leukaemia (blood cancer) curable too?
Leukaemia is a different cancer that starts in the bone marrow; read: Is leukaemia curable? and Which cancers are curable?
Key survival and prognostic figures (for doctors)
For physicians
Hodgkin lymphoma. Up to 90% of newly diagnosed patients are cured with combination chemotherapy and/or radiotherapy, and more than half of relapsed patients achieve long-term disease-free survival or cure with reinduction followed by transplant consolidation. IPS in advanced disease (number of risk factors: 5-year FFP and OS): 0: 88% and 98%; 1: 84% and 97%; 2: 80% and 92%; 3: 74% and 91%; 4: 67% and 88%; 5 or more: 62% and 73% [3]. In ECHELON-1 (stage III and IV; 664 patients A+AVD and 670 ABVD; median follow-up 73 months), 6-year overall survival was 93.9% vs 89.4% (HR for death 0.59; P=0.009) and PFS was also better (HR 0.68); peripheral neuropathy was more frequent with A+AVD, and primary prophylaxis with G-CSF was recommended [5]. In NCT03907488 (994 patients with advanced-stage disease; median follow-up 2.1 years), 2-year PFS was 92% with N-AVD and 83% with BV-AVD (HR 0.45), and grade 2 or higher peripheral sensory neuropathy occurred in 3% vs 32%; on this basis N-AVD has become the treatment of choice for stage III and IV disease [3].
Non-Hodgkin lymphoma. Indolent lymphomas have a median survival of up to 20 years but are usually not curable at advanced stages; more than 70% of patients with aggressive lymphoma are cured. In follicular lymphoma, median survival is 8 to 15 years even at advanced stages, watchful waiting remains a standard in asymptomatic patients, and FLIPI and FLIPI-2 predict prognosis but do not establish the need for therapy; in a prospective study with a median follow-up of 6.8 years, 379 of 2,652 patients (14%) transformed to an aggressive histology [4]. In the watch-and-wait versus rituximab trial (379 patients with low tumour burden), 46% of the watchful-waiting group and 88% of the rituximab maintenance group did not need new treatment at 3 years (HR 0.21) [9]. In PRIMA (1,018 patients randomised after immunochemotherapy), median PFS was 10.5 years with rituximab maintenance vs 4.1 years (HR 0.61), with no difference in survival (HR 1.04) and 10-year survival of about 80% in both arms [10].
Diffuse large B-cell lymphoma. In patients treated with R-CHOP, the R-IPI identified three groups: very good (4-year PFS and OS 94% and 94%), good (80% and 79%) and poor (53% and 55%); the IPI no longer identifies a group with less than a 50% chance of survival [7]. In POLARIX (IPI 2 to 5; 879 patients; median follow-up 64.1 months), 5-year PFS was 64.9% with Pola-R-CHP and 59.1% with R-CHOP (HR 0.77), and overall survival did not differ significantly (HR 0.85) [6]. In ZUMA-7 (359 patients with early relapsed or refractory disease), 4-year survival was 54.6% with axicabtagene ciloleucel and 46.0% with standard care (chemoimmunotherapy and autologous transplant in responders) (HR 0.73; P=0.03) [8].
Staging and response (Lugano). PET-CT is used in FDG-avid lymphomas for staging and response assessment with the 5-point scale; the A/B suffix applies only to Hodgkin lymphoma, bone marrow biopsy is not needed for routine staging of Hodgkin lymphoma and most DLBCL, and routine surveillance scans are discouraged [11]. Calculators: IPI in DLBCL, IPS in Hodgkin lymphoma and FLIPI.
Scientific evidence
Scientific evidence
5 itemsSustained Progression-Free Survival Benefit of Rituximab Maintenance in Patients With Follicular Lymphoma: Long-Term Results of the PRIMA Study.
Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: an open-label randomised phase 3 trial
Five-Year Outcomes of the POLARIX Study Comparing Pola-R-CHP and R-CHOP in Patients With Diffuse Large B-Cell Lymphoma
Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin's Lymphoma
Survival with Axicabtagene Ciloleucel in Large B-Cell Lymphoma
Related cancer types
Related questions
References
11 referencesShow all references, 6 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 2
- 3
- 4
- 5
- 6Five-Year Outcomes of the POLARIX Study Comparing Pola-R-CHP and R-CHOP in Patients With Diffuse Large B-Cell Lymphoma
- 7
- 8
- 9Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: an open-label randomised phase 3 trial
- 10Sustained Progression-Free Survival Benefit of Rituximab Maintenance in Patients With Follicular Lymphoma: Long-Term Results of the PRIMA Study
- 11
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