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Health condition · Clinically reviewed

Hodgkin and non-Hodgkin lymphoma, precisely subtyped, personalised therapy, modern immunotherapy.

Not one disease but dozens - Hodgkin, B-cell and T-cell subtypes each have their own biology and their own treatment ladder. Getting the diagnosis right is the whole game.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK haematology-oncology clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSH, NICE, NCCN and peer-reviewed haematopathology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including bispecific antibodies, CAR-T cell therapy and PET-adapted regimens.

Key facts

Lymphoma at a glance.

The essentials, in plain English - what lymphoma is, the main types, and how modern UK haematology-oncology teams tackle each subtype.

  • What it is

    Lymphoid malignancies arising from B, T or NK cells - Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), each with distinct biology.

  • Hodgkin lymphoma

    Classical HL (nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte-depleted) plus nodular lymphocyte-predominant (NLPHL).

  • B-cell NHL

    The largest group - DLBCL (most common), follicular, marginal zone/MALT, mantle cell, Burkitt, CLL/SLL, Waldenstroem, primary CNS.

  • T-cell NHL

    Rarer and often more aggressive - peripheral T-cell, anaplastic large cell (ALCL), cutaneous (mycosis fungoides, Sezary), NK/T cell.

  • Presentation

    Painless lymphadenopathy plus B symptoms - fever, drenching night sweats and weight loss - or extranodal disease in GI, skin or CNS.

  • Foundation of care

    Excisional lymph node biopsy, PET-CT staging and specialist haematology MDT review - modern therapy is highly subtype-specific.

Why this guide matters

Precision beats brute force.

Lymphoma is one of the great success stories of modern oncology - but only when the subtype is nailed and the treatment is chosen for that biology.

  • Excisional biopsy is the anchor

    A whole lymph node reviewed by a specialist haematopathologist is the single most important investigation - it drives everything that follows.

  • PET-CT staging is standard

    Specialist commissioned PET-CT defines Ann Arbor stage, guides intensity and lets us adapt therapy at the interim scan.

  • Immunotherapy has changed prognosis

    CAR-T cells, bispecific antibodies and checkpoint inhibitors offer durable remissions in disease that was once untreatable.

How the diagnosis is made

From a suspicious node to a subtype-specific plan.

The steps a UK haematology-oncology team will follow, in order - so you know what to expect and why each investigation matters.

  1. 01

    Assessing

    Clinical assessment and B symptoms

    A structured history and examination - lymph node sites, hepatosplenomegaly, extranodal features, fever, night sweats and weight loss.

  2. 02

    Assessing

    Excisional lymph node biopsy

    Whole node preferred - core biopsy only where surgery is not feasible. Specialist haematopathology review is essential for accurate subtyping.

  3. 03

    Assessing

    Immunohistochemistry panel

    CD20, CD30, BCL2, BCL6, MYC, CD3, CD5, CD10, cyclin D1 and Ki-67 - the panel that classifies the lymphoma and shapes therapy.

  4. 04

    Confirming

    PET-CT for Ann Arbor staging

    Specialist commissioned whole-body imaging - defines stage I to IV, tracks response and guides PET-adapted treatment intensity.

  5. 05

    Confirming

    Bone marrow biopsy (selective)

    Increasingly reserved for cases where PET is equivocal or in specific subtypes such as CLL/SLL, Waldenstroem or T-cell disease.

  6. 06

    Confirming

    Molecular and cytogenetic testing

    FISH for MYC, BCL2 and BCL6 rearrangements in aggressive B-cell disease; NGS panels for driver mutations - specialist molecular haematopathology.

  7. 07

    Planning

    Specialist haematology-oncology MDT

    Specialist commissioned MDT integrates pathology, imaging, molecular data and fitness - the plan is subtype and stage specific.

Typical timeline: from suspicious node to specialist plan in one to three weeks.

Symptoms

What lymphoma actually looks like.

Most lymphomas start with a painless node and non-specific systemic features - and a small number present as an oncological emergency.

  • Painless lymphadenopathy

    Firm, rubbery, non-tender neck, axillary or groin nodes - the most common presenting feature of both HL and NHL.

  • B symptoms

    Unexplained fever above 38 degrees, drenching night sweats and weight loss over 10 per cent in six months.

  • Fatigue

    Persistent, disabling fatigue beyond ordinary tiredness - often the earliest and most disruptive symptom.

  • Hepatosplenomegaly

    An enlarged liver or spleen may cause left upper abdominal fullness, early satiety or a dragging sensation.

  • Pruritus

    Generalised itch without a rash - classically associated with Hodgkin lymphoma and sometimes precedes diagnosis.

  • Extranodal disease

    GI tract, skin, bone, testis or CNS involvement - more common in NHL and shapes both staging and therapy.

  • Alcohol-induced pain

    A rare but classic Hodgkin feature - pain in affected nodes within minutes of drinking alcohol.

  • Red flag - SVC obstruction

    Facial swelling, distended neck veins and breathlessness from a bulky mediastinal mass - an oncological emergency.

Treatment

How lymphoma is treated in the UK.

Modern lymphoma therapy is subtype-specific - PET-adapted chemoimmunotherapy for most, with CAR-T cells and bispecific antibodies for relapsed or refractory disease.

  • Hodgkin - ABVD chemotherapy

    Adriamycin, bleomycin, vinblastine and dacarbazine - the backbone regimen for classical HL, often PET-adapted after two cycles.

  • Hodgkin - BV-AVD and escBEACOPP

    Brentuximab vedotin plus AVD for advanced HL, or escalated BEACOPP for high-risk disease - via our brentuximab vedotin lymphoma clinic.

  • Checkpoint inhibitors

    Pembrolizumab (Keytruda) and nivolumab for relapsed or refractory Hodgkin lymphoma - via our checkpoint immunotherapy clinic and nivolumab clinic.

  • DLBCL - R-CHOP and POLA-R-CHP

    Rituximab-based combination chemotherapy is standard first line; polatuzumab vedotin plus R-CHP improves outcomes in higher-risk DLBCL.

  • CAR-T cell therapy

    Axi-cel, tisa-cel and liso-cel for relapsed or refractory large B-cell lymphoma; brexu-cel for mantle cell - via our CAR-T cell therapy service.

  • Bispecific antibodies

    Glofitamab and epcoritamab for relapsed B-cell NHL; mosunetuzumab for follicular lymphoma - via our bispecific antibody lymphoma clinic.

  • BTK and BCL-2 inhibitors

    Ibrutinib, acalabrutinib, zanubrutinib and venetoclax for CLL and mantle cell lymphoma - via our ibrutinib clinic.

  • Targeted therapy - tazemetostat

    EZH2 inhibitor for follicular lymphoma with EZH2 mutations - via our tazemetostat lymphoma clinic and molecular profiling service.

What this guide is based on

The sources behind every claim on this page.

UK, European and international haematology-oncology guidance, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your haematologist or oncologist knows your subtype, stage and molecular profile and can tell you which parts apply. Blood Cancer UK and Lymphoma Action can offer support alongside your team.

  • British Society for Haematology (BSH). Guidelines on the diagnosis and management of Hodgkin lymphoma and NHL subtypes.

  • NICE. Non-Hodgkin lymphoma: diagnosis and management (NG52) and technology appraisals for lymphoma therapies.

  • National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: B-cell and T-cell lymphomas, Hodgkin lymphoma.

  • European Society for Medical Oncology (ESMO). Clinical practice guidelines for Hodgkin and non-Hodgkin lymphomas.

Red flags

When lymphoma is an emergency.

A handful of lymphoma presentations need urgent, same-day assessment - the features below always warrant contacting your treating team or attending A&E.

  • Superior vena cava obstruction

    Facial and neck swelling, distended veins and breathlessness from a bulky mediastinal mass - an emergency needing urgent imaging and haematology input.

  • Tumour lysis syndrome

    High tumour burden, especially Burkitt or high-grade B-cell NHL - electrolyte disturbance and acute kidney injury at diagnosis or on treatment.

  • Cord compression

    Back pain, weakness, altered bowel or bladder function - spinal disease from lymphoma requires emergency MRI and steroids.

  • CNS involvement

    Headache, confusion, seizures or cranial nerve signs - primary or secondary CNS lymphoma needs urgent neuro-oncology review.

  • Airway compromise

    Rapidly enlarging neck or mediastinal disease with stridor or dyspnoea - emergency assessment and steroid cover.

  • Neutropenic sepsis

    Fever during or after chemotherapy is a medical emergency - go directly to the treating unit or nearest emergency department.

  • HIV-associated lymphoma

    Aggressive B-cell lymphoma in the context of HIV - joint haematology and HIV specialist care is essential; see our HIV/AIDS guide.

  • Castleman disease overlap

    Multicentric Castleman disease can mimic lymphoma and needs distinct therapy - specialist haematopathology review is essential.

  • Transformation of low-grade disease

    A rapid change in nodes, new B symptoms or rising LDH in follicular lymphoma or CLL may signal transformation to aggressive disease.

Living with it

A curable or highly treatable diagnosis, with the right team.

The single biggest predictor of a good outcome is being under a specialist commissioned haematology-oncology team with expertise in your subtype.

A quiet reminder

Modern lymphoma outcomes are transformed.

Cure rates for Hodgkin lymphoma and DLBCL are among the highest in oncology, and durable remissions are now possible in disease that was once uniformly fatal.

  1. 01 Team

    One MDT, one plan

    Specialist haematology-oncology MDT review ties together pathology, imaging and molecular data - a single plan, not a scatter of opinions.

  2. 02 Monitoring

    PET-adapted therapy

    Interim PET-CT lets us de-escalate for good responders and intensify for those who need more - modern lymphoma care is personalised.

  3. 03 Support

    Blood Cancer UK and Lymphoma Action

    National charities offer helplines, peer support, financial advice and clear information alongside your NHS or private team.

  4. 04 Survivorship

    Long-term follow-up

    Late effects (cardiac, endocrine, second cancers, fertility) matter - structured survivorship review protects health for decades after cure.

Frequently asked

Everything we get asked about lymphoma.

Quick answers on biopsy, staging, chemoimmunotherapy, CAR-T and bispecific antibodies.

  • What is the difference between Hodgkin and non-Hodgkin lymphoma?

    Hodgkin lymphoma is defined by the presence of Reed-Sternberg cells and has a distinct biology and treatment ladder. Non-Hodgkin lymphoma is a broad group of B-cell, T-cell and NK-cell malignancies with very different behaviour, prognosis and therapy. Accurate subtyping by specialist haematopathology drives the whole plan.

  • How is lymphoma diagnosed?

    The gold standard is an excisional lymph node biopsy reviewed by a specialist haematopathologist with a full immunohistochemistry panel. PET-CT stages the disease using the Ann Arbor system, and molecular testing (FISH, NGS) refines subtype and prognosis. Bone marrow biopsy is now selective rather than routine.

  • What are B symptoms and why do they matter?

    B symptoms are unexplained fever above 38 degrees, drenching night sweats and unintentional weight loss of more than 10 per cent over six months. They are a marker of more active or advanced disease and influence both staging and treatment intensity.

  • What is CAR-T cell therapy and who is it for?

    CAR-T cell therapy re-engineers a patient’s own T cells to target CD19 on B-cell lymphomas. Axi-cel, tisa-cel and liso-cel are approved for relapsed or refractory large B-cell lymphoma, and brexu-cel for mantle cell lymphoma. It is delivered in specialist commissioned centres via our CAR-T cell therapy service.

  • What are bispecific antibodies?

    Bispecific antibodies bind both a lymphoma antigen (usually CD20) and CD3 on T cells, bringing them together to kill the tumour. Glofitamab and epcoritamab are used in relapsed B-cell NHL, and mosunetuzumab in follicular lymphoma - all via our bispecific antibody lymphoma clinic.

  • Can Hodgkin lymphoma be cured?

    Yes - classical Hodgkin lymphoma has one of the highest cure rates in oncology, particularly in early stage disease. Modern PET-adapted regimens (ABVD, BV-AVD, escBEACOPP) plus checkpoint inhibitors and, where needed, autologous stem cell transplant deliver excellent long-term outcomes for most patients.

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