Cancer Type Category: Lymphoma

Researchers do not have clear answers as to what causes lymphoma, but they have identified factors that can increase a person’s risk. Understanding those factors can help you and your physician make informed decisions about monitoring and care. 

Lymphoma can happen to anyone, regardless of family history. Knowing your risk is the first step toward being proactive about your health. 

Who Is at Higher Risk for Lymphoma 

Certain groups of people have a statistically higher risk of developing lymphoma. If you are at higher risk, it does not mean certainty of developing lymphoma. It simply means awareness and monitoring are more important.  

Age and lymphoma risk 

Age is a factor for non-Hodgkin lymphoma, which is more common in older adults. Hodgkin lymphoma, by contrast, often affects younger people. Neither type is limited to a single age group. 

Health history and immune function 

A weakened immune system is one of the most consistent risk factors across lymphoma types. This can result from:

 

• A serious illness like HIV/AIDS that affects immune function 
• Organ transplant medications that suppress the immune system 
• Living with an autoimmune disorder such as rheumatoid arthritis or lupus 
• Certain infections, including helicobacter pylori bacteria or the Epstein-Barr virus 

Environmental exposures 

Long-term exposure to certain chemicals, including pesticides and herbicides, has been associated with an increased risk of some lymphoma types. If you work in agriculture or with chemical agents, talk to your physician about your risk. 

What You Can Do with This Information 

Knowing your risk profile is a reason to be proactive. 

If you have several of the risk factors listed above, talk to your doctor. Together you can decide whether additional monitoring, earlier or more frequent screenings, or a conversation with a specialist makes sense for you. 

If your symptoms match what is commonly experienced by patients with lymphoma and have not been explained by a doctor, do not wait. Catching lymphoma early, when it is most treatable, begins by paying attention to the signs. 

When to Talk to a Specialist 

You do not need a diagnosis to talk to a specialist. If you are concerned about your risk or your symptoms, the team at Siteman Cancer Center is here to help you understand what you are dealing with and what your options are. 

Talk to a care coordinator to get started and they will help you figure out the right next step. 

Lymphoma treatment is not one-size-fits-all. With more than 90 subtypes and a wide range of staging possibilities, your treatment plan needs to be built around your specific diagnosis. That’s why it matters that your oncologist specializes in lymphoma, not just cancer broadly. 

WashU Medicine oncologists at Siteman Cancer Center give each patient a treatment plan tailored to their exact lymphoma type, stage, and health profile. For some patients, chemotherapy is the right answer. Others benefit from a combination of immunotherapy, targeted therapy, and CAR T-cell therapy. Our team has the subspecialty expertise to make that call — and the clinical trial access to offer options that aren’t available anywhere else in the region. 

Your Siteman care team will walk through every option with you and answer every question. You will never have to navigate this alone. 

Matching the Treatment to the Diagnosis 

The type of lymphoma you have determines which treatments are most likely to work. Hodgkin lymphoma and non-Hodgkin lymphoma are treated differently, and the subtype within each category matters too. 

Treatments used for Hodgkin lymphoma 

Hodgkin lymphoma is one of the most treatable cancers when caught and managed by the right team. Treatment often depends on your stage. 

• Stages 1 and 2: Chemotherapy, sometimes combined with radiation therapy 
• Stages 3 and 4: A combination of chemotherapy and immunotherapy 
• Relapsed or refractory cases: Stem cell transplant or CAR T-cell therapy 

Treatments used for non-Hodgkin lymphoma 

Non-Hodgkin lymphoma covers a broad range of subtypes, each with different behavior and different responses to treatment. Your oncologist will use your specific subtype and stage to determine the right combination. 

• Chemotherapy 
• Targeted therapy 
• Immunotherapy 
• CAR T-cell therapy 
• Radiation therapy 
• Stem cell transplant 

Drug Therapy  

Chemotherapy for lymphoma  

Chemotherapy is often the first line of treatment for lymphoma. These drugs work by targeting and killing rapidly dividing cancer cells. Patients may receive them as oral medications or as IV infusions. The treatment plan usually revolves in cycles, with treatment days followed by recovery days. 

Side effects like fatigue and nausea are common, and your Siteman care team will help you manage them from the start. If something is making you uncomfortable, tell us. There are real ways to reduce your side effects and protect your quality of life throughout treatment. 

Targeted therapy  

Targeted therapies block the specific pathways that cancer cells use to grow and multiply. Unlike chemotherapy, they are designed to act only on cancer cells, meaning there are fewer side effects on healthy tissue. Physicians administer targeted therapy by IV or as a daily pill, depending on the drug. 

Targeted therapy drugs are available for several lymphoma subtypes, and your oncologist will determine whether this approach fits your diagnosis. 

Immunotherapy  

Cancer cells are skilled at hiding from the immune system. Immunotherapy helps the immune system identify lymphoma cells as the threat they are, so the body can fight back. Several types of immunotherapies are used to treat lymphoma. 

Bispecific antibodies 

Bispecific antibodies are engineered to attach to two different types of cells: a lymphoma cell and one of the patient’s own T-cells. By binding them together, the antibody essentially introduces the lymphoma cell to the immune system, allowing the body to destroy it. 

Chemoimmunotherapy 

Chemoimmunotherapy combines antibodies with chemotherapy agents, using the antibody to deliver the chemotherapy directly to lymphoma cells. Physicians may use this as a standalone treatment or alongside traditional chemotherapy. 

Researchers at Siteman are also developing a vaccine for patients with follicular lymphoma. This development is an example of the next-generation immunotherapy work happening at WashU Medicine every day. 

CAR T-cell therapy: Siteman’s landmark contribution to lymphoma treatment 

CAR T-cell therapy is one of the most significant advances in lymphoma treatment in decades, and researchers at Siteman Cancer Center were there when it began (WashU Medicine’s Dr. Ghobadi was the clinical trial site principal investigator). This therapy reprograms a patient’s own immune cells to recognize and destroy lymphoma cells. It was developed through clinical trials, and Siteman was one of the centers that led that work. 

Today, CAR T-cell therapy is FDA-approved for patients with certain types of lymphoma. In a Siteman-led clinical trial, approximately 80% of patients with aggressive lymphoma achieved remission after CAR-T therapy, including patients who had already failed other treatments.  

Researchers at Siteman are now advancing next-generation CAR-T therapies through a phase 1 trial aimed at improving accessibility and reducing toxicity for patients with B-cell lymphoma. 

Read more about CAR T-cell therapy at Siteman.

Radiation Therapy  

Some patients with lymphoma receive radiation therapy as part of their treatment plan. Radiation uses focused energy beams to shrink tumors and destroy cancer cells. Radiation oncologists at Siteman are experts at delivering radiation precisely to reach the lymphoma cells while protecting the surrounding tissue. 

MR-guided adaptive radiation therapy 

Siteman Cancer Center was the first center in the world to use MR-guided adaptive radiation therapy (ART) for lymphoma. During treatment, the radiation oncologist uses MR imaging to watch the radiation in real time, making adjustments moment by moment as the tumor responds. This level of precision is not available at most centers. 

Proton beam therapy 

The S. Lee Kling Proton Therapy Center at Siteman was the first proton therapy center in Missouri and the surrounding region, and the first in the world to use a compact, single-room proton beam accelerator, the Mevion S250. Proton beams are different from traditional radiation — they stop directly on their target without passing through the body. This makes proton therapy ideal for tumors located near sensitive structures like the heart, brain, or spinal cord. 

Stem Cell Transplants  

Some patients with lymphoma need a stem cell transplant to achieve or sustain remission. Siteman Cancer Center has one of the largest stem cell transplant programs in the United States. As of 2024, our physicians have performed more than 10,000 transplants, giving us refined protocols and better outcomes than centers with less experience. 

Before high-dose chemotherapy, your team may collect and preserve your own stem cells to protect them from the treatment. After chemotherapy, those cells are returned to restore your body’s ability to produce healthy blood cells. 

Our care team knows that time outside the hospital matters to patients. Siteman’s Blood and Marrow Transplant Program and our Outpatient Cellular Therapy Center allow patients to receive this specialized care with fewer hospital stays.  

Exploring Clinical Trials as Part of Your Lymphoma Care 

Clinical trials give lymphoma patients access to treatments that aren’t yet available everywhere. Your Siteman physician may recommend a clinical trial as part of your treatment plan. You can also ask about them at any time. 

Siteman has more clinical trials available than any other cancer center in the region. That means our patients have options that patients elsewhere simply don’t have. Ask your care team what trials might be right for you. 

Thanks to clinical trials, lymphoma patients have three CAR T-cell therapies that are FDA approved. And clinical trials made several new FDA-approved bispecific antibody treatments available to patients, too.

A lymphoma diagnosis is rarely simple. With more than 90 subtypes, no two cases look exactly alike. The symptoms can mimic a cold or a lingering infection. The bloodwork may point in several directions at once. That complexity is exactly why it matters just as much where you get diagnosed — as it does the diagnosis itself. 

The lymphoma specialists at Siteman Cancer Center work exclusively with this disease every day. They are trained to read the specific combination of your symptoms, your bloodwork, and your biopsy results to arrive at a precise diagnosis. Once your diagnosis is dialed in, that drives a precise treatment plan. 

Common Lymphoma Symptoms 

Lymphoma symptoms can feel like something far less serious, such as a swollen lymph node, fatigue, or night sweats. These symptoms can be easy to dismiss or misread. But each symptom carries diagnostic information.  

The pattern of your symptoms, where they appear and how long they last, can help a specialist begin to narrow down which of the more than 90 types of lymphoma may be at work. 

When should I see a specialist for lymphoma symptoms? 

Call your doctor if you’ve noticed any of the following symptoms for more than two weeks.  

• Swollen yet painless lymph nodes that appear in the neck, chest, groin, or underarms  
• Tiredness (fatigue)  
• Night sweats  
• Fever, especially if you can’t figure out what’s causing it  
• Unintentional weight loss or sudden loss of appetite 

Less common symptoms that still matter diagnostically 

Some lymphoma subtypes produce symptoms that are easy to attribute to other conditions. These less common signs can be just as important to share with your physician. 

• Pain, tingling, or numbness in hands or feet 
• Changes in vision, such as blurred vision or blind spots 
• Unusual bruising or bleeding, such as nosebleeds or bleeding gums 
• Pain or a full feeling below the ribs 
• Itchy skin, red rash, thick patches (plaques) or nodules on the skin 

If any of these symptoms have persisted for more than a week or two without improvement, that’s your signal. Talk to your doctor. A WashU Medicine specialist at Siteman Cancer Center can help you understand what your symptoms are telling you. 

Why Diagnosing Lymphoma Takes More Than a Blood Test 

A standard blood count can raise a flag, but it cannot name your lymphoma. Arriving at the right diagnosis requires multiple layers of testing — and a specialist who knows what each result means. This is what makes lymphoma diagnosis different from many other cancers, and why precision matters from the very first test. 

Blood tests reveal the first layer of information 

A complete blood count, or CBC, is usually the first test your primary care physician orders. An abnormal white blood cell count, whether too high or too low, is often the first signal that something needs more investigation.  

From there, more specific lab work helps your care team understand what is happening at the cellular level. Additional blood tests may include: 

• Peripheral blood smear, which shows the shape and makeup of individual blood cells 
• Blood chemistry studies to assess organ function and overall health 
• Immunophenotyping and flow cytometry, which identify the type of cells involved 
• Cytogenetic analysis, which looks for chromosomal changes that can signal specific subtypes 

Biopsies confirm the diagnosis 

When blood tests suggest lymphoma, a biopsy is often the next and most definitive step. During a biopsy, a surgeon or imaging specialist removes a portion of a swollen lymph node or tissue. A pathologist examines the sample under a microscope to identify whether cancer is present, and which subtype it might be. 

The biopsy result is the foundation of your diagnosis. Getting it right the first time means your treatment plan starts on solid ground. 

Imaging maps where lymphoma has traveled 

PET and CT scans allow your care team to see beyond the lymph nodes — identifying tumors, tracing how far the disease has spread, and pinpointing areas that need attention. Both scans use contrast dye to highlight areas of concern. Together, they give your physician a complete picture of the disease before treatment begins. 

Understanding Lymphoma Stages 

Once your diagnosis is confirmed, your care team will determine your stage. Staging describes how far the lymphoma has spread through the lymphatic system. This information directly shapes your treatment plan — which therapies are recommended, in what order, and with what intensity. 

One important distinction: Lymphoma staging does not carry the same weight as staging in many other cancers. Stage 4 lymphoma often responds very well to treatment, and remission is achievable.  

• Stage 1: Lymphoma is contained to one group of lymph nodes 
• Stage 2: Lymphoma has spread to more than one group, but has not crossed the diaphragm 
• Stage 3: Lymphoma is found on both sides of the diaphragm 
• Stage 4: Lymphoma has spread to an organ outside the lymph nodes 

Additional staging designations your physician may use 

• Stage A: No symptoms are present; lymphoma was found on imaging 
• Stage E: Lymphoma is present in an organ or area outside the lymph nodes 
• Stage S: Lymphoma is present in the spleen 

Staging for cutaneous lymphoma, or lymphoma of the skin, follows a separate system, which your care team will explain.  

Your Second Opinion at Siteman 

Siteman wants to be your first choice for cancer care, but that might not always be possible. If you have received a cancer diagnosis, started care somewhere else, or are a physician seeking specialized care for your patient, ask us about a second opinion. You can start the process. To make it easy, our care coordinators guide scheduling for yourself or your patient.   

Call Us Refer a Patient 

What Your Prognosis Means 

The prognosis for lymphoma depends on factors that are specific to you: your subtype, your stage, how quickly the disease is growing, and your overall health.  

This is why the precision of your diagnosis is important. The more accurately your care team identifies your specific lymphoma, the more targeted and effective your treatment plan can be. 

Factors your care team considers when determining your prognosis include: 

• The type and subtype of lymphoma 
• Whether the lymphoma is slow-growing or aggressive 
• How far the cancer has spread at the time of diagnosis 
• Your age and overall health 
• Whether your lymphoma is newly diagnosed or has returned after prior treatment 
• Genetic changes in the lymphoma cells 

At Siteman Cancer Center, our lymphoma specialists draw on deep subspecialty expertise and hundreds of years of combined experience with access to the most advanced diagnostic tools. Their experience in this specific type of cancer gives you and your loved ones the clearest possible picture and the best possible path forward.  

If you were newly diagnosed with lymphoma or looking for a second opinion and you’re wondering what to expect, Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine is here to help guide you. Receiving a diagnosis can change everything in an instant — and every patient’s recovery path will look different. 

Lymphoma is a complex cancer with over 90 subcategories. That means there is no one-size-fits-all treatment, and the prognosis will vary greatly by type. No two lymphoma diagnoses are alike. The differences in staging and treatment options matter. At Siteman, that nuance is built into every care plan we create.

At Siteman Cancer Center, our experts understand the nuances of different subtypes, stages, and treatment options. That means you will get answers designed specifically for you, not just for lymphoma in general. 

Through leading research efforts and developing innovative therapies, Siteman is one of the best places in the region to receive lymphoma treatment — with patients traveling across the country for clinical trials and the most advanced treatment options. With clinical research from WashU Medicine and expertise from BJC HealthCare, Siteman is recognized nationally among the cancer centers for lymphoma treatment. 

On average, our physicians see more than 500 patients who have lymphoma each year, making us a center of expertise. Lymphoma falls into two main categories: Hodgkin and non-Hodgkin lymphoma, with many subtypes falling under those. Our physicians have experience with them all. 

We care for patients diagnosed with all subtypes of lymphoma, including: 

• Diffuse large B-cell lymphoma (DLBCL) 
• Follicular lymphoma 
• CLL / small lymphocytic lymphoma 
• Marginal zone lymphoma 
• Mantle cell lymphoma 
• T-cell lymphoma 
• Burkitt lymphoma 

Why Siteman is a Leader in Lymphoma 

Lymphoma is a complex disease, with countless types and subtypes that can be difficult to diagnose. Different types of lymphoma need different treatments, so an accurate diagnosis is the first step to receiving the best treatment. 

The WashU Medicine lymphoma team at Siteman ensures that you get the right diagnosis and the right treatment plan based on your specific needs. Our physician-scientists are obsessed with finding answers to the complexities of lymphoma, and our specialists focus on treating lymphoma patients with precision. This helps deepen remission and boost survivability. 

Because our physicians dedicate their careers to lymphoma, they see patterns and options that others may miss — including clinical trial eligibility, genetic features that change treatment strategy, or sequencing decisions that protect future treatment options. 

Siteman Cancer Center is the only NCI-designated cancer center in the region and our patients can access more clinical trials than any other cancer center in the area. We have a decades-long history of driving research into lymphoma. These efforts have helped people across the country with hope for positive outcomes. 

As recently as 2025, physicians from WashU Medicine found a phase 1 immunotherapy trial to be safe to use for patients with B-cell lymphoma. This discovery means that our patients have greater access to CAR T-cell therapy at lower costs. Now, cutting-edge treatments are no longer used as a last resort — but as a standard for treatment. 

Fortunately, there are many other forms of treatment for lymphomas that we use at Siteman. Chemotherapy and stem cell transplants remain effective therapies for patients with lymphoma — treatments we excel in. Additionally, our research advancements in CAR T-cell therapy led to breakthrough designations by the FDA, giving patients greater access to immunotherapy. 

Siteman Leads in Lymphoma Treatment 

At Siteman, we tailor your lymphoma treatment to your exact subtype, stage, and specific needs. Siteman’s lymphoma treatment options include CAR T-cell therapy, stem cell transplants, bispecific antibodies, and more. 

Greater patient comfort through outpatient services 

Our physicians focus on patient comfort and quality of life to ensure that your lymphoma treatment options are as minimally invasive as possible. One of the ways Siteman has advanced patient care is through the opening of our Outpatient Cellular Therapy Center for patients undergoing CAR T-cell therapy, autologous stem cell transplant or immunotherapy with the use of bispecific T-cell engagers (BiTEs). Now, patients do not have to commit to long hospital stays to undergo their treatment.  

Leadership in immunotherapy 

WashU Medicine physicians were among the first in the U.S. to perform CAR T-cell therapy at Siteman, in 2017. Plus, the depth of our clinical trials means our oncologists have a wealth of experience in the technique. This means patients have better access to these novel treatments than they can find elsewhere and can be confident in their effectiveness. 

Immunotherapy has helped patients who don’t respond to other standard treatments for lymphoma. In clinical trials, CAR T-cell therapy has achieved 40 to 80% remission rates, with some patients remaining in remission for several years.  

We partner with WashU Medicine’s Center for Gene and Cellular Immunotherapy to advance immunotherapy even further. The center is internationally recognized for developing and offering some of the most innovative gene and cellular immunotherapies available to patients with blood cancer. This means patients have a wider range of treatment options available that could be more effective for their specific cases. 

Leadership in stem cell transplants 

Siteman is a pioneer in stem cell transplants, launching our program in 1982. Today, ours is one of the largest transplant programs in the world, with over 10,000 treatments performed to date. People have traveled from all over to receive this treatment with us. 

We offer both types of stem cell transplants for patients with lymphoma – autologous (using your own stem cells) and allogeneic (using stem cells from a matched donor). This treatment uses living cells to stimulate the immune system to fight cancer.   

What Our Providers Say About Lymphoma Treatment 

Your care at Siteman Cancer Center is led by a multidisciplinary team with deep expertise in lymphoma, cellular therapy, and stem cell transplants. This expertise is integrated in your care to manage complex disease and deliver the most advanced treatment options available.   

Your team will include:  

• Medical oncologists  
• Hematologic oncologists  
• Radiation oncologists  
• Bone marrow transplant specialists  
• Psychologists  
• Other lymphoma specialists 

Researchers at Siteman received a $5 million Specializ ed Center of Research (SCOR) grant from Blood Cancer United (formerly called the Leukemia & Lymphoma Society) in 2024, the highest amount of funding possible. This grant helps researchers develop new immunotherapies for blood-based cancers. 

With this funding, researchers at WashU Medicine have divided their focus into three projects focusing on lymphoma treatment options: 

1. Advancing CAR-NK cell therapy for patients with B-cell lymphoma, using the same general strategy as CAR T-cell therapy. 
2. Addressing gene editing of T cells so they can target cancer cells without attacking a patient’s healthy tissue. This commonly occurs in graft-versus-host disease. 
3. Advancing personalized cancer vaccines for patients with follicular lymphoma. This trains a patient’s immune system to recognize and attack abnormal proteins found on their specific cancer cells. 

Siteman is advancing care of patients through scientific discovery. Patients here have greater access to novel therapies because of their proximity to such advanced and thorough research. 

The discoveries Siteman develops are especially crucial in harder-to-treat cancers. Their research findings provide greater personalization since these therapies often use the patient’s own immune system to target and eliminate cancer cells. 

Lymphoma Breakthroughs From Clinical Ttrials 

Siteman has more clinical trials than any other center in the region, with dozens specifically focused on different types of lymphoma. When you enroll in a clinical trial, you not only receive novel treatment unavailable elsewhere, but you also help shape the future of cancer care for patients who come after you. 

Here are a few examples of clinical trials that led to breakthroughs for lymphoma treatment at Siteman: 

• A targeted therapy for patients with follicular lymphoma using bispecific antibodies. These drugs help your immune system attack malignant tumors and have received promising results for effectiveness, with fewer uncomfortable side effects for patients. 
• A clinical trial conducted at Siteman led to the FDA’s Breakthrough Therapy designation for an innovative CAR-T cell therapy called WU-CART-007. This designation lowers some logistical and financial barriers linked to many cell-based therapies, reducing patients’ waiting time for treatment. 
• The ECHELON-3 trial, led by Nancy Bartlett, MD, tested adding a drug called brentuximab vedotin with a combination of either lenalidomide or rituximab. It showed the combination was safe, giving patients with typically hard-to-treat cancer another option 

Our Groundbreaking Research Means More Treatment Options for Patients 

Treatment for blood cancers is notably complex, but treatments are rapidly evolving. Siteman opens the door for patients who have faced few options with lymphoma. Whether their cancer has come back, or they aren’t eligible for a certain type of treatment, there are several therapies we offer that can help even difficult-to-treat cancers. 

In just one example, Siteman was one of the first centers nationwide to offer a new therapy for non-Hodgkin lymphoma called Yescarta. This clinical trial at Siteman was approved by the FDA in 2017, giving hope for patients who had previously failed standard therapies. 

By moving research from the bench to the clinic, WashU Medicine physicians pave a path forward for patients with cancer and give them hope to keep fighting.

“We work as hard as possible to achieve research and clinical breakthroughs. We try our best and then reset the next day. We collaborate with other institutions around the world. If something is not here, we will gladly refer outside because patient well-being comes first rather than individual accolades or ego. We also have the ‘most’ fun in treating patients and getting people into remission!” 

–Dilan Patel, MD