T-cell Lymphoma

What is T-cell lymphoma?

T-cell lymphomas are forms of non-Hodgkin lymphoma. The condition happens when abnormal T cells multiply and become cancer. T-cell lymphomas develop in the lymphoid tissues of your body, including your skin, lymph nodes, gastrointestinal tract and spleen. There are many different T-cell lymphoma subtypes. Treatment varies depending on the subtype.

What are T-cell lymphoma types?

Healthcare providers may group T-cell lymphomas based on whether the conditions are aggressive (grow very quickly) or indolent (grow more slowly).

Aggressive T-cell lymphomas

This group includes the following fast-growing subtypes:

• Adult T-cell lymphoma/leukemia (human T-cell lymphotropic virus type I positive). This form of T-cell lymphoma often affects people’s skin and bones.
• Anaplastic large cell lymphoma (ALCL). This condition may be systemic or cutaneous. Systemic ALCL develops throughout your body. Cutaneous ALCL affects your skin. Rarely, a specific subtype of ALCL can be associated with artificial breast implants.
• Angioimmunoblastic T-cell lymphoma (AITL). AITL may cause symptoms similar to autoimmune disorders like autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP).
• Enteropathy-associated T-cell lymphoma. This T-cell lymphoma affects people’s intestines.
• Hepatosplenic gamma/delta T-cell lymphoma. This condition affects your liver and spleen.
• Nasal NK/T-cell lymphoma. NK stands for natural killer cell, another white blood cell that’s similar to T cells. It typically affects the lining of your nose and upper airway, but may develop in your skin or gastrointestinal (GI) tract.
• Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). This category includes forms of T-cell lymphoma that don’t fit into one of the specific subgroups that are listed above.

Indolent T-cell lymphomas

This group includes the following less aggressive subtypes:

• Cutaneous T-cell lymphoma. This is the most common type of T-cell lymphoma. It includes mycosis fungoides and Sézary syndrome.
• T-cell prolymphocytic leukemia.
• Subcutaneous panniculitis-like T-cell lymphoma. This condition affects tissues under your skin.

What are T-cell lymphoma symptoms?

T-cell lymphomas may affect different areas of your body. Symptoms vary based on where the condition started. For example, patches of reddish skin are common symptoms of cutaneous T-cell lymphoma. Other symptoms may include:

• Heavy night sweats. This is sweating so intense that it drenches your sheets.
• Pain in your belly, bones or chest.
• Persistent fatigue. This is feeling much more tired than usual for at least several days and for no apparent reason.
• Swollen lymph nodes. You may have painless swelling in your neck, armpits or groin.
• Unexplained fever. Often, fevers are signs your body is fighting an infection. A fever that stays above 103 degrees Fahrenheit (39.5 degrees Celsius) for two or more hours after home treatment or lasts longer than two days may be a sign of a serious problem.
• Unexplained weight loss. This is losing body weight without trying. Losing 10% of your total body weight over six months is a sign of unexplained weight loss.

T-cell lymphomas cause many symptoms that are similar to other, less serious issues. Experiencing one or more of these symptoms doesn’t mean you have T-cell lymphoma. That said, you should contact your healthcare provider if you have symptoms such as fevers or swollen lymph nodes that last more than two weeks.

What causes T-cell lymphoma?

There’s no single known cause of T-cell lymphoma. In general, the condition happens when genes that control T cell development change (mutate) and create abnormal T cells. Healthcare providers don’t know all the reasons why this happens, but acquired genetic mutations are involved. (You aren’t born with these kinds of mutations, they happen during the course of your lifetime.)

There are certain risk factors that may increase the chance you’ll develop T-cell lymphoma. A risk factor is an activity or physical condition that increases your risk of developing a certain disease. T-cell lymphoma risk factors include:

• Age. People age 55 and older are more likely to develop this condition than younger people.
• Sex. Men and people assigned male at birth (AMAB) are more likely to develop T-cell lymphoma than women and people assigned female at birth (AFAB).
• Race. People who are white or Asian are more likely to develop T-cell lymphoma than people who are Black.
• Having certain autoimmune diseases.
• Being exposed to carcinogens such as ultraviolet (UV) light and workplace chemicals.

How is T-cell lymphoma diagnosed?

Healthcare providers may use one or more of the following tests to diagnose T-cell lymphoma:

• Complete blood count (CBC) with differential.
• Comprehensive metabolic panel (CMP).
• Lactate dehydrogenase (LDH).
• Peripheral blood smear.
• Tests for certain viruses such as Epstein Barr virus, human immunodeficiency virus (HIV), human T-cell lymphotropic virus type I positive or various types of hepatitis.
• Bone marrow aspiration.
• Immunophenotyping, tests that help diagnose specific lymphoma types.
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET) scan.

Staging T-cell lymphoma

Healthcare providers use cancer staging systems to plan cancer treatment and develop prognoses (what you may expect from cancer treatment). T-cell lymphoma stages are:

• Stage I: There’s lymphoma in one lymph node area or one lymphoid organ. Your thymus, spleen and bone marrow are lymphoid organs.
• Stage II: There’s lymphoma in two or more groups of lymph nodes located on the same side of your diaphragm.
• Stage III: There’s lymphoma in lymph nodes on both sides of your diaphragm, above or below your diaphragm or in your spleen.
• Stage IV: There’s lymphoma in at least one organ outside your lymphatic system, such as your bone marrow, liver or lung.

Providers may use a different staging system for cutaneous T-cell lymphoma. Cutaneous T-cell lymphoma has a different growth pattern than other forms of lymphoma.

How is T-cell lymphoma treated?

Healthcare providers use different treatment for specific T-cell lymphomas. Treatments range from watchful waiting to stem cell (bone marrow) transplantation. Treatments may include:

• Watchful waiting/active surveillance. Some slow-growing forms of T-cell lymphoma don’t cause symptoms. If this is your situation, your provider may hold off on medications or other treatments. This is watchful waiting or active surveillance. Providers carefully monitor your overall health so they’re ready to start treatment as soon as you have symptoms.
• Chemotherapy. This is the main treatment for non-Hodgkin lymphomas, including T-cell lymphomas.
• Targeted therapy. This may include monoclonal antibody therapy. This treatment uses lab-created antibodies to find and destroy specific cancer cells.
• Immunotherapy. This treatment, also called biologic therapy or biotherapy, boosts your body’s immune system. CAR T-cell therapy is an example of immunotherapy, although many healthcare providers also view monoclonal antibodies as a type of immunotherapy, as well.
• Radiation therapy. This treatment includes X-rays or other types of radiation.
• Chemotherapy with stem cell transplantation. Stem cells are immature blood cells in your blood or bone marrow. In some cases, providers may do autologous stem cell transplantation. Less frequently, they may do allogeneic stem cell transplantation.

You may want to consider participating in a clinical trial. Clinical trials are tests medical researchers do to see if proposed treatments are safe and effective. In a clinical trial, you may receive new treatment or different combinations of treatment for T-cell lymphoma.

Can T-cell lymphoma be prevented?

Experts don’t know the exact cause, making it difficult to prevent T-cell lymphoma. There are T-cell lymphoma risk factors, some of which you can avoid. Those risk factors include being exposed to carcinogens or having certain infections.

Is T-cell lymphoma curable?

Some types of T-cell lymphoma may go into remission after treatment. (Remission means you don’t have symptoms and tests show no signs of disease.) Some forms of cancer may be cured after long-term remission. That may be true for some T-cell lymphomas. In general, however, T-cell lymphoma tends to recur (come back) after treatment. If you have T-cell lymphoma, ask your healthcare provider what you can expect.

What is the prognosis for T-cell lymphoma?

A prognosis is what you may expect as you continue to live with T-cell lymphoma. Prognoses reflect what healthcare providers know about the experiences of large groups of people. What was true for them may not be true for you. For that reason, your healthcare provider is your best resource for information regarding your prognosis.

What’s it like to live with T-cell lymphoma?

There are many types of T-cell lymphomas, which makes it challenging to say exactly what it’s like to live with the condition. If you have T-cell lymphoma, you may want to explore palliative care. Palliative care provides symptom relief, comfort and support to people living with serious medical conditions. You may have palliative care on its own or with other T-cell lymphoma treatments.

How do I care for myself at home?

Self-care is an important part of managing your condition. These activities won’t make your condition go away, but they may help you feel more confident about living with it:

• Eat nutritious meals. Food is energy. Eating well is one way to maintain strength. Ask to speak to a nutritionist if you’d like more information or ideas about eating well.
• Rest as much as you can. You may feel worn out by chemotherapy and other treatments. Rest helps your body recover and regain strength.
• Exercise. Gentle exercise helps with stress.

When should I see my healthcare provider?

Contact your healthcare provider if you notice changes in your body that may be signs that T-cell lymphoma is progressing (getting worse).

When should I go to the emergency room?

You should go to the emergency room (ER) if you have treatment side effects that don’t subside after taking prescribed medication, are stronger than you expect or continue for a long time.

What questions should I ask my healthcare provider?

You’ll probably have many questions as you go through diagnosis and treatment for T-cell lymphoma. Here are some questions you may want to ask your healthcare provider:

• What type of T-cell lymphoma do I have?
• What stage is my condition?
• What’s the goal of my treatment?
• What treatments do you recommend?
• What are the side effects of those treatments?
• Should I consider a clinical trial?

Are T-cell lymphomas common?

No, they aren’t. According to the American Cancer Society, about 89,000 people in the U.S. will receive a lymphoma diagnosis in 2023. T-cell lymphomas account for 10% of all lymphomas, or about 8,000 people annually.

What’s the difference between B-cell lymphoma and T-cell lymphoma?

B-cell lymphoma and T-cell lymphoma affect different lymphocytes. B-cell lymphoma is more common than T-cell lymphoma.

A note from Cleveland Clinic

Cancer is complicated, particularly if you have a rare cancer such as T-cell lymphoma. You may have questions and wonder where you can turn for information about the condition. Don’t be afraid to ask your healthcare team for help in understanding your diagnosis. They’re your best source of information, including what you can expect from cancer treatment.