What Is T-Cell Lymphoma?

The specific treatment course and prognosis for T-cell lymphoma depends on the subtype — of which there are many — and how advanced the cancer is.

• Hodgkin lymphoma (formerly Hodgkin disease)
• non-Hodgkin lymphoma

Hodgkin lymphoma involves a type of cancer cell called Reed-Sternberg cells. Unlike Hodgkin lymphoma, the non-Hodgkin varieties look different under the microscope and don’t contain Reed-Sternberg cells. T-cell lymphoma is a type of non-Hodgkin lymphoma.

Types of T-Cell Lymphoma

• Cutaneous T-cell lymphoma
• Peripheral T-cell lymphoma

Given its many different subtypes, T-cell lymphoma can present with a wide range of signs and symptoms, and its manifestations may vary from person to person. For instance, the first signs of a type of T-cell lymphoma called mycosis fungoides is often a skin rash, while other forms may present with swollen lymph nodes.

• Red rash that may look like a sunburn and is intensely itchy
• Round scaly patches of skin that may be raised
• Light or white patches of skin
• Thick, raised plaques
• Skin lesions, including ulcers or nodules, that may break open
• Skin tumors that may be bluish or reddish brown
• Changes to nails and hair, including hair loss
• Thickened skin on the palms of hands and soles of feet
• Skin peeling
• Insomnia (from itching)

• Swollen lymph nodes, particularly in the neck, armpit, or groin
• Fever or chills
• Unexplained fatigue
• Unexplained weight loss
• Night sweats
• Respiratory issues such as coughing, shortness of breath, or chest pain
• Gastrointestinal symptoms such as abdominal pain, nausea, vomiting, constipation, or diarrhea
• Frequent urination
• Enlarged liver or spleen
• Bleeding or bruising easily
• Recurrent infections

• Headaches
• Concentration problems
• Personality changes
• Seizures

• Are age 55 or older
• Are male or assigned male at birth
• Are white or Asian
• Have a weakened immune system due to conditions like HIV/AIDS or immunosuppressive therapies following organ transplantation
• Have a family history of lymphoma or other blood cancers
• Have prolonged exposure to carcinogens such as ultraviolet light, chemicals, pesticides, or environmental toxins
• Have certain viral infections, such as Epstein-Barr virus and HTLV-1 (human T-lymphotropic virus 1)
• Have certain autoimmune diseases, such as celiac disease

• Blood tests to evaluate the number and types of blood cells, and to assess organ function and overall health
• Peripheral blood smear, an examination of blood cells and platelets under the microscope

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• CT, PET, or MRI scans to identify enlarged lymph nodes or organs affected by lymphoma and areas with abnormal cell growth
• Biopsy of any enlarged lymph nodes or involved skin (to confirm lymphoma and determine its subtype)
• Immunophenotyping, a lab test that helps diagnose specific lymphoma types

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• Bone marrow aspiration (a procedure that removes a small sample of bone marrow) and biopsy to determine if the disease has spread to the bone marrow
• Flow cytometry, a test used to identify specific types of lymphoma cells
• Collection and testing of cerebrospinal fluid to determine if the lymphoma has spread to the central nervous system
• Tests for various viruses including HIV, HTLV-1, and Epstein-Barr virus

Your healthcare provider may also run tests to identify specific genetic mutations or molecular markers to further characterize the lymphoma and guide treatment decisions.

During diagnosis, your healthcare provider will also determine the stage of your disease, which is crucial for developing an effective treatment plan.

Stages of T-Cell Lymphoma

• Stage 1 The cancer is limited to a single lymph node region or a single lymphoid organ, which includes the thymus, spleen, and bone marrow.
• Stage 2 The cancer involves two or more lymph node regions on the same side of the diaphragm, a major breathing muscle located below the lungs.
• Stage 3 The cancer involves lymph node regions on both sides of the diaphragm, above or below it, or your spleen.
• Stage 4 The cancer has spread to organs beyond the lymphatic system, such as the liver, lungs, or bone marrow.

• Stage 1A Limited patches, papules, or plaques covering less than 10 percent of the skin surface. No tumors are present, and lymph nodes, blood, and internal organs are not involved.
• Stage 1B Same as stage 1A but skin issues cover more than 10 percent of the skin surface.
• Stage 2A Lymph nodes are abnormal but not cancerous.
• Stage 2B One or more tumors 1 centimeter or larger develops on the skin. Lymph nodes are not cancerous.
• Stage 3 At least 80 percent of the skin surface is reddened and covered with patches, papules, plaques, or tumors.
• Stage 4A There is a high number of Sézary cells, or cancerous T-cells, in the blood.
• Stage 4A2 There may be a high number of Sézary cells in the blood, and the lymph nodes are very abnormal or have developed cancer.
• Stage 4B The cancer has spread to other organs, such as the spleen or liver.

Options for treatment cover a wide range of medications, procedures, and therapies.

Medication Options

Medication options may include:

• Topical corticosteroids, like clobetasol propionate

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• Retinoids (drugs related to vitamin A), like bexarotene

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   in the form of creams, gels, and ointments to help control redness and itchiness
• Topical chemotherapy drugs like mechlorethamine

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• Intravenous chemotherapy drugs like doxorubicin (Adriamycin) and pralatrexate (Folotyn)

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• Antiviral drugs such as zidovudine (Retrovir), if there is a viral infection

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• Immunotherapy medications that stimulate or boost the body's immune system to recognize and attack cancer cells, including alemtuzumab (Campath, Lemtrada) and denileukin diftitox (Ontak), imiquimod (Zyclara), and pembrolizumab (Keytruda)
• Targeted therapy medications that focus on specific molecular changes or proteins in or on cancer cells

Surgery

• Tumor resection to remove tumors
• Stem cell transplantation,  a procedure to replace damaged bone marrow cells with stem cells (immature blood cells), which may require general anesthesia

Other Treatments and Procedures

• Extracorporeal photopheresis, a procedure in which your blood is removed and treated with UV lights and light-activated drugs before being returned to your body
• Radiation therapy to eliminate cancer cells, particularly when the disease is localized
• Phototherapy, or using ultraviolet (UV) light to kill cancer cells in the skin

Lifestyle Approaches

While T-cell lymphoma requires thorough medical treatment, there are things you can do to encourage positive treatment outcomes.

These include:

• Light exercise to maintain physical strength and reduce fatigue
• A nutrient-rich diet of lean meats, fruits, and vegetables, especially cruciferous vegetables like broccoli and cauliflower

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• Palliative care for emotional and psychological support
• Complementary therapies for symptom relief with the support of your doctor

• Use mild, unscented soaps to prevent skin irritation.
• Keep skin moisturized to prevent itching and infection.
• Discuss bleach baths with your healthcare provider to reduce infection.

Clinical Trials

Researchers may be testing new therapies to help with conditions like T-cell lymphoma. If you're interested in participating in a clinical trial, speak with your doctor or visit ClinicalTrials.gov to search for studies in your area.

• Routine health checkups and screenings to aid in the early detection of lymphoma.
• Awareness of potential symptoms, and medical advice for persistent issues
• A healthy weight, physical activity, and a healthy diet
• Minimal exposure to environmental challenges, such as certain chemicals or pollutants
• Avoidance of risk factors for HIV (which increases the risk of T-cell lymphoma) and HTLV-1, including intravenous drug use and unprotected sex

Survival rates can be influenced by:

• Subtype: Different subtypes have distinct prognoses, with some being more responsive to treatment than others.
• Stage at diagnosis: Early-stage T-cell lymphomas often have a more favorable prognosis than those diagnosed at an advanced stage.
• Age and overall health: Younger patients and those in good overall health may respond better to treatment.
• Response to treatment: How well the cancer responds to initial treatment can significantly influence the prognosis.

It's crucial for you to discuss prognosis and potential treatment outcomes with your healthcare provider, as individual cases can vary widely.

• Other non-Hodgkin lymphomas, like B-cell lymphoma
• Skin conditions mimicking cutaneous T-cell lymphoma, like psoriasis and eczema

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• Autoimmune disorders like hemophagocytic syndrome
• Leukemia
• Some extracutaneous lymphomas, like systemic T-cell lymphoma

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T-cell lymphoma may present as inflammatory skin diseases like psoriasis or dermatitis in the early stages, sometimes making diagnosis more complicated.

People with T-cell lymphoma can support each other and share effective ways to manage the disease. One of these organizations may offer the resources you need.

Leukemia & Lymphoma Society (LLS)

LLS is the largest nonprofit dedicated to curing blood cancers, including leukemia, lymphoma, Hodgkin’s disease, and myeloma. It provides patient education, offers financial assistance, and advocates for policies to improve access to care and encourage treatment development.

Lymphoma Research Foundation (LRF)

The Lymphoma Research Foundation is the largest U.S. nonprofit focused exclusively on lymphoma. It funds innovative research to advance treatments and cures while providing education, support services, and resources for patients and caregivers. LRF also connects people with lymphoma through its peer-to-peer Lymphoma Support Network.

CancerCare

CancerCare is a national nonprofit offering free professional support services for individuals affected by cancer, including counseling, support groups, educational workshops, and financial assistance.

The T-Cell Leukemia & Lymphoma Foundation (TCLLF)

The TCLLF supports patients with rare T-cell cancers by funding research, hosting educational forums, promoting clinical trial participation, and raising awareness about these rare diseases.

• T-cell lymphoma is a rare cancer that affects the lymphatic system.
• It develops from the abnormal multiplication of T cells, a type of white blood cell.
• Treatment and prognosis for T-cell lymphoma depends on the subtype and how far the cancer has progressed.
• The overall five-year relative survival rate for non-Hodgkin lymphomas like T-cell is 74.3 percent.

Additional reporting by Crystal Hoshaw.