Who Gets Non-Hodgkin Lymphoma? A Look at Causes and Risk Factors

Lymphoma is a cancer of the lymphatic system, which is part of the immune system. It involves white blood cells (lymphocytes) that normally help fight off infections. 

There are two main types of lymphoma — Hodgkin and non-Hodgkin lymphoma. Non-Hodgkin lymphoma includes lymphomas that affect specific immune cells, like T cells and B cells. Here we will talk about who gets non-Hodgkin lymphoma and what the risk factors are. 

What causes non-Hodgkin lymphoma? 

Non-Hodgkin lymphoma develops when the white blood cells that make up your immune system start to grow and divide faster than normal. Non-Hodgkin lymphoma can be indolent (slow growing) or aggressive (fast growing). 

Lymphoma usually starts when the DNA inside the white blood cell changes (mutates). DNA mutations are complex, and it’s not always clear how or why it happens. But when specific mutations happen, they cause rapid, unchecked growth that leads to the lymphoma. 

What are the risk factors for non-Hodgkin lymphoma? 

There are several risk factors that increase someone’s chances of developing non-Hodgkin lymphoma. Here are the eight most common. 

1. Age

Getting older is a risk factor for almost all cancers, including lymphoma. Of all non-Hodgkin lymphoma cases, 1 in 3 occur in people over the age of 75. But some non-Hodgkin lymphoma subtypes are more common in younger people, like diffuse large B-cell lymphoma. 

2. Sex

Non-Hodgkin lymphoma is more common in men than women. There’s a 30% lower chance of non-Hodgkin lymphoma in women. 

3. Race and geography

In the U.S., non-Hodgkin lymphoma is more common in white people. And worldwide, rates of non-Hodgkin lymphoma are highest in Europe and the U.S. 

4. Medical conditions that weaken the immune system

A weakened immune system can increase the risk of non-Hodgkin lymphoma. Some specific immune conditions commonly linked to non-Hodgkin lymphoma are:

• Autoimmune disorders: Examples include lupus, rheumatoid arthritis, and Sjögren’s. In autoimmune disorders, your immune system is on overdrive. This means your white blood cells are dividing more often, which can increase the chance of a mutation. 

• Inherited immune disorders: Examples include hypogammaglobulinemia, ataxia-telangiectasia, and Wiskott-Aldrich syndrome. These syndromes make it harder for the immune system to work, causing an increase in things like infections and cancer.

• Celiac disease: This is a reaction to gluten-containing foods. It causes inflammation of the intestines. And chronic inflammation can put a stress on the immune system.

5. A weak immune system from a medical treatment

A weak immune system raises the risk of developing non-Hodgkin lymphoma. This is true even if a medical treatment is the cause. 

For example, after organ transplants, people have to take strong immunosuppressant drugs to prevent the body from attacking the new organ. This increases the chance of developing non-Hodgkin lymphoma. 

There’s also an increased risk years after chemotherapy or radiation treatment for another cancer. Being treated with both chemotherapy and radiation increases the risk even more. 

6. Viruses 

Some viral infections have been linked to different types of non-Hodgkin lymphoma: 

• HIV weakens the immune system, increasing the risk of several types of cancer, including different types of lymphoma. 

• Epstein Barr virus (EBV) increases the chance of several types of non-Hodgkin lymphoma, especially Burkitt lymphoma. EBV is in the family of herpes viruses. It typically causes a mild illness in childhood. 

• Human T-lymphotropic virus type I (HTLV-1) increases the chances of T-cell lymphomas, a subtype of non-Hodgkin lymphoma. This virus spreads through direct contact with bodily fluids, like blood and semen.

• Human herpesvirus 8 (HHV-8) can directly infect lymphocytes, causing primary effusion lymphoma, a type of non-Hodgkin lymphoma. Although this virus is in the herpes family, it’s different from the herpes that infects the mouth and genitals. 

7. Bacteria 

Just like viruses, certain bacteria have a higher chance of being linked to non-Hodgkin lymphoma: 

• Helicobator pylori typically causes ulcers in the stomach. It has also been linked to MALT lymphoma, a type of non-Hodgkin lymphoma in the stomach.

• Chlamydophila psittaci usually causes lung infections, but it has also been linked to MALT lymphoma around the eyes.

• Campylobacter jejuni is a bacteria that can cause food poisoning. It can cause MALT lymphoma in the small intestines. Scientists are still figuring out how common this association is. But developing lymphoma after a single infection seems unlikely.

8. Chemical exposures

There’s a concern that chemicals — like benzene and some pesticides — are linked to the development of non-Hodgkin lymphoma. Research is ongoing to figure out if the chemicals themselves cause the lymphoma. 

But researchers do know that people with exposure to these chemicals have a higher chance of developing lymphoma. For example, people with exposure to herbicides and pesticides have a 30% increased chance of developing lymphoma. 

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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