What is anaplastic large cell lymphoma (ALCL)?

Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL). It develops when T-cells become abnormal (cancerous). T-cells are white blood cells that normally help fight infection. They are sometimes called T-lymphocytes.

The abnormal T-cells (lymphoma cells) usually build up in lymph nodes, but they can affect other parts of the body.

People with ALCL are divided into 2 groups depending on whether the lymphoma cells have a protein called anaplastic lymphoma kinase (ALK). These are:

  • ALK-positive
    This is where the lymphoma cells have the ALK protein. This type is more likely to affect children and young adults. It is more common in males than females.
  • ALK-negative
    This is where the lymphoma cells do not have the ALK protein. This type is more common in older adults.

These types of ALCL develop quickly. Treatment is usually started soon after diagnosis.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare type of ALCL. It can develop in the breasts of people who have had breast implants. BIA-ALCL usually develops about 7 to 10 years after implant surgery but can sometimes happen earlier.

Although BIA-ALCL develops in the breast, it is not a type of breast cancer. BIA-ALCL is usually slow-growing.

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Symptoms of anaplastic large cell lymphoma (ALCL)

Painless swelling in neck, armpit or groin

Painless swelling in the neck, armpit or groin is the most common sign of anaplastic large cell lymphoma (ALCL). It is caused by lymphoma cells building up in the lymph nodes, which makes them bigger.

B symptoms

Some people also have symptoms that doctors call B symptoms. These can include:

  • drenching night sweats which require a change of nightwear and bed covers
  • high temperatures (fevers) with no obvious cause
  • unexplained weight loss.

Knowing if you have any B symptoms will help your doctor to stage the lymphoma and plan your treatment.

Other symptoms

ALCL may also affect parts of the body outside the lymph nodes. This is called extranodal disease. Symptoms depend on the area affected.

General symptoms of ALCL may include loss of appetite and tiredness.

Symptoms of breast implant-associated ALCL

The main symptoms of breast implant-associated ALCL are a build-up of fluid and pain in the area of the implant. There may also be a lump close to the implant.

Diagnosis of anaplastic large cell lymphoma (ALCL)

The most common test for diagnosing lymphoma is a biopsy. A doctor will take a sample of tissue from the affected area. The most common place to take a biopsy from is an enlarged lymph node. This is called a lymph node biopsy. You may have all or a part of the lymph node removed. The tissue will be sent to a laboratory for testing. You may also have biopsies taken from other areas of your body.

You can find out more about further tests you may have in our information about non-Hodgkin lymphoma.

Waiting for test results can be difficult. You may find it helpful to talk to your family, friends or specialist nurse.

The stages and grades of anaplastic large cell lymphoma (ALCL)

Your test results will help your doctors find out how many areas of your body are affected by lymphoma and where these areas are. This is called staging.

Lymphomas are also grouped as either low-grade or high-grade. Low-grade lymphomas are usually slow growing. High-grade lymphomas usually grow more quickly. Anaplastic large cell lymphoma (ALCL) is a high-grade lymphoma and normally develops quickly.

Breast implant-associated ALCL is usually diagnosed at an early stage. It is a low-grade lymphoma.

Knowing the stage and grade of the lymphoma helps your doctor plan the right treatment for you.

We have more information about the stages and grades of non-Hodgkin lymphoma.

Treatment for anaplastic large cell lymphoma (ALCL)

A team of specialists will meet to discuss the best possible treatment for you. They are called a multidisciplinary team (MDT).

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects to you. They will also talk to you about things to consider when making treatment decisions.

Your treatment may depend on:

  • the stage of the lymphoma
  • your general health
  • if the lymphoma is ALK-positive or ALK-negative.

You may have some treatments as part of a clinical trial.

Treatments for anaplastic large cell lymphoma ALCL may include:

  • Chemotherapy

    Chemotherapy is an important treatment for ALCL and can often get the lymphoma into remission. The most common drug treatment used is called CHOP. More intensive combinations of drugs may be used to treat young adults and children with ALCL. This may mean longer stays in hospital.

  • Steroids

    Steroids are drugs that are often given with chemotherapy to treat lymphomas. They help make chemotherapy more effective.

  • Targeted therapy

    Targeted therapies are drugs that use unique features of the cancer to find and treat cancer cells.

    Brentuximab vedotin is a targeted therapy that may be given with chemotherapy called CHP as a first treatment for ALCL. This combination is called BV-CHP and includes the drugs:

    Brentuximab vedotin may also be used if there are still signs of ALCL after treatment, or if it comes back.

  • Radiotherapy

    Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. Some people have radiotherapy after chemotherapy to treat an area of lymphoma. This can treat any remaining lymphoma cells in the area. It can also reduce the risk of lymphoma coming back in that area.

  • Stem cell transplants

    Stem cell transplants are sometimes used if there are still signs of ALCL or it comes back after other treatments. Stem cell transplants are intensive treatments, so it is not suitable for everyone. You may have a transplant:

ALCL usually responds well to chemotherapy, and treatment may make it disappear. This is called remission. There is a risk that the lymphoma may come back in the future. This is called a recurrence or relapse. If this happens chemotherapy and stem cell transplants can be used to try and control it.

We have more information about treating lymphoma that has come back.

Treating breast implant-associated ALCL

Breast implant-associated-ALCL is usually treated with surgery. The implant and any fluid or lumps will be removed. This is often the only treatment that is needed. Sometimes, chemotherapy and radiotherapy may also be given.

After anaplastic large cell lymphoma (ALCL) treatment

You will have regular follow-up appointments after your treatment. You can talk to your doctor or nurse about any concerns you may have at these appointments. Your doctor will want to know how you are feeling, and to check you are recovering from any side effects of treatment.

Late effects

Sometimes side effects may continue or develop months or years after treatment. These are called late effects. We have more information about long-term and late effects of treatment for lymphoma.

Sex life and fertility

Cancer and its treatment can sometimes affect your sex life. There ways to improve your sexual well-being and to manage any problems.

Treatment for lymphoma may affect your fertility. If you are worried about your fertility it is important to talk with your doctor before you start treatment. We have more information about:

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

Getting support

Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.

Macmillan is also here to support you. If you would like to talk, you can:

The organisations below also offer information and support:

  • Blood Cancer UK

    Blood Cancer UK offers support and information to people affected by blood cancers, including lymphoma.

  • Lymphoma Action

    Lymphoma Action gives emotional support, advice and information for people with Hodgkin lymphoma or non-Hodgkin lymphoma and those close to them. It has a national network of people with lymphoma, as well as local groups. Their website has a section called trialslink where you can see information about lymphoma clinical trials.

About our information

  • References

    Below is a sample of the sources used in our anaplastic large cell lymphoma (ALCL) information. If you would like more information about the sources we use, please contact us at  cancerinformationteam@macmillan.org.uk 

    National Institute of Health and Care Excellence (NICE). Blood and bone marrow cancers. NICE Pathways. Last accessed 3 December 2020.

    National Institute of Health and Care Excellence (NICE). Brentuximab vedotin for treating relapsed or refractory systemic anaplastic large cell lymphoma. Technology appraisal guidance (TA641). Published 12 August 2020. Last accessed 3 December 2020. Available from: nice.org.uk/guidance/ta641.

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Reviewed: 01 March 2021
Reviewed: 01/03/2021
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Next review: 01 March 2024
Next review: 01/03/2024