What is anaplastic large cell lymphoma?

Anaplastic large cell lymphoma (ALCL) is a rare type of blood cancer.

ALCL develops when blood cells called lymphocytes become abnormal. It can develop in different ways:

Systemic ALCL starts in a lymph node but may affect other areas of the body.
Breast implant ALCL starts in the tissue around a breast implant. It is also called breast implant-associated ALCL or BIA ALCL. It is very rare. Although it is a cancer that develops in the breast, it is lymphoma rather than breast cancer.

ALCL is a T-cell lymphoma. It is a type of lymphoma called non-Hodgkin lymphoma. You can find out more about this in our information about types of non-Hodgkin lymphoma.

ALCL can also develop in the skin. You can find out more about this in our information about primary cutaneous (skin) lymphoma.

Related pages

Booklets and resources

ALCL in children and teenagers

Lymphoma is more common in people who are over 50. But it can develop at any age. This information is about ALCL in adults.

We have information for teenagers and young adults about finding support. If you need information about lymphoma in children, the following charities may help:

Symptoms of ALCL

ALCL may cause a painless swelling or lump in the neck, armpit or at the top of the leg (groin). This is caused by a build-up of abnormal cells in the lymph nodes.

ALCL may also affect parts of the body other than the lymph nodes. The symptoms depend on the area affected. We have more details about possible lymphoma symptoms.

B symptoms

ALCL may also cause the following 3 symptoms:

drenching night sweats
unexplained high temperatures
unexplained weight loss.

These are called B symptoms. Along with staging and grading (below), B symptoms can help your cancer team understand:

how the lymphoma might develop
which treatments might help.

Breast symptoms and BIA ALCL

Lymphoma caused by a breast implant is called breast implant-associated ALCL (BIA ALCL). Changes usually happen around the implant. You may notice one or more of the following changes to your breast:

a build-up of fluid – this can cause swelling or make one breast a different shape or size to the other
pain
a lump
skin changes or a rash.

Skin over the implant may be itchy. It may appear red if you have white skin, or darker if you have black or brown skin. This is a less common symptom.

Most cases of BIA ALCL develop 8 to 10 years after an implant is placed and are linked to breast implants with a rough textured surface. It is always important to be aware of any breast or chest changes. These may be early stage BIA ALCL symptoms.

If you have had any type of breast implant surgery and develop any symptoms that are new, ongoing or unusual for you, contact your GP straight away.

Worried about symptoms?

A change in how you feel or how your body works can be caused by conditions other than ALCL. But always ask your GP to check any ongoing, new or unexplained symptoms.

We are also here if you need someone to talk to. You can:

call the Macmillan Support Line for free on 0808 808 00 00, 7 days a week, 8am to 8pm.
chat to our specialists online.

Related pages

Do I have cancer?

Causes of ALCL

The causes of systemic ALCL are mostly unknown.

Breast implant-associated ALCL (BIA ALCL) is caused by breast implants with a rough textured surface. But it is important to remember that most people with a textured implant do not develop ALCL. So far, no cases in the UK have been linked to implants with a smooth surface.

There may also be other factors that make some people more likely to develop BIA ALCL. You can find more information about BIA ALCL on the GOV.UK website.

Like other cancers, ALCL is not infectious. You cannot spread it to other people. We have more general information about causes and risk factors of non-Hodgkin lymphoma.

Diagnosis of ALCL

If you have symptoms that worry you, you should begin by going to your GP. They will examine you. If they think cancer may be causing your symptoms, they will refer you to a specialist doctor at a hospital.

At the hospital, the doctor will ask about any symptoms, your general health and any illnesses you have had. They will also examine you.

The most important test for diagnosing ALCL is a biopsy. This means testing a small piece of tissue or a sample of cells from an affected area of your body.

Find out more about having a biopsy and other tests in our general lymphoma information.

If you have breast symptoms, you may have the following tests:

Waiting for test results

Waiting for test results can be a difficult time. It may take up to 2 weeks for the results to be ready.

You may find it helpful to talk to family members or a close friend. Your specialist nurse can also provide support.

You can talk to one of our cancer support specialists for free on 0808 808 0000, 7 days a week, 8am to 8pm.

Related pages

Booklets and resources

Staging and grading of ALCL

Your test results give your cancer team more information about the lymphoma. This includes:

The stage

Staging describes how many areas of the body are affected by lymphoma and where these areas are.
The grade

Grading describes how quickly the lymphoma cells are likely to grow.

Systemic ALCL is a high grade lymphoma. High grade lymphoma grows more quickly and needs urgent treatment.

Breast implant ALCL is also described as high grade lymphoma. But it usually behaves differently from systemic ALCL. BIA ALCL usually only affects the breast and is found when fluid has built up around the implant. This means surgery may be the only treatment you need. Sometimes the lymphoma cells spread to nearby tissues. Rarely they spread to other areas of the body.

There are 2 main subtypes of ALCL:

ALK positive (ALK+)

This is when the lymphoma cells have a protein called anaplastic lymphoma kinase (ALK). ALK+ ALCL is more common in children and young adults. It tends to have a better outlook than ALK- ALCL.
ALK negative (ALK-)

This is when the lymphoma cells do not have the ALK protein.

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

We have more information about staging and grading non-Hodgkin lymphoma.

Treatment for ALCL

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

After the MDT meeting, you will usually meet with your cancer doctor and specialist nurse. They will explain the different treatment options and possible side effects. They will also talk to you about things to consider when making treatment decisions.

Your treatment options will depend on:

the stage of the lymphoma
whether the lymphoma is ALK positive (ALK+) or ALK negative (ALK-)
your general health
your preferences.

You may only need one type of treatment. Or you may need a combination of treatments.

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

The following treatments are used to treat ALCL:

Cancer drug treatments
Treatment for systemic ALCL usually involves a combination of chemotherapy, steroids and targeted therapy drugs.

The most common treatment is called BV-CHP. This is a combination of:

2 chemotherapy drugs, called cyclophosphamide and doxorubicin

a targeted therapy drug called brentuximab vedotin

a steroid called prednisolone.

You usually have a course of 6 cycles of treatment over a few months. The aim is to make the lymphoma disappear completely. This is called complete remission.

More intensive combinations of drugs may be used to treat young adults and children with ALCL. This may mean longer stays in hospital.
Radiotherapy

Radiotherapy uses high-energy rays called radiation to treat cancer. It destroys cancer cells in the area you have it.

Some people have radiotherapy after cancer drug treatment 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 to treat ALCL. But they are intensive treatments, so they are not suitable for everyone.

Your cancer team may talk to you about this option to:

reduce your risk of ALCL coming back

treat ALCL that has not responded to other treatments

treat ALCL that has come back after other treatments.

ALCL usually responds well to cancer drugs, and treatment may make it disappear. This is called remission. If treatment is not effective or the lymphoma comes back, you may have more cancer drug treatments or a stem cell transplant.

Treating breast implant-associated ALCL

ALCL around a breast implant is usually treated with surgery. A surgeon will remove the implant and the capsule around it containing any fluid. Surgery may be the only treatment you need to cure the lymphoma.

You may need cancer drug treatments and radiotherapy:

if the lymphoma had started to spread to other areas
to reduce the risk of lymphoma coming back.

Related pages

After ALCL treatment

Follow-up after treatment for ALCL

You will have regular check-ups during and after your treatment. Your cancer doctor or specialist nurse will explain what to expect.

Follow-up appointments are a good time for you to talk to your cancer doctor or specialist nurse about any concerns you have. Tell them as soon as possible if you have any problems or notice new symptoms between appointments. We have more information about follow-up care after treatment.

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

Wellbeing and recovery

Looking after yourself can help speed up your recovery after ALCL treatment. Even small lifestyle changes may improve your wellbeing and long term health.

Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.

Related pages

Support for people with ALCL

People often have many different feelings during and after ALCL treatment. If you have finished treatment, you may feel relieved it has ended but worried about what might happen in the future.

It is important to know where to get support or information if you need it. People often need support even some time after ALCL treatment. But sometimes it is difficult to know who to ask for help.

You can:

ask your GP or someone from your cancer team for advice about support in your area
find cancer support services near you
call the Macmillan Support Line for free on 0808 808 00 00.
chat to our cancer information specialists online.
visit our non-Hodgkin lymphoma forum to talk to people who have been affected by lymphoma, share your experience, and ask your questions.

You may also find the HOPE programme helpful. The programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer. Topics include goal setting, fatigue management, and wellbeing.

You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk

Other organisations who offer information and support

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

Lymphoma Action provides high quality information and support for people affected by lymphoma. It provides helpline services and a range of peer support including online support meetings, educational events and webinars. Its website includes TrialsLink, a database of lymphoma clinical trials.

More information and advice

We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:

References

Below is a sample of the sources used in our lymphoma information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk

Cwynarski K, Marzolini MAV, Barrington SF, et al. The management of primary mediastinal B-cell lymphoma: a British Society for Haematology Good Practice Paper. Br J Haematol. 2019;185:402-9.

Eyre TA, Bishton MJ, McCulloch R, et al. Diagnosis and management of mantle cell lymphoma: A British Society for Haematology Guideline. Br J Haematol. 2024;204(1):108–26.

Ferreri AJM, Illerhaus G, Doorduijn K, et al., on behalf of the EHA and ESMO Guidelines Committees. Primary central nervous system lymphomas: EHA–ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(6):491-507.

Fox CP, Ahearne MJ, Pettengell R, et al. Guidelines for the management of mature T- and natural killer-cell lymphomas (excluding cutaneous T-cell lymphoma): a British Society for Haematology Guideline. Br J Haematol. 2022;196:507-22.

Fox CP, Chaganti S, McIlroy G, et al. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol. 2024;204(4):1178–92.

McNamara C, Montoto S, Eyre TA, et al. The investigation and management of follicular lymphoma. Br J Haematol. 2020;191:363-81.

Pratt G, El-Sharkawi D, Kothari J, et al. Diagnosis and management of Waldenström macroglobulinaemia—A British Society for Haematology guideline. Br J Haematol. 2022;197:171–87.

Walewska R, Eyre TA, Barrington S, et al. Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline. Br J Haematol. 2024;204(1):86–107.

Cancer Information Development team

Author

Professor Chris Fox

Reviewer

Consultant Haematologist

Nottingham University Hospitals NHS Trust

Date reviewed

Reviewed: 01 February 2025

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Next review: 01 February 2028

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.