Stage IV Lymphoma

Written by Treacy Colbert | Published on April 30, 2013
Medically Reviewed by George T. Krucik, MD, MBA on April 30, 2013

If you or a loved one has been diagnosed with stage IV lymphoma, you likely have a lot of questions about treatment, prognosis, and more. Learn more about this condition in this slideshow.

Fight Fear with Knowledge

The words “stage IV lymphoma” may strike you with fear because no stage V exists. Before you assume the worst, you need to know that stage IV lymphoma may be curable, depending on the type of the disease.

Read more to learn key details about lymphoma subtypes, as well as treatment and prognosis for stage IV lymphoma.

Lymphoma Facts

Lymphoma is not just one disease. The term refers to a group of blood cancers that develop in the lymphatic system. There are two main types:

  • Hodgkin lymphoma, a highly curable form
  • non-Hodgkin lymphoma (NHL)

According to 2011 Leukemia & Lymphoma Society data, there were roughly 159,846 people with living with Hodgkin lymphoma or in remission, and approximately 502,943 people with NHL.

Aggressive and Indolent NHL

There are approximately 60 subtypes of NHL, categorized as either B-cell type—which 85 percent of people with lymphoma have, according to the Leukemia and Lymphoma Society—and T-cell type, which 15 percent of people with lymphoma have.

The multiple subtypes of NHL are further categorized as aggressive and indolent. As the name implies, aggressive NHL progresses rapidly. Approximately 60 percent of people with NHL have aggressive cases, the most common subtype of which is diffuse large B-cell lymphoma (DLBCL).

Roughly 40 percent of people with NHL have indolent NHL, which is slow-growing. Follicular lymphoma is the most common subtype of slow-growing lymphoma.

Stage IV Means Different Things

Stage IV Hodgkin lymphoma is characterized by affecting the lymph nodes both above and below the diaphragm, and cancer cells elsewhere in the body, in a lung, or in the liver or bone.

The description of Stage IV NHL differs. When this type of lymphoma spreads to one or more organs other than the lymph nodes and possibly one or more lymph node areas in the body, it is considered Stage IV.

Stage IV Symptoms

Hodgkin and non-Hodgkin lymphoma have similar symptoms. Stage IV symptoms depend on the type and extent of the cancer, and may include these indications:

  • worsening fatigue
  • night sweats
  • recurrent high- or low-grade fevers
  • weight loss
  • bone pain if the bone marrow is involved in Hodgkin lymphoma
  • chest pain, shortness of breath, or coughing if lymphomas press on the trachea, or superior vena cava, the large vein that transports blood from the arms and head to the heart
  • loss of appetite, abdominal pain or swelling, nausea, vomiting, and constipation if lymphoma causes fluid buildup in the abdomen, enlarges the spleen, or perforates the intestinal wall
  • itching

Hodgkin Lymphoma Stage IV Treatment

Chemotherapy regimens for stage IV Hodgkin lymphoma may include:

  • six or more cycles of ABVD, which includes the drugs doxorubicin, bleomycin, vinblastine, and dacarbazine
  • 12 weeks of the Stanford V protocol, a combination of the drugs mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, and etoposide, followed by radiation
  • the BEACOPP regimen, if the prognosis is unfavorable, which uses bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone

When stage IV Hodgkin lymphoma doesn’t respond to treatment, other drug combinations, higher doses, or a stem cell transplant may be considered. The monoclonal antibody brentuximab vedotin is a possible choice when other treatment methods fail.

NHL Stage IV Treatment

Stage IV treatment for DBLCL involves chemotherapy, frequently a regimen called R-CHOP. R-CHOP stands for the chemotherapy drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, with the addition of rituximab, a monoclonal antibody. Treatment usually lasts about six months.

Treatment for the slow-growing follicular lymphoma often begins with rituximab, with either a single chemotherapy drug such as bendamustine or fludarabine, or a combination of drugs like CHOP. Monoclonal antibodies (ibritumomab and tositumomab) may be used as second-line therapy in advanced follicular lymphoma.


The news is encouraging for people with Stage IV Hodgkin lymphoma. According to the American Cancer Society (ACS), the five-year survival rate is 65 percent.

The survival rate for Stage IV NHL depends on a variety of factors, such as:

  • the type of NHL and its extent
  • your age
  • your ability to handle daily living activities
  • your blood level of lactate dehydrogenase, which rises as fast-growing lymphoma progresses

The prognosis for slow-growing lymphoma looks at slightly different factors, one of which is hemoglobin level.

Seek Support, Take Heart

Living with Stage IV cancer of any kind requires support. Reach out to the Leukemia & Lymphoma Society for email, phone, or live chat support, or to find a support group in your area. You may want to consider participating in a clinical trial that is studying new therapies for Stage IV lymphoma.

The National Cancer Institute maintains a database that allows you to search for a trial in your area targeting stage IV lymphoma patients, and classified by subtype.

Lymphoma treatments—and survival—continue to improve. Fifty years ago, the five-year relative survival rate for NHL was only 31 percent for whites. Measured for all races from 2001 to 2007, it climbed to 69.5 percent.

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