Non-Hodgkin’s lymphoma subtypes: list, diagnosis and perspectives

Non-Hodgkin’s lymphoma is a common type of blood cancer with several subtypes that require different treatment and have different outlooks.

Non-Hodgkin’s lymphoma (NHL), sometimes just called lymphoma, is a type of cancer that starts in the immune system’s lymphocytes, which are white blood cells. NHL is not just one cancer. Instead, it is a term for several different types of cancer that share similar characteristics.

To obtain appropriate treatment, a person needs to know their NHL subtype. Each subtype may have different treatment options and outlooks for the person.

This article reviews the different NHL subtypes, diagnosis, and outlook.

Learn more about the NHL here.

Aggressive NHLs grow and spread rapidly. They usually require prompt treatment to prevent them from spreading. The most common type of the aggressive NHL in the United States is diffuse large B-cell lymphoma (DLBCL).

Treatment for aggressive NHL can cure the cancer in some cases. Treatment often includes drug chemotherapy and radiation therapy combined.

With combination drug chemotherapy, doctors use different combinations of chemotherapy drugs. One of the most common is known as R-CHOP. The combination understand rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisone.

Radiation therapy is where doctors use radiation to kill cancer cells and shrink tumors.

Learn more about radiation therapy here.

Indolent NHL refers to lymphoma subtypes that grow and spread slowly. Some indolent lymphomas will not require treatment and doctors will recommend a “watch and wait” approach. Follicular lymphoma is the most common type of indolent lymphoma in the United States

Treatments for indolent types of NHL can vary depending on factors such as:

  • the stage of the cancer
  • a person’s age
  • outlook factors, such as overall health

Treatments can vary in intensity and by exact subtype. For example, cutaneous T-cell lymphoma can include topical treatments as well as chemotherapy.

There are several subtypes of NHL. The aggressive NHL represents approximately 60% of all cases, and indolent NHL accounts for 40%.

However, the American Cancer Society notes that the number of NHL subtypes is high, making it difficult for doctors to categorize them. The most recent classification system comes from the World Health Organization (WHO).

The WHO system breaks down NHL subtypes into:

  • what they look like under the microscope
  • the type of lymphocyte in which the cancer started
  • presence of certain proteins on the surface of cancer cells
  • characteristics of cancer cell chromosomes

B cell lymphomas vs T cell lymphomas

The lymphatic system contains two main types lymphocytes, a type of white blood cell that helps fight infection. Lymphoma can start in either type of lymphocyte or cell.

  • B lymphocytes or B cells: B cells make antibodies that attach to harmful bacteria or viruses. This marks them for destruction by other parts of the immune system.
  • T lymphocytes or T cells: Some T cells destroy harmful germs or abnormal cells. Other T lymphocytes stimulate or reduce the activity of other cells of the immune system.

Doctors classify NHL into B-lymphocytes or T-lymphocytes depending on the origin of the cancer.

B-cell lymphomas account for approximately 85–90% of all NHL cases. They can be aggressive or indolent.

The aggressive types to understand:

  • transformed follicular and mucosa-associated lymphoid lymphomas
  • mantle cell lymphomawho can be aggressive or indolent
  • lymphoblastic lymphoma
  • Primary mediastinal (thymic) large B-cell lymphoma
  • Burkitt’s lymphoma
  • Primary linfome of the central nervous system
  • high-grade B-cell lymphoma with double or triple hits
  • Primary cutaneous DLBCL, leg type
  • diffuse large B-cell lymphoma
  • Primary central nervous system DLBCL
  • AIDS-associated lymphoma

Indolent types of B-cell lymphoma include:

T-cell lymphomas are another type of NHL that accounts for approximately 10–15% of all cases. Like B-cell NHL, they include both aggressive and indolent types.

Aggressive types can to understand:

  • angioimmunoblastic T-cell lymphoma
  • lymphoblastic lymphoma
  • Primary cutaneous anaplastic large cell lymphoma
  • systemic anaplastic large cell lymphoma
  • hepatosplenic gamma/delta T-cell lymphoma
  • Subcutaneous panniculitis-like T-cell lymphoma
  • enteropathy-like intestinal T-cell lymphoma
  • peripheral T-cell lymphoma, not otherwise specified

Indolent types can include:

Leukemia and lymphoma are two types of cancer that affect the blood. The main difference between the two is their starting point.

Lymphoma usually begins in the lymph nodes and lymphatic system. Leukemia usually starts and grows in the bone marrow.

There are several types of leukemia, including The most common in adults known as chronic lymphocytic leukemia. Like NHL, this type of leukemia starts in lymphocytes while they are still in the bone marrow.

This type of leukemia grows slowly and can take years to spread to other parts of the body.

Learn more about lymphoma and leukemia here.

A person may notice certain signs and symptoms associated with NHL. They may include:

If a doctor suspects NHL based on symptoms and a physical exam, they will likely order a biopsy of an affected lymph node. A pathologist should be able to identify both the presence of NHL and the subtype based on the biopsy.

A doctor may order additional tests to determine the stage of the cancer. Tests may include:

  • PET-scan
  • computed tomography
  • blood test
  • bone marrow biopsy
  • heart and lung function test

Doctors use a staging system which ranges from stages 1 to 4. Stage 1 is the least advanced and stage 4 is the most advanced.

The outlook for the NHL can vary greatly from person to person. Factors that affect it include:

  • NHL subtype aggression
  • subtype itself
  • person’s age
  • overall health
  • cancer stage
  • tumor size
  • where it spread

The average 5-year survival rate for all types and stages of NHL is 73.8%. A more positive outlook has links to factors such as:

  • stage 1 or 2 NHL
  • cancer localized only to the lymph nodes
  • under 60
  • normal levels of lactate dehydrogenase (LDH) in the blood
  • ability to function normally

Learn more about survival rates for the NHL here.

There are many subtypes of NHL, each with different treatment options and outlooks.

Aggressive NHLs are fast growing and indolent NHLs are slow growing.

Doctors classify NHLs as B cells or T cells depending on the type of lymphocyte in which they first appear.

Many factors can affect a person’s outlook, including how aggressive the NHL is, their age, and their overall health. A person can ask a doctor about the outlook for their particular NHL.

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