Non-Hodgkin lymphoma is a common type of blood cancer with several subtypes that require different treatment and have different outlooks.
Non-Hodgkin 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 one single cancer. Instead, it is a term for several different types of cancer that share similar characteristics.
To get proper treatment, a person needs to know their NHL subtype. Each subtype can have different treatment options and outlooks for the person.
This article reviews the different subtypes of NHL, diagnosis, and outlook.
Aggressive NHLs grow and spread quickly. They typically require prompt treatment to prevent them from spreading. The
Treatment for aggressive NHL can cure cancer in some instances. Treatment often includes combined medication chemotherapy and radiation therapy.
With combined medication chemotherapy, doctors use different combinations of chemotherapy drugs. One of the most common is known as R-CHOP. The combination includes rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone.
Radiation therapy is where doctors use radiation to kill cancer cells and shrink tumors.
Indolent NHL refers to subtypes of lymphoma 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 U.S.
Treatments for indolent types of NHL can vary according to factors such as:
- the stage of the cancer
- a person’s age
- outlook factors, such as overall health
Treatments can vary in intensity and according to the exact subtype. For example, cutaneous T-cell lymphoma may include topical treatments as well as chemotherapy.
There are several subtypes of NHL. Aggressive NHL accounts for about 60% of all cases, and indolent NHL accounts for 40%.
The WHO’s system breaks up NHL subtypes by:
- how they look under a microscope
- the type of lymphocyte the cancer started in
- presence of certain proteins on the surface of the cancer cells
- features of the chromosomes of the cancer cells
B-cell vs. T-cell lymphomas
The lymph system contains
- 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 cells boost or reduce the activity of other immune system cells.
Doctors classify NHLs as B cell or T cell depending on where the cancer originates.
B-cell lymphomas account for about 85–90% of all NHL cases. They may be aggressive or indolent.
The aggressive types include:
- transformed follicular and transformed mucosa-associated lymphoid tissue lymphomas
- mantle cell lymphoma, which can be either aggressive or indolent
- lymphoblastic lymphoma
- primary mediastinal (thymic) large B-cell lymphoma
- Burkitt lymphoma
- primary central nervous system lymphoma
- high-grade B-cell lymphoma with double or triple hits
- primary cutaneous DLBCL, leg type
- diffuse large B-cell lymphoma
- primary DLBCL of the central nervous system
- AIDS-associated lymphoma
The indolent types of B-cell lymphoma include:
- Waldenström macroglobulinemia
- marginal zone lymphoma
- chronic lymphocytic leukemia/small-cell lymphocytic lymphoma
- splenic marginal zone lymphoma
- lymphoplasmacytic lymphoma
- follicular lymphoma
- nodal marginal zone lymphoma
- gastric mucosa-associated lymphoid tissue lymphoma
T-cell lymphomas are another type of NHL that account for about 10–15% of all cases. Like B-cell NHL, they include both aggressive and indolent types.
The aggressive types can include:
- 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-type intestinal T-cell lymphoma
- peripheral T-cell lymphoma, not otherwise specified
The indolent types can include:
Leukemia and lymphoma are two types of cancer that affect the blood. The main difference between the two is where they start.
Lymphoma typically starts in the lymph nodes and lymphatic system. Leukemia typically starts and develops in the bone marrow.
There are a few types of leukemia, including the
This type of leukemia is slow-growing and can take years to spread to other areas of the body.
A person may notice some signs and symptoms associated with NHL. They can include:
If a doctor suspects NHL based on symptoms and a physical review, 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 further tests to determine the stage of the cancer. Tests may include:
- PET scan
- CT scan
- blood test
- bone marrow biopsy
- heart and lung function test
Doctors use a
Outlook for NHL can vary greatly between people. The factors that affect it include:
- aggressiveness of the NHL subtype
- subtype itself
- age of the person
- overall health
- stage of the cancer
- size of the tumor
- where it has spread
- stage 1 or 2 NHL
- cancer located within lymph nodes only
- younger than age 60
- normal levels of lactate dehydrogenase (LDH) in blood
- ability to function normally
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 cell or T cell depending on the type of lymphocyte they first appear in.
Many factors can affect a person’s outlook, including how aggressive the NHL is, a person’s age, and their overall health. A person can ask a doctor about the outlook for their particular NHL.