What is worse nonHodgkins lymphoma or lymphoma?

ON THIS PAGE: You will find descriptions of the most common types and subtypes of NHL. Use the menu to see other pages.

There are different types and subtypes of NHL. It is very important to know which type and subtype have been diagnosed. Sometimes more than 1 type of lymphoma can be found in the same patient. Below are the most common types and subtypes. For information about treatment options, see the Types of Treatment section.

Cell types of NHL

First, the doctor will determine what type of cell the lymphoma started in and classify the disease within 1 of the 3 major groups:

B-cell lymphoma. About 90% of people in western countries with lymphoma have B-cell lymphoma.
T-cell lymphoma. About 10% of people with lymphoma have T-cell lymphoma. These lymphomas are more frequent in Asian countries.
NK-cell lymphoma. Less than 1% of people with lymphoma have NK-cell lymphoma.

Indolent and aggressive NHL

NHL is also described by how quickly the cancer is growing. “Indolent” NHL grows slowly, while “aggressive” NHL may develop rapidly. Indolent and aggressive NHL are equally common in adults. In children, aggressive NHL is more common. Some subtypes of lymphoma cannot easily be classified as indolent or aggressive. For example, mantle cell lymphoma has both indolent and aggressive NHL features.

Subtypes of NHL

In addition to determining if the NHL is indolent or aggressive and whether it is B-cell, T-cell, or NK-cell lymphoma, it is very important to determine the subtype of NHL. This is because each subtype can behave differently and may require different treatments. There are more than 60 NHL subtypes, although some are quite rare. The most common subtypes are described below. Learn how they are treated in the Types of Treatment section.

Distinguishing among the different subtypes of NHL can be difficult and requires pathologists or hematopathologists who are experts in the diagnosis of lymphoma. These specialists use sophisticated techniques and work closely with experienced oncologists. The diagnosis is based on how the lymphoma looks under the microscope and which marker proteins are expressed on the lymphoma cells. The doctors confirm the diagnosis with additional information from other tests, including tests of genetic material within the lymphoma cells. For more information on this process, see the Diagnosis section.

Subtypes of B-cell lymphoma

These are the common subtypes of B-cell lymphoma.

Diffuse large B-cell lymphoma (DLBCL). DLBCL is the most common form of lymphoma. About 30% of NHL in the United States is DLBCL. It is an aggressive form of NHL that involves organs other than the lymph nodes about 40% of the time. Recent research shows that there are different types of DLBCL, including germinal center and non-germinal center. Research studies, called clinical trials , continue to look at whether patients should receive different types of treatment for these different types of DLBCL.

Follicular lymphoma. Follicular lymphoma is the second most common form of lymphoma in the United States and Europe. About 20% of people with NHL have this subtype. It usually begins in the lymph nodes, is most often indolent, and grows very slowly. Over time, follicular lymphoma may turn into DLBCL (see above). This is called transformation. Clinical trials suggest that people with follicular lymphoma have lived longer over the last few decades due to treatment advances. Follicular lymphoma sometimes has a genetic change within the lymphoma cells involving chromosomes 14 and 18. This genetic abnormality changes the function of a protein called BCL2.

Mantle cell lymphoma. About 5% to 7% of people with NHL have mantle cell lymphoma. It most often appears in people older than 60 and is much more common in men than in women. It usually involves the bone marrow, lymph nodes, spleen, and gastrointestinal system, which includes the esophagus, stomach, and intestines. Mantle cell lymphoma is characterized by a genetic change within lymphoma cells involving chromosomes 11 and 14. This genetic change alters the function of a protein called cyclin D1. Some patients have a slower-growing form of the disease, and if they do not have symptoms or a significant amount of disease, they may be monitored using the watchful waiting approach.

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Small lymphocytic lymphoma. This type of lymphoma is the same disease as B-cell chronic lymphocytic leukemia (CLL) but without a significant amount of disease circulating in the blood. About 5% of people with NHL have this subtype, which is considered an indolent lymphoma.

Double hit/triple hit lymphoma. This is a highly aggressive subtype of DLBCL, accounting for about 5% of these cases. Rarely, low-grade follicular lymphoma may also transform into double hit lymphoma. Double hit lymphomas have changes in the MYC gene and in either the BCL2 or BCL6 gene. Double hit lymphoma is often diagnosed in older adults. Triple hit lymphomas have changes in the MYC , BCL2 , and BCL6 genes.

Primary mediastinal large B-cell lymphoma. This is an aggressive form of DLBCL (see above). It appears as a large mass in the central chest. The mass may cause breathing problems or superior vena cava (SVC) syndrome , a collection of symptoms caused by the partial blockage or compression of the superior vena cava. The superior vena cava is the major vein that carries blood to the heart from the head, neck, upper chest, and arms. Mediastinal large B-cell lymphoma is most common in women between 30 and 40 years old. About 2.5% of people with NHL have this subtype. A closely related lymphoma called mediastinal grey-zone lymphoma (MGZL) may also occur in the same age group.

Splenic marginal zone B-cell lymphoma. This type of lymphoma begins in the spleen and usually involves the bone marrow and the blood. It is usually slow growing.

Extranodal marginal zone B-cell lymphoma of MALT. This type of lymphoma is usually localized at diagnosis. It most commonly occurs in the stomach. However, it may also occur in the lung, skin, thyroid, salivary gland, or in the orbit, adjacent to the eye, or in the bowel. Patients with this type of lymphoma sometimes have a history of autoimmune disease, such as lupus, rheumatoid arthritis, or Sjögren syndrome. When MALT occurs in the stomach, it is sometimes caused by a bacteria called Helicobacter pylori .

Nodal marginal zone B-cell lymphoma. This rare type of indolent lymphoma involves the lymph nodes. About 1% of people with lymphoma have this subtype.

Lymphoplasmacytic lymphoma. This is an indolent form of lymphoma, and 1% of people with NHL have this subtype. This form of lymphoma often involves the bone marrow, sometimes lymph nodes, and spleen. In most patients, this lymphoma produces an immunoglobulin (IgM antibody) protein, called an “M protein,” that is found in the blood. When this occurs, the condition is called Waldenstrom’s macroglobulinemia (WM) . Patients with WM sometimes have elevated serum viscosity, or “thickened” blood, which may cause symptoms such as headache, blurry vision, dizziness, and shortness of breath. Changes in the MYD88 gene are detected in more than 90% of cases of lymphoplasmacytic lymphoma and WM. Looking for mutations in this gene may be helpful in diagnosing lymphoplasmacytic lymphoma.

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Burkitt lymphoma/Burkitt cell leukemia. This is a very rare and aggressive form of lymphoma. There are 3 forms of Burkitt lymphoma:

Endemic
Sporadic
Immunodeficiency-related lymphoma

The endemic subtype occurs most commonly in Africa, appears most often in the jawbones of children, and is usually associated with infection with EBV. It can also be associated with HIV. In the United States, Burkitt lymphoma sometimes appears with a mass in the abdomen, but it can affect many other parts of the body. Because this type of lymphoma spreads quickly, it needs immediate treatment. This subtype is characterized by genetic changes on chromosome 8 involving the MYC gene, which contributes to rapid cancer growth.

Subtypes of T-cell and NK-cell lymphoma

These are the most common subtypes of T-cell and NK-cell lymphoma:

Anaplastic large cell lymphoma, primary cutaneous type. This subtype of lymphoma only involves the skin. It is often indolent, although aggressive subtypes of the disease are possible.

Anaplastic large cell lymphoma, systemic type. This aggressive form of lymphoma makes up about 2% of all lymphomas and about 10% of all childhood lymphomas. Some people with this subtype have genetic changes on chromosome 2, involving the ALK gene. Individuals with cancer cells that have changes in ALK , called ALK -positive, often have a a better prognosis than those without this change, called ALK -negative.

Breast implant-associated anaplastic large cell lymphoma. This is a relatively recently recognized subtype that arises in tissue near breast implants. It is usually less aggressive than the systemic type of anaplastic large cell lymphoma.

Peripheral T-cell lymphoma, not otherwise specified (NOS). This is an aggressive form of lymphoma that is often advanced when doctors find it. It is most common in people older than 60 and makes up about 6% of all lymphomas in the United States and Europe. The cells of this lymphoma vary in size, and they have certain types of proteins, called CD4 or CD8, on their surface. Researchers are studying many new drugs in clinical trials to treat this subtype.

Angioimmunoblastic T-cell lymphoma. This is an aggressive form of lymphoma with specific symptoms:

Enlarged, often tender, lymph nodes
Fever
Weight loss
Rash
High levels of immunoglobulins in the blood

People with angioimmunoblastic lymphoma have a lowered immune system function, so infections are also common.

Adult T-cell lymphoma/leukemia (human T-cell lymphotropic virus type I positive). This type of lymphoma is caused by a virus called the human T-cell lymphotropic virus type I. It is an aggressive disease that often involves the bone and skin. Often, lymphoma cells are found in the blood, which is why this condition is sometimes also called leukemia.

Extranodal NK/T-cell lymphoma, nasal type. This is an aggressive type of lymphoma that is very rare in the United States and Europe in general, but more common in Asian and Hispanic communities. It can occur in children or adults, most often involving the nasal area and sinuses. It can also involve the gastrointestinal tract, skin, the testicles, or other areas in the body.

Enteropathy-associated T-cell lymphoma. This type of lymphoma is rare in the United States but is more common in Europe. It is an aggressive form of T-cell lymphoma that involves the intestines. Some people with this subtype have celiac disease or a history of gluten intolerance.

Hepatosplenic T-cell lymphoma. This is an aggressive form of peripheral T-cell lymphoma that involves the liver and spleen. It is more common in males and occurs more frequently in teenagers and young adults, with a median age at diagnosis of 35 years.

Subcutaneous panniculitis-like T-cell lymphoma. This is a form of peripheral T-cell lymphoma that is similar to hepatosplenic T-cell lymphoma (see above). The disease involves the tissue under the skin and is often first diagnosed as panniculitis, which is inflammation of fatty tissues.

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Mycosis fungoides. This rare T-cell lymphoma primarily involves the skin, either in patches or with diffuse redness of the skin. It often has a very long and indolent course but may become more aggressive and spread to lymph nodes or internal organs.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Types of lymphoma

There are over 60 different types of lymphoma, which can affect people of all ages. Different types of lymphoma are sorted into groups or sub-types. Each type of lymphoma can cause different symptoms and need different treatment.

Hodgkin lymphoma

Learn more about the two main types of Hodgkin lymphoma: classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is split into two main groups: low-grade (slow-growing) NHL and high-grade (fast-growing) NHL. Find out more about these different types and how they might be treated.

Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL)

CLL and SLL are different forms of the same illness and are often grouped as types of B-cell non-Hodgkin lymphoma. They are treated in the same way.

Lymphoma in children and young people

Some types of lymphoma are more common in children and young people than in adults, and might need different treatment.

Find more information about lymphoma in specific situations, such as lymphoma in your brain, spinal cord and eyes (central nervous system) or lymphoma that has changed (transformed) from one type into another.

Transformation of lymphoma

Learn more about when slow-growing lymphomas become fast-growing (transform).

Skin lymphoma

Learn more about the different types of skin lymphoma, how they might be treated and tips on living with skin lymphoma.

Central nervous system (CNS) lymphoma

Read about lymphoma that affects your brain, spinal cord and eyes (central nervous system).

Lymphoma in people who have HIV

Learn more about lymphoma in people who have HIV, including how it is diagnosed and how it might be treated.

Lymphoma that develops after an organ transplant (PTLD)

Learn more about lymphoma that develops in people who are taking treatment to dampen their immune system after an organ transplant.

Other rare high-grade B-cell lymphomas

In some cases, it’s difficult to identify (classify) the type of lymphoma you have. Learn more about grey zone, double-hit, triple-hit and high-grade B-cell lymphomas not otherwise specified (NOS).

Lymphoma types in numbers

Some statistics about the different types of lymphoma.

Treatment — Non-Hodgkin lymphoma

In a few cases, if the initial cancer is very small and can be removed during a biopsy, no further treatment may be needed.

Your treatment plan

The recommended treatment plan will depend on your general health and age, as many of the treatments can put a strain on the body.

Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma.

This is known as a multidisciplinary team (MDT). Your MDT will recommend the best treatment options for you.

But you shouldn’t be rushed into making a decision about your treatment plan.

Before deciding, you may wish to talk to friends, family and your partner.

You’ll be invited back to see your care team for a full discussion about the risks and benefits of any treatments planned before treatment begins.

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You can ask your care team if a clinical trial is available to take part in.

Wait-and-see approach

If non-Hodgkin lymphoma is low grade (slow developing) and you’re well, a period of «watch and wait» is often recommended.

This is because some people take many years to develop troublesome symptoms and starting treatment immediately is often felt to be unnecessary.

If watch and wait is recommended, you’ll be seen regularly for reviews and invited to come back at any stage if you feel your symptoms are getting worse.

Chemotherapy

Chemotherapy is a widely used treatment for non-Hodgkin lymphoma that involves using medicine to kill cancer cells.

It may be used on its own, combined with biological therapy, or combined with radiotherapy.

The medicine can be given in a number of different ways, depending on the stage of your cancer.

You’ll normally get chemotherapy through a drip directly into a vein (intravenous chemotherapy), as tablets taken by mouth, or a combination of both.

If there’s a risk of the cancer spreading to your brain, you may have chemotherapy injections directly into the cerebrospinal fluid around your spine.

Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you get treatment during the day and shouldn’t have to stay in hospital overnight.

But there may be times when your symptoms or the side effects of treatment become particularly troublesome and a longer hospital stay may be needed.

If you’re taking chemotherapy as tablets, you might be able to take these at home.

Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow.

This can interfere with the production of healthy blood cells and cause the following problems:

feeling very tired (fatigue)
breathlessness
increased vulnerability to infection
bleeding and bruising more easily

If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells.

Growth factor medicines can also stimulate the production of blood cells.

Other possible side effects of chemotherapy include:

nausea and vomiting
diarrhoea
loss of appetite
mouth ulcers
tiredness
skin rashes
hair loss
infertility, which may be temporary or permanent (see complications of non-Hodgkin lymphoma for more information)

Most side effects should pass once your treatment has finished.

Tell your care team if side effects become particularly troublesome, as there are treatments that can help.

High-dose chemotherapy

If non-Hodgkin lymphoma doesn’t get better with initial treatment (known as refractory lymphoma), you may have a course of chemotherapy at a stronger dose.

But this intensive chemotherapy destroys your bone marrow, leading to the side effects mentioned.

You’ll need a stem cell or bone marrow transplant to replace the damaged bone marrow.

Radiotherapy

Radiotherapy is most often used to treat early-stage non-Hodgkin lymphoma, where the cancer is only in one part of the body.

How long you will need treatment for will depend on the type of non-Hodgkin lymphoma you have and what stage it’s at.

It’s normally given in short daily sessions, Monday to Friday, usually for no more than 3 weeks.

You shouldn’t have to stay in hospital between appointments.

Radiotherapy itself is painless, but it can have some significant side effects. These can vary, depending on which part of your body is being treated.

For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss.

Other common side effects include:

sore and red skin in the treatment area
tiredness
nausea and vomiting
dry mouth
loss of appetite

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Most side effects are temporary, but there’s a risk of long-term problems, including infertility and permanently darkened skin in the treatment area.

Monoclonal antibody therapy

For some types of non-Hodgkin lymphoma, you may have a type of medicine called a monoclonal antibody.

These medicines attach themselves to both healthy and cancerous cells, and signal to the immune system to attack and kill the cells.

Once the treatment is over the level of healthy cells goes back to normal over time.

You may be given monoclonal antibody therapy as your only treatment, or they’re sometimes given in combination with chemotherapy to make the treatment more effective.

For some types of non-Hodgkin lymphoma, you may continue having monoclonal antibody treatment regularly for up to 2 years after initial treatment, in combination with chemotherapy.

This can reduce the chances of the cancer coming back in the future.

One of the main monoclonal antibody medicines used to treat non-Hodgkin lymphoma is called rituximab.

Rituximab can be given as an injection directly into a vein over the course of a few hours.

Side effects of rituximab can include:

tiredness
feeling sick (nausea)
night sweats
an itchy rash
tummy pain
hair loss

You may be given additional medicine to prevent or lessen these side effects. Side effects should improve over time as your body gets used to rituximab.

Steroid medicine

Steroid medicine is commonly used in combination with chemotherapy to treat non-Hodgkin lymphoma.

This is because research has shown that using steroids makes the chemotherapy more effective.

The steroid medicine is normally given as tablets or injections, usually at the same time as your chemotherapy.

You’ll usually take the steroids for a few days or 1 week during each cycle of chemotherapy, and take breaks in between. This helps to reduce the side effects.

Common side effects of short-term steroid use include:

increased appetite, which can lead to weight gain
indigestion
problems sleeping
feeling agitated

On rare occasions, you may have to take steroids on a long-term basis.

Side effects of long-term steroid use include high blood pressure, weight gain, and swelling in your hands, feet and eyelids.

The side effects of steroid medicine usually start to improve once treatment finishes.

Follow-up

After your course of treatment ends, you may have a repeat scan to see how well the treatment has worked.

Following this, you’ll need regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning (known as a relapse).

These appointments will start off being every few weeks or months, but become less frequent over time.

For more information, see:

Lymphoma Action
Cancer Research UK: treating non-Hodgkin lymphoma
Cancer Research UK: living with non-Hodgkin lymphoma
Macmillan: treating non-Hodgkin lymphoma
Macmillan: after non-Hodgkin lymphoma treatment

Your multidisciplinary team

During your treatment for non-Hodgkin lymphoma, you may see any of the following professionals:

specialist cancer nurse or key worker – the first point of contact between you and the members of the care team
haematologist – a specialist in drug treatments
clinical oncologist – a specialist in radiotherapy
pathologist – a specialist in looking at biopsies
radiologist – a specialist in X-rays and scans
social worker
transplant specialist
psychologist
counsellor

Page last reviewed: 20 June 2022
Next review due: 20 June 2025