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Different types of non Hodgkin lymphoma

Men and women discussing non Hodgkin's lymphoma

This page tells you about different types of non Hodgkin lymphoma and how they are divided into groups. You can find the following information

 

A quick guide to what's on this page

Types of non Hodgkin lymphoma

There are many different types of NHL. Doctors estimate that there are more than 60 subtypes. They put non Hodgkin lymphomas into 2 main groups depending on how quickly they are likely to grow and spread

  • Low grade (indolent) NHL – these grow very slowly
  • High grade (aggressive) NHL – these grow more quickly

Your doctor will be able to give your type of non Hodgkin lymphoma a name depending on the appearance of the lymphoma cells. The most common type of low grade NHL is follicular lymphoma. And the most common type of high grade lymphoma is diffuse large B cell lymphoma. 

Transforming from low grade to high grade

Over time, low grade lymphomas may change into a more aggressive high grade type lymphoma. This happens to between 10 and 70 out of every 100 people diagnosed with NHL, depending on the type they have. So it doesn't always happen. If it does, it may be several years after you were first diagnosed.

After a low grade NHL has transformed, it has to be treated as a high grade lymphoma. Unfortunately, a transformed NHL is generally harder to control than when it was low grade. And the treatment is more intense.

 

CR PDF Icon You can view and print the quick guides for all the pages in the About NHL section.

 

 

How doctors group non Hodgkin lymphomas

There are many different types of non Hodgkin lymphoma. Doctors estimate that there are more than 60 subtypes. Understanding how the  different types of NHL are grouped, or classified, can be difficult. A variety of systems for classifying lymphomas have been used over the years. The latest is the World Health Organisation classification of 2008. We give a simple description of the groups on this page.

Your doctor will find out which type of non Hodgkin lymphoma you have by taking a lymph node out and sending it to the lab. This is called a biopsy. A specialist doctor called a pathologist examines this under a microscope.

Look in the section about diagnosing non Hodgkin lymphoma for information about this. 

The pathologist will examine the cells to see

 

Grade of NHL

Doctors put non Hodgkin lymphomas into 2 groups depending on how quickly they are likely to grow and spread

  • Low grade (indolent) – these tend to grow very slowly
  • High grade (aggressive) – these tend to grow more quickly

The different grades of non Hodgkin lymphoma are treated in slightly different ways. 

Look in the treating non Hodgkin lymphoma section for treatment information.

 

Type of white blood cell

One way of classifying NHL is by the type of white blood cells (lymphocytes) affected – B cells or T cells. Most people with NHL have B cell lymphomas.

 

What the lymphoma cells look like

Your doctor will be able to give your type of non Hodgkin lymphoma a name depending on the appearance of the lymphoma cells. These names are quite complicated. But they are useful to doctors because the different types can behave differently. Different treatments are used for the different types. So knowing the type helps the doctor know how to treat them. In the laboratory a pathologist looks at the cells to see if they are

  • Large or small
  • Grouped together in structures called follicles (follicular type) or spread out (diffuse type)

Low grade non Hodgkin lymphomas tend to have small cells that are grouped together.

Remember that the word diffuse can also be used to describe NHL that is widespread in the body. This is not the same as the diffuse type of NHL called diffuse large B cell lymphoma. As you can see, the classification of lymphoma can be a confusing subject.

 

Low grade (slowly growing) NHL

Low grade lymphomas tend to grow very slowly. Doctors call them indolent lymphomas. They include

Follicular lymphoma

Follicular lymphoma is the most common type of low grade lymphoma. About a quarter of lymphomas in the UK are the follicular type (25%). It is a type of B cell lymphoma. They mainly occur in adults over the age of 50. They normally have a protein called CD20 on their cell surface. CD20 can be a target for some types of cancer treatment. 

Follicular lymphomas can be divided into 3 separate grades – 1, 2 and 3. Grade 3 is divided into 3A and 3B. The grades are based on how the lymphoma cells look under the microscope. There is a lot of discussion amongst doctors about whether grading for follicular lymphoma is accurate. It can be difficult to tell the difference between different types of lymphoma cells. Grade 3B follicular lymphoma is faster growing and is likely to be treated as a high grade lymphoma.

Mantle cell lymphoma

Mantle cell lymphoma is a rare type of NHL that makes up between 5 and 10 out of every 100 (5 to 10%) of all non Hodgkin lymphomas diagnosed. It most often affects people in their 50s and 60s. It is a B cell lymphoma. Even though mantle cell lymphomas are classed as low grade, they may grow quickly and may be treated more like high grade lymphomas. There is a page about mantle cell lymphoma in this section.

Marginal zone lymphoma

Marginal zone lymphomas are a group of slow growing B cell lymphomas. They account for about 12 out of 100 B cell lymphomas (12%). They tend to occur in people over the age of 60.

There are 3 types of marginal zone lymphoma. They include

Extranodal marginal zone lymphoma is also called mucosa associated lymphoid tissue lymphoma or MALT lymphoma. It is the most common type of marginal zone lymphoma. It makes up about 7 out of 100 B cell lymphomas (7%) in the UK. This lymphoma does not start in the lymph nodes. It starts in the mucosa, which is a soft, moist tissue layer that protects and covers organs in different parts of the body. 

The most common place for MALT lymphomas to develop is the stomach and they are called gastric MALT lymphoma. Less commonly it can develop outside the stomach, in the small bowel, salivary gland, thyroid gland, tear glands, or lungs. These lymphomas tend not to spread beyond the place where they started.

We have a page of information about MALT lymphomas in this section.

Nodal marginal zone lymphoma (sometimes called monocytoid B cell lymphoma) occurs within the lymph nodes. It makes up about 2 out of 100 B cell lymphomas (2%). It tends to occur in people over the age of 60 and is very slightly more common in women than men. 

Splenic marginal zone lymphoma starts in the spleen and can also be found in the bloodstream. This type makes up about 1 out of 100 B cell lymphomas (1%). It usually affects people over the age of 50. 

Small lymphocytic lymphoma

Small lymphocytic lymphoma is also called chronic lymphocytic leukaemia (CLL). It makes up about 6 out of 100 lymphomas in the UK (6%). In theory, lymphoma is an illness that starts in the lymph nodes and leukaemia is an illness of the blood. But leukaemia and lymphoma have many similarities and often affect the body in similar ways. Chronic lymphocytic leukaemia is the term used for this condition if many of the abnormal cells are in the blood. Doctors call it small lymphocytic lymphoma when the disease involves the lymph nodes in particular. 

We have a whole section of information about chronic lymphocytic leukaemia which covers diagnosis, treatment and ways of coping.

Lymphoplasmacytic lymphomas (including Waldenstrom's macroglobulinaemia)

Lymphoplasmacytic NHL are low grade lymphomas. Abnormal B cells fill up the bone marrow or they enlarge the lymph nodes or spleen. Most of these lymphomas are a type called Waldenstrom's macroglobulinaemia or immunocytoma. This type makes up less than 2 out of 100 B cell lymphomas (less than 2%). This type of lymphoma usually affects people over the age of 65. It is slightly more common in men than women.

People with Waldenstrom's macroglobulinaemia have a high level of a protein called immunoglobulin M (IgM) in their blood. The protein makes the blood thicker.

Skin lymphomas

A rare type of non Hodgkin lymphoma is mycosis fungoides. It affects the skin and is also called cutaneous T cell lymphoma. 

We have a page about cutaneous T cell lymphoma in this section.

 

High grade (quickly growing) NHL

High grade lymphomas generally grow more quickly than low grade lymphomas. Doctors may call them aggressive types of lymphoma. They include the following types.

Diffuse large B cell lymphoma (DLBCL)

Diffuse large B cell lymphoma is the most common type of high grade non Hodgkin lymphoma. About a third of people with NHL have this type of lymphoma. It tends to occur in people in the mid to late 60s but can occur at any age. It is slightly more common in men. 

Mediastinal large B cell lymphoma is one type of DLBCL. Its official name is primary mediastinal (thymic) large B cell lymphoma. It makes up about 3 out of 100 lymphoma cases in the UK (3%). It tends to occur in people in their 20s and 30s. The mediastinum is the centre area of the chest. People with this type of lymphoma develop enlarged lymph glands in this area of the chest. 

Burkitt's lymphomas

Burkitt's lymphomas can grow quite quickly. They include Burkitt like lymphomas, which are also called atypical Burkitt's lymphoma. They are B cell lymphomas and occur most commonly in children and young adults. But they can also occur in people over the age of 40. They make up about 3 out of 100 cases of lymphoma in the UK (3%). The symptoms tend to happen quite quickly. They are more common in men than women. These lymphomas can occur in people with low immunity, for example after an organ transplant or in people who have AIDS

Peripheral T cell lymphoma

Peripheral T cell lymphomas (PTCL) are a group of quickly growing non Hodgkin lymphomas that develop from mature T cells. They account for about 6 in every 100 cases of NHL (6%). These lymphomas are divided into various subtypes and they all have very different characteristics and behaviour. The most common types are peripheral T cell lymphoma not otherwise specified (PTCL-NOS), anaplastic large cell lymphoma (ALCL), and angio immunoblastic T cell lymphoma (AITL).

Peripheral T cell Lymphoma Not Otherwise Specified (PTCL NOS) refers to a group of lymphomas that don't fit into any of the other subtypes of PTCL. PTCL-NOS is the most common PTCL subtype. It makes up about a quarter of all PTCLs. It is also the most common of all the T cell lymphomas. The term PTCL can be confusing as it can refer to the whole group of T cell lymphomas, but it can also refer to the specific PTCL-NOS subtype. 

Although most people with PTCL-NOS have lymphoma cells only in the lymph nodes, it can occur also in the liver, bone marrow, digestive system and skin.

Anaplastic large cell lymphoma (ALCL) occurs most commonly in children and young adults. It is more common in males than females. It makes up around 2 out of 100 cases of NHL (2%). It can appear in the skin, in lymph nodes, or in organs throughout the body. ALCL has several different subtypes and they each have different outcomes and treatment options. 

Angio immunoblastic T cell lymphoma (AITL) is a quickly growing T cell lymphoma that accounts for about 2 out of every 100 of all NHL cases.

Lymphoblastic lymphoma

Lymphoblastic lymphoma usually occurs in people under the age of 35. It is very rare in adults and most common in children and teenagers. It usually develops from T cells but occasionally develops from B cells. It makes up about 2 out of 100 cases of NHL in the UK (2%).

Lymphoblastic lymphoma is very similar to acute lymphoblastic leukaemia (ALL). In lymphoma, the abnormal white blood cells (lymphocytes) are generally in the chest lymph nodes or thymus gland. But in ALL the abnormal cells are mainly in the blood and bone marrow. The treatments for lymphoblastic lymphoma and acute lymphoblastic leukaemia are often very similar.

Blastic NK cell lymphoma

Blastic NK cell lymphoma is a very rare type of T cell lymphoma and affects only a few people each year. It usually occurs in adults. It tends to grow very quickly and can be difficult to treat. It can start almost anywhere in the body. 

Enteropathy associated T cell lymphoma (EATL)

EATL is a very rare type of T cell lymphoma. It is also called enteropathy type T cell lymphoma (ETTL) or intestinal T cell lymphoma (ITCL). It usually occurs in the small bowel, most often the middle part (jejunum) or the lower part closest to the large intestine (ileum). EATL occurs more often in people with coeliac disease. It most often affects people in their 30s and 40s. It may spread to the liver, spleen, lymph nodes, gallbladder, stomach, colon or skin.

Hepatosplenic gamma delta T cell lymphoma

Hepatosplenic gamma delta T cell lymphoma is a very rare type that starts in the liver or spleen. It tends to grow very quickly. This lymphoma may occur in people with Crohn’s disease who have a suppressed immune system.

Treatment related T cell lymphomas

Treatment related T cell lymphomas sometimes occur after people have had an organ transplant or a stem cell or bone marrow transplant. After these procedures people need to take medicines that suppress the immune system. This can increase the risk of developing lymphoma. The treatment for these lymphomas is often different than for other lymphomas.

 

Transforming from low grade to high grade

Over time, low grade lymphomas may change into a more aggressive high grade type lymphoma. This can happen to between 10 and 70 out of every 100 people diagnosed with NHL (10 to 70%), depending on the type they have. So it doesn't always happen. If it does, it may be several years after you were first diagnosed with the low grade lymphoma.

Sometimes, a low grade and higher grade lymphoma can be there at the same time, in the same person. It can even occur in the same lymph node. If this happens, your doctor may assume that it is in the process of transforming to the higher grade type.

After a low grade NHL has transformed, it has to be treated as high grade. Unfortunately, a transformed NHL is generally harder to control than when it was low grade. And the treatment is more intense.

 

More about rare types of NHL

There are other rare subtypes of non Hodgkin lymphoma. 

For information about lymphoma of the eye, there is some information in our eye cancer section.

For information about lymphoma in the brain or spinal cord look on our page in the brain tumour section.

If you have a type of NHL that is not mentioned on this page you can get information from the Cancer Research UK nurses. Call them on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to help you.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 1 September 2014