Types of Hodgkin lymphoma

The World Health Organisation's (WHO) classification system puts Hodgkin lymphoma into 2 main groups. They are:

  • classical type
  • nodular lymphocyte predominant type

Classical Hodgkin lymphoma

Classical Hodgkin lymphoma is the most common form of Hodgkin lymphoma. 

There are 4 types and they all contain abnormal cells called Reed-Sternberg cells. These cells are a type of white blood cell (B lymphocyte) that have become cancerous. 

The 4 subtypes are:

Nodular sclerosing is the most common type of Hodgkin lymphoma in the UK. It is the most common type in young adults. It is usually found at an early stage when lymph nodes in the neck become swollen (enlarged).

Mixed cellularity often affects a few groups of lymph nodes when it is diagnosed. These lymph nodes contain a mixture of different types of lymphocytes and other blood cells.

These lymphocytes look very small. When doctors look at a sample of the affected lymph node under the microscope, they see lots of lymphocytes with very few Reed-Sternberg cells.

The lymphocyte depleted type of classical Hodgkin lymphoma is very rare. The lymph nodes may contain a lot of fibrous tissue with very few Reed-Sternberg cells. Or they may contain a lot of a type of lymphocyte called the reticular lymphocyte, and many Reed-Sternberg cells.

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is not very common – around 5 in 100 cases (around 5%) of Hodgkin lymphoma are NLPHL. It's more common in older people but can occur in young people.

The main difference between this type and classical Hodgkin lymphoma is that in the nodular lymphocyte predominant type there are very few Reed-Sternberg cells. But there are other abnormal cells that doctors call popcorn cells.

This type of Hodgkin lymphoma is often only in one group of lymph nodes when it is diagnosed (localised disease). It tends to be slower growing than classical Hodgkin lymphoma and the treatment is different.

Depending on the stage of NLPHL you might have surgery to remove the affected lymph nodes and radiotherapy or chemotherapy. A combination chemotherapy called R-CHOP is sometimes used. This type of chemotherapy is also used to treat non-Hodgkin lymphoma. 

  • Cancer Research UK incidence statistics for Hodgkin lymphoma 

  • Cancer and its management (7th edition)
    J Tobias and D Hochhauser
    Wiley-Blackwell, 2015

  • Principles and practice of oncology (11th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Wolters Kluwer, 2019

  • The 2016 revision of the World Health Organization classification of lymphoid neoplasms
    SH Swerdlow and others
    Blood, 2016. Volume 127, Issue 20, Pages 2375 - 2390

  • Nodular lymphocyte-predominant Hodgkin lymphoma: a unique disease deserving unique management
    Dennis A. Eichenauer and Andreas Engert
    American Society of Haematology, 2017 

Last reviewed: 
23 Sep 2020
Next review due: 
23 Sep 2023

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