Doctors put NHL into 2 groups, depending on how quickly they are likely to grow and spread. The 2 groups are:
- low grade (slow growing)
- high grade (fast growing)
Sometimes high grade lymphomas are also called aggressive lymphomas.
Types of high grade NHL
The most common types of high grade NHL are:
- diffuse large B cell lymphoma (DLBCL)
- Burkitt lymphoma
- peripheral T cell lymphoma
Rarer types of high grade NHL include:
- lymphoblastic lymphoma
- blastic NK cell lymphoma
- enteropathy associated T cell lymphoma (EATL)
- hepatosplenic gamma delta T cell lymphoma
- treatment related T cell lymphoma
- angioimmunoblastic T-cell lymphoma (AITL)
Diffuse large B cell lymphoma
Each year about 5,500 people are diagnosed with diffuse large B cell lymphoma (DLBCL). This makes up about 40 out of 100 cases (40%) of NHL in adults.
Diffuse large B cell lymphoma is more common in males than females.
Primary mediastinal (thymic) large B cell lymphoma
People with this type of DLBCL develop enlarged lymph glands in the central area of their chest. This area is called the mediastinum.
There are two main types of lymphocytes – B cells and T cells. They both help us fight infections but in slightly different ways. Burkitt lymphoma affects the B cells and so is called a B cell lymphoma.
Each year around 210 people are diagnosed with Burkitt lymphoma in the UK. This makes up about 2 out of 100 cases (2%) of NHL. Burkitt lymphoma is the most common type of NHL in children in the UK. Adults can also be diagnosed, but it is more unusual. It is more common in males than females.
Burkitt lymphomas can affect people with low immunity, such as people who have had an organ transplant or who have AIDS.
People with Burkitt lymphoma tend to develop symptoms quite quickly.
Peripheral T cell lymphoma
These are a group of quickly growing lymphomas that develop from mature T cells.
Peripheral T cell lymphomas (PTCL) are divided into various subtypes. They all have very different characteristics and behaviour.
The most common subtype is called Peripheral T Cell Lymphoma Not otherwise Specified (PTCL NOS).
Most people with PTCL NOS have lymphoma cells only in the lymph nodes. But it can also happen in the liver, bone marrow, digestive system and skin.
Rarer types include:
- anaplastic large cell lymphoma (ALCL)
- angioimmunoblastic T cell lymphoma (AITL)
It usually develops from T cells but occasionally develops from B cells.
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 ALL are similar.
Blastic NK cell lymphoma
This very rare type of T cell lymphoma only affects a few people each year. It usually affects adults.
Blastic NK cell lymphoma tends to grow very quickly and can be difficult to treat. It can start almost anywhere in the body.
Enteropathy associated T cell lymphoma
This 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).
EATL usually happens in the small bowel, most often the middle part (jejunum) or the lower part closest to the large intestine (ileum). It can spread to the liver, spleen, lymph nodes, gallbladder, stomach, colon or skin.
Hepatosplenic gamma delta T cell lymphoma
This very rare type of lymphoma starts in the liver or spleen. It tends to grow very quickly.
Hepatosplenic gamma delta T cell lymphoma can affect people with Crohn’s disease, who have a suppressed immune system.
Treatment related T cell lymphomas
These lymphomas sometimes develop 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.
Treatment related T cell lymphomas often need different treatment to other lymphomas.
Transforming from low grade to high grade
Over time, low grade lymphomas can sometimes change into a faster growing (high grade) lymphoma.
This change is more common in some types of NHL than others. So it does not always happen. If it does, it can happen some years after you are first diagnosed with low grade NHL.
Sometimes, you can have a low grade and higher grade lymphoma at the same time. This can even happen in the same lymph node. Your doctor might assume that your low grade lymphoma is in the process of transforming to the higher grade type if this happens.
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.
Treatment for high grade lymphomas
The type of treatment most suitable for you depends on your:
- type of lymphoma
- general health