High grade NHL
Doctors often group non-Hodgkin lymphoma (NHL) as either low grade or high grade. The grade depends on how quickly the NHL is likely to grow and spread.
High grade NHL tends to grow quite quickly. Doctors sometimes describe them as aggressive lymphomas. They grow faster than low grade lymphomas, which tend to grow slowly. Doctors call low grade lymphomas indolent lymphomas.
This page is about the different types of high grade NHL.
NHL begins in a type of white blood cell called a lymphocyte. There are two types of lymphocytes. These are B cells and T cells. So you can develop a B cell lymphoma or a T cell lymphoma. There are different types of B cell and T cell lymphomas. Some of these are low grade, and some are high grade.
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:
- blastic NK cell lymphoma
- enteropathy associated T cell lymphoma (EATL)
- hepatosplenic gamma delta T cell lymphoma
- angioimmunoblastic T-cell lymphoma (AITL)
- lymphoblastic lymphoma
- treatment related lymphoma
Over time, a low grade lymphoma can sometimes change into a high grade type lymphoma. Doctors call this transformation.
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.
DLBCL grows quickly and your treatment starts soon after diagnosis.
There are different sub types of DLBCL. Most people with DLBCL do not have a specific sub type. You might see this written as ‘DLBCL not otherwise specified’ or ‘DLBCL NOS’.
Other types of large B-cell lymphomas cause specific symptoms because of where they develop. These include primary mediastinal (thymic) large B cell lymphoma. This causes enlarged lymph nodes in the central area of your chest (mediastinum).
Burkitt Lymphoma
Burkitt lymphoma is 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
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 T cells.
Peripheral T cell lymphomas (PTCL) are divided into subtypes. They all have very different characteristics and behaviour.
The most common subtype is 'peripheral T cell lymphoma, not otherwise specified' (PTCL NOS). PTCL NOS includes all T cell lymphomas that don't fit into another group.
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 of peripheral T cell lymphoma include:
- anaplastic large cell lymphoma (ALCL)
- angioimmunoblastic T cell lymphoma (AITL)
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
Hepatosplenic gamma delta T cell lymphoma
This very rare type of lymphoma starts in the liver or
Hepatosplenic gamma delta T cell lymphoma can affect people with
Lymphoblastic lymphoma
Lymphoblastic lymphoma (LL) is a rare type of high-grade NHL. It usually develops from T cells but occasionally develops from B cells.
LL is very similar to acute lymphoblastic leukaemia (ALL). In lymphoblastic 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.
Treatment related T and B 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 or B 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. Doctors call this transformation.
Transformation is more common in some types of NHL than others. So it does not always happen. Most low grade lymphomas do not transform. If lymphoma does transform it can happen any time. Sometimes, it can happen many years after you are first diagnosed with low grade NHL.
Sometimes, you can have a low grade and high grade lymphoma at the same time. Your doctor might assume that your low grade lymphoma 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 can sometimes be harder to control than when it was low grade. And the treatment is more intense.
Treatment for high grade lymphomas
The type of treatment you have for high grade NHL depends on:
- the
stage and type of your lymphoma when it is diagnosed - the symptoms you have at the time
- your general health and fitness
The main types of treatment for high grade NHL are:
- chemotherapy
- targeted cancer drugs
- radiotherapy
- stem cell transplant
We have treatment information for some of the different types of high grade lymphoma. You can look for your lymphoma type at the link below.