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 immunity Open a glossary item. For example, 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 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 small bowel Open a glossary item. It is most often in 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 Open a glossary item. It tends to grow very quickly.

Hepatosplenic gamma delta T cell lymphoma can affect people with Crohn’s disease Open a glossary item, who have a weak immune system Open a glossary item.

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 Open a glossary item 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.

  • The incidence data were compiled by the Statistical Information Team at Cancer Research UK using data from the Office for National Statistics and the regional cancer registries in Wales, Scotland and Northern Ireland using the latest data for 2017.

  • The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms
    R Allagio and others
    Leukemia. 2022. Volume 36, Issue 7, Pages 1720-1748

  • Guidelines for the management of mature T- and natural killer-cell lymphomas (excluding cutaneous T-cell lymphoma): a British Society for Haematology Guideline
    C Fox and others
    British Journal of Haematology, 2022. Volume 196, Issue 3, Pages 507 - 522

  • The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline
    C Fox and others
    British Journal of Haematology, 2024 (accessed online)

  • Post-transplant lymphoproliferative disorder: Update on treatment and novel therapies
    S. Atallah- Yunes and others
    British Journal of Haematology, 2023. Volume 201, Issue 3, Pages 383- 395

  • What is new in the classification of peripheral T cell lymphomas?
    L de Leval and B Bisig
    Pathologie (Heidelberg), 2023. Volume 44, Supplement 3, Pages 128-135

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
28 Feb 2024
Next review due: 
28 Feb 2026

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