High grade NHL

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.

Burkitt Lymphoma

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)

Lymphoblastic lymphoma

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 
Last reviewed: 
24 Nov 2020
Next review due: 
24 Nov 2023
  • 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.

  • WHO classification of tumours of haematopoietic and lymphoid tissues: International Agency for Research on Cancer (4th edition)
    S Swerdlow and International Agency for Research on Cancer
    IARC Press, 2008

  • Peripheral T-Cell Lymphomas: ESMO Clinical Practice Guidelines

    F D'Amore and others 

    Annals of Oncology, 2015. 26 (suppl 5): v108-v115

  • Diffuse Large B-Cell Lymphoma: ESMO Clinical Practice Guidelines

    H Tilly and others  

    Annals of Oncology, 2015. 26 (suppl 5): v116-v125

  • ESMO Consensus Conference on Malignant Lymphoma: General Perspectives and Recommendations for Prognostic Tools in Mature B-cell Lymphomas and Chronic Lymphocytic Leukaemia

    M Ladetto and others 

    Annals of Oncology, 2017. 00: pages 1–12

  • 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.