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What are some non-Hodgkin lymphoma subtypes Medically reviewed by Julie Scott, DNP, ANP-BC, AOCNP — By Jenna Fletcher on June 10, 2022Non-Hodgkin lymphoma is a common type of blood cancer with several subtypes that require different treatment and have different outlooks. Non-Hodgkin lymphoma (NHL), sometimes just called lymphoma, is a type of cancer that starts in the immune system’s lymphocytes, which are white blood cells. NHL is not one single cancer.
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Instead, it is a term for several different types of cancer that share similar characteristics. To get proper treatment, a person needs to know their NHL subtype.
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Each subtype can have different treatment options and outlooks for the person. This article reviews the different subtypes of NHL, diagnosis, and outlook. Learn more about NHL here.
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Aggressive NHLs
Share on PinterestMd Ariful Islam/Getty ImagesAggressive NHLs grow and spread quickly. They typically require prompt treatment to prevent them from spreading. The most common type of aggressive NHL in the United States is diffuse large B-cell lymphoma (DLBCL).
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Treatment for aggressive NHL can cure cancer in some instances. Treatment often includes combined medication chemotherapy and radiation therapy.
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With combined medication chemotherapy, doctors use different combinations of chemotherapy drugs. One of the most common is known as R-CHOP. The combination includes rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone.
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Radiation therapy is where doctors use radiation to kill cancer cells and shrink tumors. Learn more about radiation therapy here. Indolent NHLs
Indolent NHL refers to subtypes of lymphoma that grow and spread slowly.
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Some indolent lymphomas will not require treatment, and doctors will recommend a “watch and wait” approach. Follicular lymphoma is the most common type of indolent lymphoma in the U.S. Treatments for indolent types of NHL can vary according to factors such as:the stage of the cancera person’s ageoutlook factors, such as overall health
Treatments can vary in intensity and according to the exact subtype.
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For example, cutaneous T-cell lymphoma may include topical treatments as well as chemotherapy. What are some NHL subtypes
There are several subtypes of NHL.
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Aggressive NHL accounts for about 60% of all cases, and indolent NHL accounts for 40%. However, the American Cancer Society notes that the number of NHL subtypes is extensive, making it difficult for doctors to classify them.
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The most recent classification system comes from the World Health Organization (WHO). The WHO’s system breaks up NHL subtypes by:how they look under a microscopethe type of lymphocyte the cancer started inpresence of certain proteins on the surface of the cancer cellsfeatures of the chromosomes of the cancer cells
B-cell vs T-cell lymphomas
The lymph system contains two main types of lymphocytes, a type of white blood cell that helps fight infections.
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Lymphoma can start in either type of lymphocyte or cell.B lymphocytes or B cells: B cells make antibodies that attach to harmful bacteria or viruses. This marks them for destruction by other parts of the immune system.T lymphocytes or T cells: Some T cells destroy harmful germs or abnormal cells. Other T cells boost or reduce the activity of other immune system cells.
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Doctors classify NHLs as B cell or T cell depending on where the cancer originates. B-cell lymphomas
B-cell lymphomas account for about 85–90% of all NHL cases.
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They may be aggressive or indolent. The aggressive types include:transformed follicular and transformed mucosa-associated lymphoid tissue lymphomasmantle cell lymphoma, which can be either aggressive or indolentlymphoblastic lymphoma primary mediastinal (thymic) large B-cell lymphoma Burkitt lymphoma primary central nervous system lymphomahigh-grade B-cell lymphoma with double or triple hits primary cutaneous DLBCL, leg typediffuse large B-cell lymphomaprimary DLBCL of the central nervous systemAIDS-associated lymphoma
The indolent types of B-cell lymphoma include:Waldenström macroglobulinemia marginal zone lymphoma chronic lymphocytic leukemia/small-cell lymphocytic lymphomasplenic marginal zone lymphoma lymphoplasmacytic lymphoma follicular lymphoma nodal marginal zone lymphoma gastric mucosa-associated lymphoid tissue lymphoma
T-cell lymphomas
T-cell lymphomas are another type of NHL that account for about 10–15% of all cases. Like B-cell NHL, they include both aggressive and indolent types.
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The aggressive types can include:angioimmunoblastic T-cell lymphoma lymphoblastic lymphoma primary cutaneous anaplastic large-cell lymphomasystemic anaplastic large-cell lymphoma hepatosplenic gamma/delta T-cell lymphomasubcutaneous panniculitis-like T-cell lymphoma enteropathy-type intestinal T-cell lymphomaperipheral T-cell lymphoma, not otherwise specified
The indolent types can include:Sézary syndromecutaneous T-cell lymphomamycosis fungoidesextranodal NK/T-cell lymphoma, nasal typeadult T-cell leukemia//lymphoma
Lymphoma and leukemia
Leukemia and lymphoma are two types of cancer that affect the blood. The main difference between the two is where they start.
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Lymphoma typically starts in the lymph nodes and lymphatic system. Leukemia typically starts and develops in the bone marrow. There are a few types of leukemia, including the most common in adults known as chronic lymphocytic leukemia.
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Like NHL, this type of leukemia starts in the lymphocytes when they are still in the bone marrow. This type of leukemia is slow-growing and can take years to spread to other areas of the body.
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Learn more about lymphoma and leukemia here. Diagnosis of NHL
A person may notice some signs and symptoms associated with NHL. They can include:fatigueunexplained weight lossfeverswollen lymph nodesnight sweats
If a doctor suspects NHL based on symptoms and a physical review, they will likely order a biopsy of an affected lymph node.
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A pathologist should be able to identify both the presence of NHL and the subtype based on the biopsy. A doctor may order further tests to determine the stage of the cancer. Tests may include:PET scanCT scanblood testbone marrow biopsyheart and lung function test
Doctors use a staging system that ranges from stages 1–4.
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Stage 1 is the least advanced and stage 4 is the most advanced. Outlook
Outlook for NHL can vary greatly between people.
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The factors that affect it include:aggressiveness of the NHL subtypesubtype itselfage of the personoverall healthstage of the cancersize of the tumorwhere it has spread
The average 5-year survival rate for all types and stages of NHL is 73.8%. More positive outlooks have links with factors such as:stage 1 or 2 NHLcancer located within lymph nodes onlyyounger than age 60normal levels of lactate dehydrogenase (LDH) in bloodability to function normally
Learn more about survival rates for NHL here.
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Summary
There are many subtypes of NHL, each with different treatment options and outlooks. Aggressive NHLs are fast-growing and indolent NHLs are slow-growing.
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Doctors classify NHLs as B cell or T cell depending on the type of lymphocyte they first appear in. Many factors can affect a person’s outlook, including how aggressive the NHL is, a person’s age, and their overall health.
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A person can ask a doctor about the outlook for their particular NHL. Last medically reviewed on June 10, 2022LymphomaCancer / OncologyMedically reviewed by Julie Scott, DNP, ANP-BC, AOCNP — By Jenna Fletcher on June 10, 2022
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New clues arise
Related CoverageNon-Hodgkin lymphoma and dietMedically reviewed by Katherine Marengo LDN, R.D. There is no diet that can cure this form of cancer, but it may help someone manage treatment side effects.
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Learn more here.READ MOREHomeopathy for non-Hodgkin lymphoma
There is no evidence that homeopathic treatment for non-Hodgkin lymphoma works, but it may help people feel more in control. Learn more.READ MOREHelping Someone With Cancer
Many people know someone with cancer, a friend, a relative or a colleague at work and want to help, but don't know how to go about offering it or what…READ MOREWhat are the stages of cancer?Medically reviewed by Christina Chun, MPH
Doctors use cancer stages to describe how severe a cancer is and to guide the treatment. Learn more about staging systems and cancer grading here.READ MORECancer and genetics: What's the connection?Medically reviewed by Alana Biggers, M.D., MPH
The causes of many cancers are generally unknown.
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Some cancer cases, however, occur through a person inheriting a genetic mutation. Learn more about…READ MORE
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