There are more than 60 subtypes of non-Hodgkin lymphoma (NHL) according to the Leukemia & Lymphoma Society. The subtype of non-Hodgkin lymphoma impacts the treatments given and their timing. It’s important to know which subtype, or in some cases more than one subtype, of NHL has been identified.

The type of cell the lymphoma started in determines the subtype along with how the lymphoma cells look, their genetic makeup, and whether there are proteins present on the surface of the cells.

If you've received a diagnosis of non-Hodgkin Lymphoma the sub-type is important. Talk to your hematologic oncologist about it, or find a specialist near you throughout Colorado.

Where Does Non-Hodgkin Lymphoma Start?

Non-Hodgkin lymphoma usually starts in the lymphocytes. A lymphocyte is a type of immune cell made in the bone marrow that moves into the lymph system where it fights foreign bodies like bacteria and viruses. When a lymphocyte cell mutates it can lead to the development of non-Hodgkin lymphoma. The type of lymphocyte plays a large role in the subtype of NHL.

B-cells

B-cells, which help fight off infections, account for about 90% of non-Hodgkin lymphoma.

T-cells

T-cells, which have a few jobs including helping the B-cells make antibodies, make up about 10% of NHL in the United States.

Natural Killer (NK)

Natural Killer (NK) cell mutations are rare, accounting for less than 1% of NHL.

B-Cell Non-Hodgkin Lymphoma Subtypes

Diffuse large B-cell lymphoma (DLBCL)

The most common subtype, is aggressive, often involving organs other than the lymph nodes.

Follicular lymphoma

The second most common subtype, usually develops in lymph nodes and is slow-growing. Long-term, it can transform into DLBCL. Genetic changes can change the function of certain proteins.

Mantle cell lymphoma

Occurs in 5% to 7% of people with NHL, mostly males over age 60. This aggressive type can affect the bone marrow, lymph nodes, spleen, esophagus, stomach, and intestines.

Small lymphocytic lymphoma

Is the same disease as B-cell chronic lymphocytic leukemia (CLL) but with less disease in the blood. It grows slowly, affecting about 5% of NHL patients.

Double hit/triple hit lymphoma

A highly aggressive subtype of DLBCL, causes changes in certain genes. The double hit subtype is more common in older adults. Although rare, follicular lymphoma can become double hit lymphoma.

Primary mediastinal large B-cell lymphoma

An aggressive form of DLBCL, is more common in women 30 to 40 years of age. A large mass develops in the middle of the chest, causing breathing problems. It can also cause the superior vena cava – a major vein that carries blood from your head and upper chest to the heart – to be compressed.

Splenic marginal zone B-cell lymphoma

Usually grows slowly and begins in the spleen, involving bone marrow and blood.

Extranodal marginal zone B-cell lymphoma of MALT

Usually occurs in the stomach, where it’s caused by H. pylori bacteria. It can also develop in the lungs, skin, thyroid gland, salivary glands, bowels, or eyes. Patients may have a history of autoimmune disease.

Nodal marginal zone B-cell lymphoma

Is a rare type of slow-growing lymphoma in the lymph nodes.

Lymphoplasmacytic lymphoma

Is a slow-growing, rare lymphoma involving bone marrow, lymph nodes, and spleen. If it produces a protein in the blood, it’s called Waldenstrom’s macroglobulinemia (WM). WM causes blood to thicken, triggering headaches, blurry vision, dizziness, and shortness of breath.

Burkitt lymphoma

Is aggressive but very rare. It develops as an abdominal mass but can affect other parts of the body. It involves genetic changes, and because it spreads rapidly, treatment must start immediately.

T-Cell and NK-cell Subtypes

Anaplastic large cell lymphoma

The primary cutaneous type, involves only the skin. It’s slow-growing but can become aggressive.

Anaplastic large cell lymphoma, systemic type

Is an aggressive although uncommon subtype, affecting only 2% of all adult lymphomas. It can cause genetic changes.

Breast implant-associated anaplastic large cell lymphoma

Only recently recognized as a lymphoma subtype, develops in tissue near breast implants.

Peripheral T-cell lymphoma, not otherwise specified (NOS)

Is fast-growing and is often advanced when diagnosed. Comprising about 6% of lymphomas, it’s more common in people over age 60.

Angioimmunoblastic T-cell lymphoma

Is an aggressive form that causes enlarged and tender lymph nodes, fever, weight loss, rash, frequent infections, and a high level of blood immunoglobulins.

Adult T-cell lymphoma/leukemia (human T-cell lymphotropic virus type I positive)

Is an aggressive subtype caused by human T-cell lymphotropic virus type I. It often involves bone and skin. When these cells are found in the blood, it’s called leukemia.

Extranodal NK/T-cell lymphoma, nasal type

Is usually limited to nasal and sinus areas but can include skin, testicles, stomach, or intestines. Very aggressive, it’s rare in the United States.

Enteropathy-associated T-cell lymphoma

Involves the intestines. It’s very aggressive but rare in the United States. Patients may also have gluten intolerance or celiac disease.

Hepatosplenic T-cell lymphoma

Is an aggressive subtype involving the liver and spleen. The median age of diagnosis is 35, and it is more common in males.

Subcutaneous panniculitis-like T-cell lymphoma

Involves tissues under the skin. It’s often diagnosed as inflammation of fatty tissues (panniculitis).

Mycosis fungoides

Are rare, primarily causing red patches or diffuse redness of the skin. Initially slow-growing, it can become aggressive and spread to lymph nodes or internal organs.

Fast or Slow-Growing NHL

As mentioned in the descriptions of the subtypes, there are fast-growing non-Hodgkin lymphomas, called aggressive and there are slow-growing NHL’s called indolent. The types of treatments and the timing of them will be impacted by both the type of lymphocyte affected and its likelihood of growing quickly.

Because B-cells account for about 90% of all non-Hodgkin lymphomas, here is a breakout of some of the more common subtypes.

Aggressive B-Cell non-Hodgkin lymphomas

About 60% of all NHL cases are aggressive with diffuse large B-cell lymphoma (DLBCL) being the most commonly diagnosed fast-growing NHL subtype. Other aggressive B-Cell subtypes of lymphoma include:

  • Anaplastic large-cell 
  • Mantle cell (MCL)
  • High-grade B-cell lymphoma with double or triple hits (HBL)
  • Lymphoblastic 
  • Burkitt 
  • Peripheral T-cell (PTCL)
  • Central nervous system (CNS) 
  • Transformed follicular and transformed mucosa-associated lymphoid tissue (MALT)
  • Acquired immune deficiency syndrome (AIDS)-associated 

Indolent B-Cell non-Hodgkin lymphomas

About 40% of non-Hodgkin lymphomas are slow-growing, or indolent, showing fewer signs and symptoms. Follicular lymphoma is the most common subtype of slow-growing NHL. Other slow-growing NHLs include:

  • Marginal zone lymphoma (MZL)
  • Chronic lymphocytic leukemia/small-cell lymphocytic (CLL/SLL)
  • Gastric mucosa-associated lymphoid tissue (MALT) 
  • Waldenstrom macroglobulinemia
  • Lymphoplasmacytic
  • Nodal marginal zone lymphoma (NMZL) 
  • Splenic marginal zone lymphoma (SMZL)

Once the subtype of lymphoma has been identified, the right treatment plan can be developed. Other factors such as how advanced the lymphoma is, and where it's located in the body, will impact the order of treatments and the specific types of treatments that are likely to work best. 

If you’ve been diagnosed with lymphoma recently this information can seem like a lot of information. Learn more about how you can navigate through a new lymphoma diagnosis

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