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Common Types of Lymphoma
Hodgkin lymphoma
Follicular
Small lymphocytic lymphoma
Chronic lymphocytic leukemia
Marginal zone lymphoma
Waldenstrom's macroglobulinemia
Cutaneous T-Cell lymphoma
Diffuse large B-cell lymphoma
Mantle cell lymphoma
Burkitt's lymphoma
Peripheral T-cell lymphomas
Transformed lymphomas
Anaplastic Large Cell lymphoma
AIDS-related lymphomas
Primary Central Nervous System Lymphoma
Pediatric lymphoma
Indolent Non-Hodgkin Lymphomas
Follicular lymphoma
Follicular lymphomas are divided into grade I, II, or III, and are relatively common, making up 20%-30% of all NHLs. Follicular lymphomas arise from B-lymphocytes and are therefore, one of the B-cell lymphomas. These lymphomas typically affect middle-aged and older adults. Because they are common, follicular lymphomas are often used as a model for the treatment of other indolent lymphomas. About half of follicular lymphomas may eventually transform into a more aggressive lymphoma. Indolent forms that transform into more aggressive lymphomas are often more difficult to treat than those that are aggressive at diagnosis. People with follicular NHL usually have lymphoma in many parts of the body, including the bone marrow, and are rarely localized. Follicular lymphomas are divided into three grades according to the numbers of small and large cells. Grades I and II have a similar clinical course, whereas some grade III lymphomas are considered to be more aggressive.
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Small lymphocytic lymphoma (SLL)/Chronic lymphocytic leukemia (CLL)
Small lymphocytic lymphoma (SLL) is found in both the lymph nodes and ultimately in the bone marrow. Accounting for about 4% of NHL, SLL is initially sensitive to treatment but may eventually become resistant or transform into a more aggressive large cell lymphoma. Chronic lymphocytic leukemia (CLL) is nearly identical to SLL, but in CLL the cancer cells are found primarily in the blood, whereas in SLL the cancer cells are primarily in the nodes. SLL and CLL are considered the same disease but doctors may use either term based on whether the cancer cells are found in the blood or nodes. About 20% of all cases of SLL/CLL eventually progress to a higher grade such as diffuse large cell lymphoma (called Richter's syndrome). This progression can take many years.
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Marginal zone lymphoma
Marginal zone tumors are indolent B-cell lymphomas and may occur either outside lymph nodes (extranodal) or within lymph nodes (nodal). They are divided into two categories depending on the location of the lymphoma. Mucosa-associated lymphoid tissue lymphomas (also called MALT or MALTomas) are forms of marginal zone lymphomas that affect places outside the lymph nodes (such as the gastrointestinal tract, eyes, thyroid, salivary glands, lungs, or skin). Many people who develop these lymphomas have a history of autoimmune disease. A higher incidence of this disease involving the stomach is seen in patients who have been infected with the bacterium Helicobacter pylori (H. pylori). Other bacteria have also been implicated in other forms of MALT lymphoma. Nodal marginal zone B-cell lymphomas are uncommon and are sometimes called monocytoid B-cell lymphomas. The median age for diagnosis of this type of lymphoma is 65. Some marginal zone lymphomas are found in the spleen and blood.
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Waldenstrom's macroglobulinemia (also called lymphoplasmacytic lymphoma or immunocytoma)
This B-cell lymphoma is rare, occurring in only 1%-2% of people with NHL. This disease usually affects older adults, and there is often bone marrow involvement at the time of diagnosis. A high level of protein (IgM) produced by the cells, may cause symptoms.
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Cutaneous T-cell lymphoma (CTCL)
CTCL represents a spectrum of T-cell lymphomas that arise in the skin. The most common type is mycosis fungoides, which is often indolent. The skin may have localized, thickened patches that appear reddish. If the cells are found in the blood, this disease is more aggressive and may be called Sezary Syndrome. CTCL comprises about 2%-3% of all NHLs. The age of presentation is usually between 55-60 years.
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Aggressive Non-Hodgkin Lymphomas
Diffuse large B-cell lymphoma (DLBCL)
Large cell lymphomas are the most common type of lymphoma, comprising about 30%-40% of NHLs. The median age of those affected is 57, with a range of 10 to 88 years. Although most frequently seen in adults, large cell lymphomas may also be seen in children. These aggressive cancers may arise in lymph nodes or in extranodal sites, including the gastrointestinal tract, testes, thyroid, skin, breast, central nervous system, or bone. These lymphomas may be localized or Generalized (spread throughout the body).
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Mantle cell lymphoma (MCL)
Mantle cell lymphoma is a B-cell lymphoma that accounts for about 5%-10% of all cases of NHL in the United States. MCL usually affects men over 50, who are almost always diagnosed when the disease is disseminated. Frequently, patients with mantle cell lymphoma have many lymph nodes, one or more organs, and bone marrow involved. This lymphoma usually is more aggressive than most low-grade lymphomas. New treatment modalities now in clinical trials have, however, shown some effect on this disease.
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Burkitt's lymphoma, Burkitt-like lymphoma (small non-cleaved cell lymphoma)
Burkitt's lymphoma is an aggressive B-cell form of lymphoma that was first described in Africa, where it is called endemic Burkitt's lymphoma. When diagnosed in other parts of the world, such as in the United States or Europe, this disease is called sporadic Burkitt's lymphoma. It is seen in both children and adults. It is also one of the lymphomas often diagnosed in people infected with HIV. All varieties of Burkitt's lymphoma occur more frequently in men. Burkitt's lymphoma and Burkitt-like lymphoma behave similarly and aggressively.
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Peripheral T-cell lymphomas
Peripheral T-cell lymphomas comprise 10%-15% of all NHLs in adults. The term peripheral T-cell lymphoma is based on the fact that these are tumors composed of T-cells (not B-cells) and that the cells are mature. Most peripheral T-cell lymphoma are aggressive, with the exception of mycosis fungoides (CTCL), mentioned above with the indolent or low grade lymphomas. Peripheral T-cell lymphomas such as angioimmunoblastic T-cell lymphoma or anaplastic large cell lymphoma can arise in lymph nodes, while others like subcutaneous panniculitis-like T-cell lymphoma, nasal NK/T-cell lymphoma, or intestinal T-cell lymphoma can arise in extranodal sites. These tumors are not well understood, but they are usually aggressive and have widespread involvement at diagnosis.
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Transformed lymphomas
Although indolent B-cell lymphomas, such as follicular lymphoma, are most commonly associated with transforming to aggressive disease, slow-growing T-cell lymphomas can also progress to aggressive disease. We asked Andrew D. Zelenetz, M.D., Ph.D., Chief, Lymphoma Service, Memorial Sloan-Kettering Cancer Center in New York City to explain why indolent lymphomas become aggressive and how to tell if your disease is transforming.
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Anaplastic Large Cell lymphoma
Anaplastic large cell lymphoma (ALCL) is a rare aggressive T-cell lymphoma comprising only about 3 percent of all lymphomas in adults and between 10 percent and 30 percent of all lymphomas in children and can present in either the systemic or cutaneous form. We talked with Andrei Shustov, M.D., assistant professor of medicine, Division of Hematology at the University of Washington in Seattle, about what you need to know about ALCL and what’s on the horizon for new treatment.
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Other Lymphomas
AIDS-related lymphomas
Lymphomas occurring in HIV-positive patients are usually aggressive. It is estimated that as many as 10% of people who are HIV-positive will ultimately develop lymphoma. The most common lymphomas that are seen in patients with HIV include: diffuse large B-cell, Burkitt's/Burkitt-like, primary central nervous system, and Hodgkin’s lymphoma.
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Primary Central Nervous System Lymphoma (PCNSL)
Primary central nervous system lymphoma is a type of cancer that is limited to the brain or spinal cord. An increasing occurrence of this disease has been seen in patients with AIDS and others whose immune system has been compromised. Median age of diagnosis for patients with PCNSL is 55 years for patients with a normal immune system, and 31 years for AIDS patients.
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Pediatric lymphoma
Childhood NHL comprises about 5% of all cases of NHL diagnosed in the United States. The most common types are lymphoblastic lymphoma, Burkitt's lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma. Lymphoblastic lymphoma is closely related to acute lymphoblastic leukemia of childhood. Anaplastic large cell lymphoma is a type of T-cell lymphoma often diagnosed in children and young adults. Of all T-cell lymphomas, these tumors have the highest cure rate. The number of children with NHL has continued to increase.
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