Different Forms of Lymphoma

Within the two main categories of NHL and Hodgkin lymphoma, there are a number of different types of lymphoma.

Non-Hodgkin Lymphoma (NHL)

NHL isn’t just one type of lymphoma. It’s the name given to describe a group of cancers that share similar characteristics. In fact, there are more than 90 types of NHL. (3)

This form of lymphoma can begin in the:

• B Lymphocytes (B Cells) These cells make antibodies to fight infections. Most NHL is caused by B cells.
• T Lymphocytes (T Cells) T cells have several jobs, including helping B cells make antibodies and fighting viruses.

They typically develop in the lymph nodes and lymphatic tissue. But sometimes they can affect bone marrow and blood. (3)

Some NHLs are slow-growing, while others can be aggressive. Your treatment options will depend on the type of NHL you have and how advanced it is.

Types of NHL

Some of the more common types of NHL include:

• Diffuse Large B-Cell Lymphoma (DLBCL) This form of NHL accounts for about 1 in every 3 lymphomas, making it the most common type. It’s often aggressive but responds well to treatment. DLBCL mostly impacts older people, though there are several subtypes, including primary mediastinal B-cell lymphoma, which primarily affects young women. (4)
• Follicular Lymphoma Follicular lymphoma accounts for about 1 in 5 lymphomas in the United States. These NHLs are typically slow-growing, although some can be aggressive. This type of lymphoma is rare in younger people and is difficult to cure, though patients often live for many years with this, oftentimes with long periods of not needing treatment. Some follicular lymphomas can turn into fast-growing DLBCL. (4)
• Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) These are closely related diseases. They’re usually slow-growing, and though they’re not typically cured with standard treatments, many people with CLL and SLL live long lives. Both diseases are treated the same way, and there are many new therapies available. (4) The main difference between the two conditions is that when the cancer cells are found primarily in the lymph nodes, it is referred to as SLL. If the cancer cells are found mostly in the bloodstream and bone marrow, it is diagnosed as CLL. It is most common in older adults and is so slow growing that doctors sometimes opt to watch the disease for a time or monitor it with tests before treating.
• Mantle Cell Lymphoma (MCL) MCLs are much more prevalent in men than in women. They’re also more likely to affect older people and are challenging to treat. This type accounts for about 5 percent of lymphomas. (4)

Some rarer types of NHL include:

• Cutaneous T-Cell Lymphomas Sezary syndrome and mycosis fungoides are considered cutaneous T-cell lymphomas, which are lymphomas that start in the skin. (4)
• Cutaneous B-Cell Lymphomas These lymphomas also attack the skin. (5)
• Primary Central Nervous System Lymphoma This type of lymphoma affects the brain or spinal cord. It’s more common in older people and those who have weakened or compromised immune systems. (4)
• Waldenstrom Macroglobulinemia In some cases, Waldenstrom macroglobulinemia doesn’t cause signs or symptoms for years. This type of NHL is rare and slow-growing. (6)
• Burkitt Lymphoma This fast-growing lymphoma is more common in children, and more common in the developing world. The disease can grow quickly and requires prompt treatment. (4)

Hodgkin Lymphoma 

Hodgkin lymphoma, which used to be called “Hodgkin’s disease,” is thought to start in the B cells of the body. It can begin anywhere but most often affects lymph nodes in the upper body, such as those located near the chest, neck, or underarms. (7)

This form of lymphoma can spread from lymph node to lymph node.

Hodgkin lymphoma is most common in people in their early twenties and those over age 55, but it can affect adults and children of any age.

Types of Hodgkin Lymphoma

There are two main types of Hodgkin lymphoma: (7)

• Classical Hodgkin Lymphoma Classical Hodgkin lymphoma is the more common form, accounting for about 9 in 10 cases of Hodgkin lymphomas in developed countries. People with this form of lymphoma have large, abnormal cells, known as Reed-Stern cells, in their lymph nodes. There are four subtypes of classical Hodgkin lymphoma: nodular sclerosis Hodgkin lymphoma, mixed cellularity Hodgkin lymphoma, lymphocyte-rich Hodgkin lymphoma, and lymphocyte-depleted Hodgkin lymphoma.
• Nodular Lymphocyte Predominant Hodgkin Lymphoma This rare type of Hodgkin lymphoma is characterized by abnormal, large cells that look like popcorn. It usually starts in the lymph nodes of the neck and underarms.

The exact cause of lymphoma isn’t known, but it begins when special white blood cells, called lymphocytes, develop a genetic change that instructs them to multiply. This mutation triggers many lymphocytes to grow out of control. (2)

You might be at a greater risk for developing lymphoma if you:

• Are male
• Have a family history of lymphoma
• Are over 55
• Develop certain types of infection, such as Epstein-Barr virus, hepatitis C, or Helicobacter pylori
• Have a compromised or weak immune system
• Have received chemotherapy or radiation in the past (10)

The diagnosis of lymphoma begins with a physical exam, looking for swollen lymph nodes in the neck, underarm, groin, and elsewhere. Your doctor might then take a biopsy of a lymph node for laboratory analysis to determine whether the cells are characteristic of lymphoma. A bone-marrow sample might then be obtained to see whether it contains lymphoma cells.

Doctors can also take a sample of bone marrow from your hip bone to look for lymphoma cells. Your doctor also could order computerized tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans to look for signs of lymphoma elsewhere in the body.

There are many types of lymphoma, and it takes an expert to identify which kind of lymphoma you have. That’s key to getting proper treatment. You need an experienced pathologist, and you might want to get a second opinion. (11,12)

Learn More About Diagnosing Lymphoma

Prognosis of Lymphoma

The five-year survival rate describes the percentage of people who live at least five years after being diagnosed with a particular type of cancer.

According to the American Cancer Society, the overall five-year survival rate for NHL is 74 percent. (13) It’s important to note that these figures are variable for each subtype of NHL.

The five-year relative survival rate for people with localized Hodgkin lymphoma is about 93 percent. It’s about 83 percent for those with distant-stage disease (when the cancer has spread to areas such as the lungs, liver, or bone marrow). (14) The survival rates have steadily improved for this type of cancer in recent years. Hodgkin lymphoma is now considered one of the most curable forms of cancer. (15)

It’s important to remember that survival rates are only estimates. Your outlook will depend on several factors, including the type of lymphoma you have and how aggressive your disease is, as well as your age and general health.

While treatment for lymphoma is often successful and leads to complete remission, for some patients, lymphoma may be a chronic illness. The cancer doesn’t go away, but with ongoing treatment and close monitoring, it can be controlled and might not grow or spread for months or years. (16)

Treatment options are different for Non-Hodgkin Lymphomas and Hodgkin Lymphomas. And treatment will also depend on the stage of the cancer, among other factors.

Non-Hodgkin Lymphoma Treatment Options

Non-Hodgkin lymphoma is an umbrella term for a variety of cancers. Some of the most common are B-cell lymphomas, which include follicular lymphoma and small lymphocytic lymphoma (SLL). Once a proper classification of the lymphoma has been made, you and your doctor must consider a broad array of possible treatments, each with its own benefits and risks. The good news is you have a wide array of treatment options.

Medication Options

Chemotherapy is the main treatment for most people with non-Hodgkin lymphoma. Chemotherapy agents available for treatment include steroids, platinum drugs, such as cisplatin (Platinol), and other chemotherapy drugs, such as vincristine (Oncovin), doxorubicin (Adriamycin), and methotrexate. (17)

Immunotherapy (in which medication helps the immune system recognize and eliminate cancer cells), radiation, targeted therapy, and stem cell transplants are other treatment options. (12)

Tisagenlecleucel (Kymriah) and axicabtagene ciloleucil (Yescarta) are two types of CAR T-cell therapy (a form of immunotherapy) that are approved for the treatment of some B cell lymphomas. Additional medication may be used to treat the effects of chemotherapy. Antiviral drugs or antibiotics may be used to prevent infection.

Learn More About Treating Non-Hodgkin Lymphoma

Hodgkin Lymphoma Treatment

Most Hodgkin disease is usually what’s called “the classical type,” meaning it is characterized by large, abnormal lymphocytes (a type of white blood cell) in the lymph nodes. The treatment of Hodgkin lymphoma depends upon the stage of the cancer (how advanced it is). (18)

There are a variety of treatments for Hodgkin disease, but chemotherapy is the first-line treatment. Radiation is an additional option. And increasingly, immunotherapy can be used to treat Hodgkin lymphoma. (19)

Learn More About Treating Hodgkin Lymphoma

While many of the risk factors for lymphoma can’t be controlled, there are some that you can manage.

Because HIV and hepatitis C weaken the immune system, and are known to increase lymphoma risk, it’s important to avoid behavior that increases your risk for these infections — such as intravenous drug use and unprotected sex with multiple partners. (20) Treatments for both HIV and hepatitis C are available and may help mitigate complications, so be sure to talk to your doctor about your options.

Avoiding unnecessary exposure to radiation is another precaution you can take to lower your risk, as is maintaining a healthy weight and diet.

In rare instances, women have developed lymphoma in the scar tissue around breast implants. (21)

Treatments for Hodgkin and non-Hodgkin lymphoma are now so varied and effective that many patients will be cured and live long lives after diagnosis and treatment. But there can be complications as a result of treatment. Depending upon the type of treatment and the health of the patient, doctors will watch for heart disease, secondary cancers (elsewhere in the body), lung and bone health, and cognitive and memory problems. Regular follow-up care is essential.

Learn More About the Complications of Surviving Lymphoma: How It Affects Your Body in the Short and Long Term

About 90,390 new cases of lymphoma were expected to be diagnosed in the United States (8,830 cases of HL, 81,560 cases of NHL) in 2021. (15)

An estimated 825,000 people are living with, or in remission from, lymphoma in the United States. (15)

NHL is one of the most prevalent cancers in the United States, accounting for about 4 percent of all cancers. (8)

The chance that a man will develop NHL in his lifetime is around 1 in 43, which is higher than the 1 in 53 risk for a woman. (8)

In the United States, NHL is more likely to develop in white Americans than in Black Americans or Asian Americans. (22)

While white Americans are more likely to develop and be diagnosed with lymphoma, studies have shown that prognosis and treatment outcomes are often worse in Black and Hispanic Americans.

Black Americans and Lymphoma

A review of research published in 2017 noted that studies suggest that while the incidence of lymphoma is lower among Black Americans than white Americans, Black patients are generally younger and the lymphoma is at more advanced, aggressive stages when diagnosed. (23) Additionally, Black patients have a decreased rate of event-free survival and overall survival.

A study from 2015 examined the association between race and survival in pediatric Hodgkin lymphoma. (24) Study authors concluded that Black Americans had a worse survival rate than white or Hispanic Americans.

Another study, published in 2019, examined data for over 1,600 patients with pediatric and adolescent Hodgkin lymphoma. (25) The researchers found that five-year post-relapse survival probabilities were 66 percent for non-Hispanic Black Americans compared with 90 percent for white Americans.

The authors of both of these studies suggested that the reasons for these disparities are complex and warranted more investigation.

Hispanic Americans and Lymphoma

The 2019 study also found that Hispanic children and adolescents diagnosed with Hodgkin lymphoma had an 80 percent survival probability, compared with the 90 percent probably for white children and teens. (25)

There are several conditions that may raise your risk for lymphoma. People with HIV, AIDS, or hepatitis C have weakened immune systems, which puts them at greater risk for lymphoma. Rheumatoid arthritis and psoriasis are other conditions that also weaken your immune system, increasing the body’s inflammatory response, and research suggests this may affect the development of white blood cells, turning them malignant. (26)

But while an association with lymphoma has been shown, the reasons aren’t clear. It’s possible that immunosuppressive medication taken for these conditions is also a factor, and in the case of psoriasis, misdiagnosis of cutaneous T-cell lymphoma as psoriasis may contribute to the connection, according to a 2017 study. (27)