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Classifying non-Hodgkin lymphoma can be confusing because there are so many different types and because several different classification systems have been used. The most recent system is the World Health Organization (WHO) classification. The WHO classification system groups lymphomas based on microscopic appearance, the chromosome features of the lymphoma cells, and the presence of specific chemicals on the surface of the cells. This is a more thorough classification system–older systems classified lymphomas based only on how they looked under a microscope.
B-cell lymphomas make up most (about 85%) of non-Hodgkin lymphomas in the United States.
This is one of the more common types of non-Hodgkin lymphoma in the United States (around 40% all lymphoma cases in the United States). Of all cancers involving the same class of blood cell, 31% of cases are DLBCL.
Diffuse large B-cell lymphoma (DLBCL) can affect any demographic age group but occurs more often in older patients–the average age in the mid-60s. It usually starts as a growing mass in an internal lymph node, such as in the chest or abdomen, neck or armpit. Lymphomas usually start in the lymph nodes but can also grow in other areas such as the intestines, bone, or even the brain or spinal cord.
About 1 out of 3 of these lymphomas is localized to one part of the body and are easier to treat than if they have spread to other parts of the body. Genetic tests have shown that there are different subtypes of DLBCL, even though they look the same under the microscope. These subtypes seem to have different prognoses and responses to treatment.
This is an aggressive lymphoma, but often responds well to chemotherapy treatment. About 75% of patients will have no signs of disease after initial treatment, and about half of all people with this lymphoma are cured with therapy.
Around 20 per-cent of all lymphoma cases in the United States are follicular lymphoma. It is called follicular because the cells grow in circular or nodular patterns within the lymph nodes.
This is another lymphoma that is fairly common in the elderly with an average age of 60. It very rare in young patients. In most cases this lymphoma occurs in many lymph node sites of the body as well as in the bone marrow.
Follicular lymphomas are often slow-growing and is very difficult to cure. Median survival rate is around 10 years, but the range can be from less than one to more than 20. Usually follicular lymphomas are not treated when first diagnosed if patients do not display any symptoms of the disease. About 33 per-cent of follicular lymphomas transforms into a fast-growing diffuse B-cell lymphoma.
Both are closely related diseases–many doctors consider them to be different versions of the same disease. The same lymphocyte cell is responsible for both chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL). The difference being where the cancer occurs. CLL usually occur in the blood and bone marrow, in contrast SLL usually occurs in the lymph nodes. SLL accounts for about 5% to 10% of all lymphomas.
CLL and SLL are both slow-growing diseases and are treated the same way. They are usually not considered curable with standard treatments, but depending on the stage and growth rate of the disease, most patients have a life expectancy of more than 10 years. Occasionally, these slow-growing lymphomas may transform into a more aggressive form of lymphoma.
This is one of the rarer non-Hodgkin lymphomas comprising 6 per-cent of NHL cases. Very difficult to treat and rarely cured, it affected most often. The average age of patients is in the early 60s and the ratio of males to females affected is about 4:1. The lymphoma is usually widespread when it is diagnosed involving lymph nodes, bone marrow, and spleen.
Difficult to treat and slow growing, what causes MCL is still unknown.
There are no proven standards of treatment for MCL, and not even consensus among specialists on how to treat it optimally. Many regimens are available and often get good response rates, but patients almost always get disease progression after chemotherapy. Each relapse is typically more difficult to treat, and relapse is generally faster. Fortunately, regimens are available that will treat relapse, and new approaches are under test. Because of the aforementioned factors, many MCL patients enroll in clinical trials to get the latest treatments.
There are four classes of treatments currently in general use: chemotherapy, immune based therapy, radioimmunotherapy and new biologic agents
Marginal zone lymphomas account for about 5-10 per-cent of lymphomas. Marginal zone lymphomas (MZL) are indolent lymphomas that affect the B-cells. The marginal zone is the area in the B-cell in which the mutation occurs resulting in cancer.. There are 3 main types of marginal zone lymphomas.
The name extranodal identifies these lymphomas as starting in places other than the lymph nodes and are the most common type of MZL. Many MALT lymphomas start in the stomach and are believed to be connected to a bacteria called Helicobacter pylori, which also causes many different types of stomach ulcers. The lung, skin, thyroid, salivary glands, and tissues surrounding the eye are other possible sites of MALT lymphomas. Usually it is confined to the area where it begins and does not spread.
A slow-growing lymphoma that is often curable in its early stages–doctors often use antibiotics as the first treatment for this type of lymphoma.
A rare disease usually found in older women. Usually most lymph nodes are involved, although at times lymphoma cells can be found in the bone marrow.
Another slow growing lymphoma, patients are usually cured when diagnosed in the early stages.
This is a rare lymphoma. Most often the lymphoma is found only in the spleen and bone marrow.
Patients are often elderly and male and have fatigue and discomfort caused by an enlarged spleen. Because the disease is slow-growing, treatment may not be needed unless the symptoms become troublesome.
This type accounts for about 2% of all lymphomas and is a diffuse large B-cell lymphoma arising in the thymus.
This lymphoma starts in the mediastinum (the area around the heart and behind the chest bone). Usually localized when found and rarely involves the bone marrow. It can cause trouble breathing because it often presses on the windpipe (trachea) leading into the lungs. It can also block the superior vena cava (the large vein that returns blood to the heart from the arms and head). This can cause the arms and face to swell.
About66 percent of patients with this lymphoma are women. Most are young — in their 30s. It is a fast growing lymphoma but it is treatable. About half of patients can be cured.
This type makes up about 1-2 percent of lymphomas named after the doctor who first described this disease in African children and young adults.
This is a very aggressive lymphoma often starting as tumors in the jaws or other facial bones in the African variety. The more common types seen in the United States, the lymphoma usually starts in the abdomen, where it forms a large tumor mass. It can also start in the ovaries, testes, or other organs, and can spread to the brain and spinal fluid.
About 90% of patients are male with an average age of about 30. Although this is a fast-growing lymphoma, over half of patients can be cured by intensive chemotherapy.
A rare lymphoma accounting for 1-2% of lymphomas. The cells are small and found mainly in the bone marrow, lymph nodes, and spleen.
Most of the time the lymphoma cells make an antibody called immunoglobulin M (IgM), a very large protein. The attributes of this antibody is that when it circulates in the blood in large amounts, and acting as a thickener can lead to decreased blood flow to many organs–causing vision problems and neurological problems (such as headache, dizziness, and confusion). This lymphoma is slow growing. Although it isn’t usually considered to be curable, most patients live longer than 5 years.
Despite the name, this is sometimes considered to be a type of lymphoma. Hairy cell leukemia (HCL) is rare — about 1,000 people in the United States are diagnosed with it each year. The cells are small B lymphocytes with projections coming off them that give them a “hairy” appearance. They are typically found in the bone marrow and spleen and circulating in the blood.
Patients with HCL tend to be older in general. Since hairy cell leukemia is slow-growing, and some patients may never need treatment. An enlarging spleen or dropping blood counts (due to cancer cells invading the bone marrow) are the usual reasons to begin treatment, which is highly effective.
This lymphoma usually involves the brain (called primary brain lymphoma), but it may also be found in the spinal cord and in tissues around the spinal cord and the eye. Over time, it tends to become widespread in the central nervous system. Primary CNS lymphoma is more common in people with immune system problems, such as those infected with HIV, the virus that causes AIDS. Most people develop headaches and confusion. They can also have vision problems, paralysis of some facial muscles, and even seizures in some cases.
The outlook for people with this condition has always been thought to be fairly poor, but about 30% to 50% of people can live at least 5 years with today’s treatments.
T-cell lymphomas make up less than 15% of non-Hodgkin lymphomas in the United States.
This disease accounts for about 1% of all lymphomas and can be considered either a lymphoma or leukemia, depending on how much of the bone marrow is involved (leukemias have more bone marrow involvement).
It often starts in the thymus gland (where many T cells are made) and can develop into a large tumor in the mediastinum just as PMBL causing breathing problems if it presses on the windpipe.
Patients are most often young adults, with males being affected more often than females.
This lymphoma is aggressive, but if it hasn’t spread to the bone marrow when it is first diagnosed, the chance of cure with chemotherapy is quite high. Once it is in the bone marrow, only about 40% to 50% of patients can be cured.
These types of lymphomas develop from more mature forms of T cells. A rare lymphoma accounting for about 5% of all lymphomas.
These lymphomas start in the skin causing lesions. These lesions can change shape as the disease progresses, typically beginning with was appears as a rash and eventually forming plaques and tumors before metastasizing to other parts of the body.
This lymphoma tends to occur in the lymph nodes and may affect the spleen or liver. Patients usually have fever, weight loss, and skin rashes and often develop infections. This lymphoma often progresses quickly.
It is called “extranodal” to emphasize that the location is not in the lymph node. It is sometimes further qualified as “nasal type”.This type often involves the upper airway passages, such as the nose and upper throat, but it can also invade the skin and digestive tract. It is much more common in parts of Asia and South America. All ages can be affected.
This lymphoma occurs in the small intestines with people whom are sensitive to gluten–the main protein in wheat flour. The disease, called gluten-sensitive enteropathy, can progress to this lymphoma, which typically invades the walls of the intestines.
(PTCL) is defined as a diverse group of aggressive lymphomas that develop from mature-stage white blood cells (T-Cells) and is rare. It invades the deep layers of the skin, where it causes nodules to form.
About 1% to 2% of lymphomas are of this type and is more common in young people–including children, but also occurs in patients in their 50s and 60s. It usually starts in lymph nodes and can also spread to skin. This type of lymphoma tends to be aggressive but often very curable.
This name is given to T-cell lymphomas that don’t readily fit into any of the groups above. They make up about 50% of all T-cell lymphomas. The tumor cells can be small or large and most patients are in their 60s. As a group, these lymphomas tend to be widespread and be aggressive. Some cases respond well to chemotherapy, but long-term survival is not common.
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