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Non-Hodgkin lymphoma

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Types of non-Hodgkin lymphoma

Lymphoma is a cancer that affects a type of white blood cell called a lymphocyte. Lymphocytes are immune cells that normally protect us from illness.

Non-Hodgkin lymphomas (NHL) are classified according to the World Health Organization (WHO) classification system. The WHO classification system is an updated version of the Revised European American Lymphoma (REAL) classification system. The different types of lymphoma are determined by the type of lymphocyte that has become cancerous and the stage in its development at which it became cancerous. The WHO classification system classifies NHL according to whether they are B- or T–cell lymphomas. NK-cell lymphomas are included in the T-cell group.

The B- and T–cell lymphomas are further classified into 2 basic types based on their stage of development (maturation):

  • precursor lymphomas – develop in immature lymphocytes during the earliest stages of their development
  • mature (peripheral) lymphomas – develop in more mature lymphocytes

Lymphomas and lymphoid leukemias are both included in the WHO classification for lymphomas because they both start in the same type of cell – the lymphocyte. They are basically the same disease and only differ in how and where they present:

  • lymphomas – mainly present as tumours in lymph nodes or other organs
  • leukemias – mainly present as a blood and bone marrow disease

About 85% of cases of NHL are B-cell lymphomas. The remaining 15% are T-cell and NK-cell lymphomas. Some of the more common subtypes of NHL include:

  • diffuse large B-cell lymphoma (DLBCL) – the most common and accounts for about 33% of all cases of NHL
  • follicular lymphoma – the second most common subtype and accounts for about 22% of NHL cases
  • extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) – accounts for about 8% of cases
  • peripheral T-cell lymphoma – accounts for about 7% of cases
  • chronic lymphocytic leukemia and small lymphocytic lymphoma – accounts for close to 7% of cases
  • mantle cell lymphoma – accounts for about 6% of cases

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Classification of NHL

The WHO classifies non-Hodgkin lymphomas according to the appearance of the lymphoma cells, genetic or chromosome characteristics of the cells and the presence of certain markers on the surface of the cells. There are over 30 subtypes of NHL.

B-cell non-Hodgkin lymphomas

Precursor B-cell lymphoma

precursor B-lymphoblastic leukemia or lymphoma

Mature B-cell lymphoma

  • diffuse large B-cell lymphoma (DLBCL)
  • follicular lymphoma
  • extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)
  • chronic lymphocytic leukemia and small lymphocytic lymphoma
  • mantle cell lymphoma
  • B-cell prolymphocytic leukemia
  • lymphoplasmacytic lymphoma
  • splenic marginal zone lymphoma
  • nodal marginal zone lymphoma
  • primary mediastinal large B-cell lymphoma
  • intravascular large B-cell lymphoma
  • primary effusion lymphoma (PEL)
  • Burkitt lymphoma

AIDS-related lymphoma, primary central nervous system (CNS) lymphoma and post-transplant lymphoproliferative disorder are other types of non-Hodgkin lymphomas that are mostly B-cell tumours.

Hairy cell leukemia and plasmacytoma (plasma cell myeloma or multiple myeloma) are also B-cell cancers, but are addressed elsewhere. For more information, go to hairy cell leukemia and multiple myeloma.

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T-cell and NK–cell non-Hodgkin lymphomas

Precursor T-cell lymphoma

precursor T-lymphoblastic leukemia or lymphoma

Mature T- and NK–cell lymphoma

  • peripheral T-cell lymphoma, unspecified
  • T-cell prolymphocytic leukemia
  • T-cell large granular lymphocytic leukemia
  • aggressive NK-cell leukemia
  • adult T-cell leukemia/lymphoma (HTLV-1)
  • cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)
  • extranodal NK/T-cell lymphoma, nasal type
  • enteropathy-associated T-cell lymphoma
  • angioimmunoblastic T-cell lymphoma
  • hepatosplenic T-cell lymphoma
  • subcutaneous panniculitis-like T-cell lymphoma
  • anaplastic large cell lymphoma – primary cutaneous, primary systemic

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