Low grade NHL
S.No. Types of NHL Description
1. Follicular lymphoma It is the most common type (25%) of B-cell low grade lymphoma in the UK. About 1 out of 5 lymphomas in the United States is follicular lymphoma. It mainly occurs in adults at site of lymph node and bone marrow over the age of 50. Over time about 1 in 3 follicular lymphomas turns into a fast-growing diffuse B-cell lymphoma.
2. Mantle cell lymphoma Mantle cell lymphoma is a rare type of B-cell lymphoma. Mostly, It affects lymph node, bone marrow and often spleen over people in their 50s and 60s age. It is also a B-cell lymphoma. However, it is classified as low grade but it grows quickly and may be treated more like high grade lymphomas.
3. Marginal zone B-cell lymphomas Marginal zone lymphomas are a group of slow growing B-cell lymphomas. They account 5% to 10% of lymphomas and tend to occur in people over the age of 60. The cells in these lymphomas look small under the microscope. There are 3 types of marginal zone lymphoma. 1. Extra-nodal marginal zone B-cell lymphoma is also called mucosa associated lymphoid tissue lymphoma or MALT lymphoma-The most common site for MALT is the stomach due to infection of Helicobacter pylori. 2. Nodal marginal zone lymphoma-It also called monocytoid B-cell lymphoma which occurs within the lymph nodes sometimes can found in bone marrow. It makes up about 2% and more common in women than men over the age of 60. 3. Splenic marginal zone lymphoma-This is a rare type of lymphoma which associated with hepatitis-C virus infection. It starts in the spleen and can also be found in the bloodstream. This type makes up about 1% over the age 50.
4. Small lymphocytic lymphoma or CLL It is also called chronic lymphocytic leukemia (CLL). It makes up about 6% in the UK. In theory, Chronic lymphocytic leukemia is the term used for this condition if many of the abnormal cells are in the blood. Doctors call it small lymphocytic lymphoma when the disease particularly occurs in lymph nodes.
5. Lymphoplasmacytic lymphomas (including Wald Enstrom’smacroglobulinaemia) It accounts only 1 or 2% and specifically found in the bone marrow, lymph nodes, and spleen peoples over the age of 65. It is slightly more common in men than women. People with Wald Enstrom’smacroglobulinaemia have a high level of a protein called immunoglobulin M (IgM) in their blood. The protein makes the blood thicker.
6. Skin lymphomas A rare type of NHL is mycosis fungoid. It affects the skin and is also called cutaneous T-cell lymphoma.
7. Hairy cell leukemia It is rare type B-cell lymphoma. It is typically found in the bone marrow and spleen and in the blood. Men are more likely to get HCL than women and the average age is around 50.
8. Primary central nervous system (CNS) lymphoma This lymphoma usually involves the brain (called primary brain lymphoma) but it may also be found in the spinal cord, in HIV infected people.
High grade NHL
1. Diffuse large B-cell lymphoma (DLBCL) This is the most common type of non-Hodgkin lymphoma in the world. It can affect any age group but mostly occurs in older people (the average age is mid-60s).It usually starts as a quickly growing mass in a lymph node deep inside the body such as in the chest, abdomen, neck or armpit. It can also start in other areas such as the intestines, bone or even the brain or spinal cord. It is slightly more common in men. Genetic tests have shown that there are different subtypes of DLBCL 1. Mediastinal large B cell lymphoma-It develop enlarged lymph gland and accounts about 3% in UK. 2. Intravascular large B-cell lymphoma -In this rare subtype and found inside blood vessels, not in the lymph nodes or bone marrow.
2. Burkitt's lymphomas This is a very fast-growing lymphoma. In the Africa it often starts as a tumor of the jaw or other facial bones. It is linked to infection with the Epstein-Barr virus It mostly occurs in children and young adults. They make up about 3% cases of lymphoma in the UK and USA. It is more common in men (90%) than women.
3. Peripheral T-cell lymphomas (PTCL) It is a group of quickly growing NHLs that develop from mature T-cells and accounts 6%. These are following types and have very different characteristics and behavior. 1. Cutaneous T-cell lymphomas (mycosis fungoid, Sezary syndrome and others): These lymphomas start in the skin and accounts 5%. 2. Adult T-cell leukemia/lymphoma: It is caused by HTLV-1 infection. It is rare in the US and more common in the Japan, Caribbean, and parts of Africa. 3. Angio-immunoblastic T-cell lymphoma: It accounts only 3% and commonly occurs in older adults. It tends to grow quickly in the lymph nodes as well as the spleen and liver. 4. Extra-nodal NK/T-cell lymphoma, nasal type: It often involves 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. 5. Enteropathy-associated intestinal T-cell lymphoma (EATL):EATL is a very rare type of T-cell lymphoma over people 30s and 40s. It usually occurs in the jejunum or ileum. EATL occurs more often in people with coeliac disease. It may spread to the liver, spleen, lymph nodes, gallbladder, stomach, colon and skin. 6. Anaplastic large cell lymphoma (ALCL): It found in about 2% young peoples in their 50s and 60s. It usually starts in lymph nodes and can also spread to skin.
4. Lymphoblastic lymphoma It is very rare in adults and most common in children and teenagers under the age of 35s. It usually develops from T-cells but occasionally develops from B-cells. It makes up about 2% in the UK. It is very similar to acute lymphoblastic leukemia (ALL). In lymphoma, the abnormal white blood cells (lymphocytes) are generally in the chest, lymph nodes and thymus gland. But in ALL the abnormal cells are mainly in the blood and bone marrow. .
5. BlasticNK cell lymphoma It is a very rare type of T-cell lymphoma and can affect few adults throughout body. It tends to grow very quickly and can be difficult to treat.
6. Hepatosplenic gamma delta T-cell lymphoma It is a very rare type that starts in the liver or spleen. It tends to grow very quickly in peoples have suppressed immune system due to Crohn’s disease.
7. Treatment related T-cell lymphomas It sometimes occurs after people have had an organ or stem cells or bone marrow transplant. During this people have suppressed immune system resulting have high risk of developing lymphoma.
Table 1: Sub-types of non-Hodgkin lymphomas (NHL).