Types and grades of non-Hodgkin lymphoma
Doctors often group non-Hodgkin lymphoma (NHL) as either low grade or high grade. The grade depends on how quickly the NHL is likely to grow and spread.
High grade NHL tends to grow quite quickly. Doctors sometimes describe them as aggressive lymphomas. They grow faster than low grade lymphomas, which tend to grow slowly. Doctors call low grade lymphomas indolent lymphomas.
This page is about the different types of high grade NHL.
NHL begins in a type of white blood cell called a lymphocyte. There are different types of lymphocytes. These include B cells, T cells and natural killer (NK) cells. So you can develop a:
B cell lymphoma
T cell lymphoma
NK cell lymphoma
There are different types of B cell and T cell lymphomas. Some of these are low grade, and some are high grade. In the UK, B cell lymphomas are more common than T cell or NK cell lymphomas.
The most common types of high grade NHL are:
diffuse large B cell lymphoma (DLBCL)
high grade B cell lymphoma
Burkitt lymphoma
peripheral T cell lymphoma
Rarer types of high grade NHL include:
anaplastic large cell lymphoma (ALCL)
angioimmunoblastic T-cell lymphoma (AITL)
enteropathy associated T cell lymphoma (EATL)
hepatosplenic gamma delta T cell lymphoma
EBV positive NK / T cell lymphomas
Other rare types of high grade lymphomas include:
lymphoblastic lymphoma
treatment related lymphoma
Over time, a low grade lymphoma can sometimes change into a high grade type lymphoma. Doctors call this transformation.
This is the most common type of NHL in the UK. Each year about 5,000 people are diagnosed with diffuse large B cell lymphoma (DLBCL) in the UK. This makes up more than 40 out of 100 cases (40%) of NHL in adults.
DLBCL grows quickly and treatment usually starts soon after diagnosis.
There are different sub types of DLBCL. Most people with DLBCL do not have a specific sub type. You might see this written as ‘DLBCL not otherwise specified’ or ‘DLBCL NOS’.
Other types of large B-cell lymphomas cause specific symptoms because of where they develop. For example, primary mediastinal (thymic) large B cell lymphoma. This causes enlarged lymph nodes in the central area of your chest (mediastinum).
Another example is primary . DLBCL can develop in the brain or spinal cord and cause symptoms such as headaches, vision changes or fits (seizures).
Read more about diffuse large B cell lymphoma
Burkitt lymphoma is a B cell lymphoma.
Each year around 260 people are diagnosed with Burkitt lymphoma in the UK. This makes up only 2 out of 100 cases (2%) of NHL. Burkitt lymphoma is the most common type of NHL in children in the UK. Adults can also be diagnosed, but it is more unusual. It is more common in males than females.
Burkitt lymphomas can affect people with low . For example, people who have had an organ transplant or who have AIDS. But it can also affect people who don't have any problems.
People with Burkitt lymphoma tend to develop symptoms quite quickly. It tends to progress rapidly.
These are a group of quickly growing lymphomas that develop from T cells. In the UK, around 500 people are diagnosed with this type of lymphoma each year.
Peripheral T cell lymphomas (PTCL) are divided into subtypes. They all have very different characteristics and behaviour.
The most common subtype is 'peripheral T cell lymphoma, not otherwise specified' (PTCL NOS). PTCL NOS includes all T cell lymphomas that don't fit into another group.
Most people with PTCL NOS have lymphoma cells only in the lymph nodes. But it can also develop in the liver, bone marrow, digestive system and skin.
This is a rare type of lymphoma. It can affect T cells or NK cells. NK stands for natural killer cells. NK cells are a type of lymphocyte, similar to B and T cells.
This type of lymphoma is linked to infection with the Epstein Barr virus (EBV). EBV is a common viral infection. In most people it doesn't cause a serious disease. But in rare cases it can lead to the development of some types of lymphoma.
You can get it:
inside your lymph nodes and lymphatic system – this is called EBV positive nodal NK/T cell lymphoma
outside your lymphatic system, for example in your nose – this is called extranodal NK/T cell
NK T cell lymphomas can be very difficult to treat.
This is a very rare type of T cell lymphoma. It is also called enteropathy type T cell lymphoma (ETTL) or intestinal T cell lymphoma (ITCL).
EATL usually happens in the . It is most often in the middle part (jejunum) or the lower part closest to the large intestine (ileum). It can spread to the liver, spleen, lymph nodes, gallbladder, stomach, colon or skin.
This very rare type of lymphoma starts in the liver or . It tends to grow very quickly.
Hepatosplenic gamma delta T cell lymphoma can affect people with , who have a weak . It can also affect people with no previous medical problems.
This is a type of lymphoma that starts in T cells. The term anaplastic means that under the microscope, the cancer cells look large and abnormal.
There are different types of ALCL. These are:
ALK positive ALCL
ALK negative ALCL
breast implant associate ALCL
primary cutaneous (skin) ALCL
Angioimmunoblastic T cell lymphoma is a high grade (aggressive) lymphoma that affects T cells. Around 140 people are diagnosed with AITL in the UK every year.
It usually affects older people, typically around the age of 70. But it can occur at any age. Unusually, AITL can undergo a change (transformation) to a B cell NHL.
Read more about angioimmunoblastic T cell lymphoma (AITL)
Lymphoblastic lymphoma (LL) is a rare type of high-grade NHL. It usually develops from T cells but occasionally develops from B cells.
LL is very similar to acute lymphoblastic leukaemia (ALL). In lymphoblastic lymphoma, the abnormal white blood cells (lymphocytes) are generally in the chest lymph nodes or thymus gland. But in ALL the abnormal cells are mainly in the blood and bone marrow. The treatments for lymphoblastic lymphoma and ALL are similar.
Read about acute lymphoblastic leukaemia
Lymphomas can sometimes develop after:
an
some types of
After transplants people take medicines that suppress their . This is to prevent rejection of their transplant. This can increase the risk of developing lymphoma.
Different types of lymphoma can develop. Diffuse large B cell lymphoma is the most common, but others include Burkitt lymphoma and rarer T cell lymphomas.
As part of your treatment, you usually reduce or stop taking the medicine that suppresses your immune system. This decision must be taken carefully. It usually involves discussions between your lymphoma specialist and your transplant team. Stopping these medicines can increase the chance of your body rejecting the transplant.
For some people, stopping these medicines is the only treatment you need. But some other patients need treatment with an drug (rituximab). You might have it together with (immunochemotherapy).
Low grade lymphomas can sometimes change into a faster growing (high grade) lymphoma. Doctors call this transformation.
Transformation is more common in some types of NHL than others. So it does not always happen. Most low grade lymphomas do not transform. If lymphoma does transform it can happen any time. Sometimes, it can happen many years after you are first diagnosed with low grade NHL. But it can also happen early on in your disease.
Sometimes, you can have a low grade and high grade lymphoma at the same time. Your doctor might assume that your low grade lymphoma is in the process of transforming to the higher grade type.
After a low grade NHL has transformed, it has to be treated as high grade. Unfortunately, a transformed NHL can sometimes be harder to control than when it was low grade. And the treatment is more intense.
The type of treatment you have for high grade NHL depends on:
the and type of your lymphoma when it is diagnosed
the symptoms you have at the time
your general health and fitness
The main types of treatment for high grade NHL are:
You might have one or more of these treatments.
Chemotherapy can be combined with a targeted immunotherapy drug. This is called chemoimmunotherapy.
Read more about treatment options for high grade NHL
We have treatment information for some of the different types of high grade lymphoma. You can look for your lymphoma type at the link below.
Last reviewed: 28 Feb 2024
Next review due: 28 Feb 2026
Low grade NHL tends to grow very slowly. There are different types of low grade NHL.
Non-Hodgkin lymphoma (NHL) is a type of blood cancer that affects white blood cells called lymphocytes. It's the 6th most common type of cancer in adults.
Doctors look at several different factors to group non-Hodgkin lymphoma (NHL) into different types.
The stage tells you about the number and places in your body that are affected by lymphoma. There are 4 stages for NHL. Or doctors describe it as either early or advanced stage.
Your treatment depends on the type and stage of your NHL. Common treatments include chemotherapy, targeted and immunotherapy drugs, radiotherapy and a stem cell transplant.
Practical and emotional support is available to help you cope with non-Hodgkin lymphoma.
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