Subtypes of Non-Hodgkin Lymphoma in Adults – An Introduction, with Dr. Sonali Smith

Last Updated: April 27, 2017

In this video, Dr. Sonali Smith discusses the many different subtypes of Non-Hodgkin lymphoma found in adults. She explains the different categories that doctors use to help them understand the best way to treat this disease.

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Lymphoma - Non-Hodgkin

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Cancer.Net®: Doctor-Approved Patient Information from ASCO®

Subtypes of Non-Hodgkin Lymphoma in Adults

Types of Lymphoma

Sonali Smith, MD: Lymphomas are a group of blood cancers of either B cells, T cells or NK cells.  These are cells that are normally part of our immune system and their job is to help us fight off infection.  However they too can turn into a cancer and when they do we call them lymphomas.  Many times people will ask what’s the difference between a Hodgkin and a non-Hodgkin lymphoma? And there is a bit of a historical approach to this.  Hodgkin lymphoma was described first and was described as a disease that involved lymph nodes and spleen in typically younger patients. 

About 100 years later a different disease that also involved the lymph nodes and spleen was described.  And to make a distinction it was called non-Hodgkin lymphoma as opposed to the original description of Hodgkin’s.  Now in the last decade and a half we actually understand that Hodgkin lymphoma is a cancer of B cells. So ironically Hodgkin lymphoma turns out to be a type of non-Hodgkin lymphoma.

Today we still use the distinction of Hodgkin versus non-Hodgkin lymphoma because the treatment is very, very different and it’s important for your physician to know which one you have. 

Subtypes of Non-Hodgkin Lymphoma

Dr. Smith: Non-Hodgkin lymphoma is an umbrella term.  There is actually somewhere between 60 and 80 different kinds of non-Hodgkin lymphoma that we know about right now.  In order to better understand them and also to communicate more effectively with our patients we often divide these lymphomas based on either which cell has turned cancerous such as a B cell or a T cell or whether it’s Hodgkin or non-Hodgkin lymphoma. 

More commonly we divide these lymphomas into one of three categories based on how fast we expect them to grow.  Some lymphomas grow very, very slowly, on the order of decades.  And we call these lymphomas indolent lymphomas or low grade lymphomas. These are synonyms that are often used and they apply to a group of lymphomas that grow very, very slowly and only need treatment when the disease starts to flair and cause symptoms or problems with organ function, including the bone marrow.

A second group of lymphomas we call intermediate grade or fast growing lymphomas also called aggressive lymphomas.  Again we have three different words for the same type of lymphoma.  These lymphomas tend to grow a little bit more quickly, usually on the order of weeks to months and require treatment.  Unlike the indolent or the slow growing lymphomas these are lymphomas where the treatment often leads to cure and the goal of therapy is to not just put patients into remission, but hopefully to eliminate the disease. 

The third group of lymphomas can be described as being very fast growing or highly aggressive. These are lymphomas, for example, Burkett lymphoma that grow very, very quickly, sometime on the order of days to weeks and require treatment almost immediately. 

For these patients cure is the goal and a good portion of patients can be put into a very long lasting remission.  Unfortunately this categorization of these three different types of lymphoma, slow growing, fast growing and very fast growing doesn’t always apply as we learn about new different types of lymphoma.  For example, mantel cell lymphoma is one that grows more quickly than your typical indolent or slow growing lymphoma and yet is very difficult to cure.  In addition, many of the T cells lymphomas don’t fit very nicely into these categories, because they tend to be aggressive or very highly aggressive.

Role of a Pathologist

Dr. Smith: The most important part of having a diagnosis of lymphoma is being confident in the specific subtype.  The people who make this diagnosis are pathologists and specifically people who have trained extra to study blood cancers that are called hematic pathologists.  It is incredibly important both for treatment, prognosis, as well as all future management to know exactly what type of lymphoma you have. 

In many cases a pathologist may not have been exposed to all the different tests that are used to specifically classify your type of lymphoma. And we often recommend that a hematic pathologist review the material and sometimes even have it sent for a second opinion. 

The two most important factors for anybody with lymphoma is exactly what kind of lymphoma they have and then how much of it they have.  The only way to understand what type of lymphoma somebody has is to have their biopsy specimen examined by an experienced hematic pathologist who can do all of the diagnostic testing to make the clinician, your doctor feel comfortable with they’re treating. 

Where to Get More Information

Dr. Smith: I always refer my patients to to learn more about lymphoma as well as the management of cancer. 

There’s an entire sub-site within that website that’s focused on lymphomas.  There’s a wealth of information that is updated on a routine  basis and can be very helpful as you’re trying to understand and navigate this diagnosis. 

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical Oncology.  

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

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