Types of B-cell Lymphoma - American Cancer Society

About 5% of lymphomas are mantle cell lymphomas. MCL is much more common in men than in women, and it most often appears in people older than 60 ... Search Verenespañol | Downloadthistopic[PDF] AboutNon-HodgkinLymphoma WhatIsNon-HodgkinLymphoma? TypesofB-cellLymphoma TypesofT-cellLymphoma KeyStatisticsforNon-HodgkinLymphoma What’sNewinNon-HodgkinLymphomaResearchandTreatment? Home CancerA-Z Non-HodgkinLymphoma AboutNon-HodgkinLymphoma TypesofB-cellLymphoma B-celllymphomasmakeupmost(about85%)ofthenon-Hodgkinlymphomas(NHL)intheUnitedStates.ThesearetypesoflymphomathataffectBlymphocytes.ThemostcommontypesofB-celllymphomasarelistedbelow. DiffuselargeB-celllymphoma(DLBCL) ThisisthemostcommontypeofNHLintheUnitedStates,accountingforabout1outofevery3lymphomas.Thelymphomacellslookfairlylargewhenseenwithamicroscope.  DLBCLcanaffectpeopleofanyage,butitoccursmostlyinolderpeople.Theaverageageatthetimeofdiagnosisismid-60s.Itusuallystartsasaquicklygrowingmassinalymphnodedeepinsidethebody,suchasinthechestorabdomen,orinalymphnodeyoucanfeel,suchasintheneckorarmpit.Itcanalsostartinotherareassuchastheintestines,bones,oreventhebrainorspinalcord. DLBCLtendstobeafast-growing(aggressive)lymphoma,butitoftenrespondswelltotreatment.Overall,about3outof4peoplewillhavenosignsofdiseaseaftertheinitialtreatment,andmanyarecured. AsubtypeofDLBCLisprimarymediastinalB-celllymphoma. Thistypeoflymphomaoccursmostlyinyoungwomen.Itstartsinthemediastinum(theareainthemiddleofthechestbehindthebreastbone).Itcangrowquitelargeandcancausetroublebreathingbecauseitoftenpressesonthewindpipe(trachea)leadingintothelungs.Itcanalsoblockthesuperiorvenacava(thelargeveinthatreturnsbloodtotheheartfromthearmsandhead),whichcanmakethearmsandfaceswell.Thisisafast-growinglymphoma,butitusuallyrespondswelltotreatment.  ThereareseveralothersubtypesofDLBCL,butthesearerare. Follicularlymphoma About1outof5lymphomasintheUnitedStatesisafollicularlymphoma.Thisisusuallyaslow-growing(indolent)lymphoma,althoughsomefollicularlymphomascangrowquickly. Theaverageageforpeoplewiththislymphomaisabout60.It’srareinveryyoungpeople.Usually,thislymphomaoccursinmanylymphnodesitesinthebody,aswellasinthebonemarrow.  Follicularlymphomasoftenrespondwelltotreatment,buttheyarehardtocure.Theselymphomasmaynotneedtobetreatedwhentheyarefirstdiagnosed.Instead,treatmentmaybedelayeduntilthelymphomastartscausingproblems.Overtime,somefollicularlymphomascanturnintoafast-growingdiffuselargeB-celllymphoma. Chroniclymphocyticleukemia(CLL)/smalllymphocyticlymphoma(SLL) CLLandSLLarecloselyrelateddiseases.Infact,manydoctorsconsiderthemdifferentversionsofthesamedisease.Thesametypeofcancercell(knownasasmalllymphocyte)isseeninbothCLLandSLL.Theonlydifferenceiswherethecancercellsarefound.InCLL,mostofthecancercellsareinthebloodandbonemarrow.InSLL,thecancercellsaremainlyinthelymphnodesandspleen. BothCLLandSLLareusuallyslow-growing(indolent)diseases,althoughCLL,whichismuchmorecommon,tendstogrowmoreslowly.TreatmentisthesameforCLLandSLL.Theyareusuallynotcurablewithstandardtreatments,butmanypeoplecanlivealongtime(evendecades)withthem.Sometimes,thesecanturnintoamoreaggressive(fast-growing)typeoflymphomaovertime. Formoreinformation,see ChronicLymphocyticLeukemia. Mantlecelllymphoma(MCL) About5%oflymphomasaremantlecelllymphomas.MCLismuchmorecommoninmenthaninwomen,anditmostoftenappearsinpeopleolderthan60.WhenMCLisdiagnosed,itisusuallywidespreadinthelymphnodes,bonemarrow,andoftenthespleen. MCLcanbechallengingtotreat.Ittendstogrowfasterthanindolent(slow-growing)lymphomas,butitdoesn’tusuallyrespondtotreatmentaswellasaggressive(fast-growing)lymphomas.Butnewertreatmentsmightofferabetterchanceforlong-termsurvivalforpatientsnowbeingdiagnosed. Marginalzonelymphomas Marginalzonelymphomasaccountforabout5%to10%oflymphomas.Theytendtobeslow-growing(indolent).Thecellsintheselymphomaslooksmallunderthemicroscope.Thereare3maintypesofmarginalzonelymphomas: ExtranodalmarginalzoneB-celllymphoma,alsoknownasmucosa-associatedlymphoidtissue(MALT)lymphoma:Thisisthemostcommontypeofmarginalzonelymphoma.Itstartsinplacesotherthanthelymphnodes(extranodal). Therearegastricandnon-gastricMALTlymphomas.GastricMALTlymphomasstartinthestomachandarelinkedtoinfectionbyHelicobacterpylori(thebacteriathatcausesmanystomachulcers).MALTlymphomamightalsostartoutsidethestomach(non-gastric)inthelung,skin,thyroid,salivaryglands,ortissuessurroundingtheeye.Usuallythelymphomastaysintheareawhereitbeginsandisnotwidespread.ManyoftheseotherMALTlymphomashavealsobeenlinkedtoinfectionswithbacteria(suchasChamydophilaandCampylobacter)orviruses. TheaverageageofpeoplewithMALTlymphomaatthetimeofdiagnosisisabout60.Thislymphomatendstogrowslowlyandisoftencurableiftheamountofcancerislimited .DoctorsoftenuseantibioticsasthefirsttreatmentforMALTlymphomaofthestomach,becausetreatingtheHelicobacterpyloriinfectionoftencuresthelymphoma. NodalmarginalzoneB-celllymphoma:Thisisararedisease.Itstartsandusuallystaysinthelymphnodes,althoughlymphomacellscanalsosometimesbefoundinthebonemarrow.  Thislymphomatendstobeslow-growing(althoughnotusuallyasslowasMALTlymphoma),andistreatedsimilarlytofollicularlymphoma. SplenicmarginalzoneB-celllymphoma:Thisisararelymphoma.Oftenthelymphomaisfoundmainlyinthespleen,blood, andbonemarrow. Itcancausefatigueanddiscomfortduetoanenlargedspleen.Becausethediseaseisslow-growing,itmightnotneedtobetreatedunlessthesymptomsbecometroublesome.ThistypeoflymphomahasbeenlinkedhepatitisCinfection.SometimestreatingthehepatitisCviruscanalsotreatthislymphoma. Burkittlymphoma Thisfast-growinglymphomaisnamedafterthedoctorwhofirstdescribedthisdiseaseinAfricanchildrenandyoungadults.Itmakesupabout1%to2%ofalladultlymphomas.Itisrareinadults,butismorecommoninchildren.It’salsomuchmorecommoninmalesthaninfemales. ThecellsinBurkittlymphomaaremedium-sized.Asimilarkindoflymphoma,Burkitt-likelymphoma ,hasslightlylargercellsbutdifferentchromosomechanges. Differentvarietiesofthislymphomaareseenindifferentpartsoftheworld:  IntheAfrican(orendemic)variety,Burkittlymphomaoftenstartsasatumorofthejaworotherfacialbones.MostcasesofthistypearelinkedtoinfectionwiththeEpstein-Barrvirus(EBV,whichcanalsocauseinfectiousmononucleosisor“mono”).ThistypeofBurkittlymphomaisrareintheUnitedStates. InthetypeseenmoreoftenintheUnitedStates(nonendemicorsporadic),thelymphomausuallystartsintheabdomen(belly),whereitformsalargetumor.Itcanalsostartintheovaries,testicles,orotherorgans,andcanspreadtothebrainandspinalfluid.SomeofthesearelinkedtoEBVinfection. Anothertype(immunodeficiency-associated)ofBurkittlymphomaisassociatedwithimmunesystemproblems,suchasinpeoplewithHIVorAIDSorwhohavehadanorgantransplant. Burkittlymphomagrowsveryquickly,soitneedstobetreatedrightaway.Butmorethanhalfofpatientscanbecuredbyintensivechemotherapy. Lymphoplasmacyticlymphoma(Waldenstrommacroglobulinemia) Thisslow-growinglymphomaisnotcommon,accountingforonly1%to2%oflymphomas.Thelymphomacellsaresmallandfoundmainlyinthebonemarrow,lymphnodes,andspleen.ThislymphomaisdiscussedindetailinWaldenstromMacroglobulinemia. Hairycellleukemia Despitethename,hairycellleukemia(HCL)issometimesconsideredtobeatypeoflymphoma.Itisrare–about700peopleintheUnitedStatesarediagnosedwithiteachyear.MenaremuchmorelikelytogetHCLthanwomen,andtheaverageageatdiagnosisisaround50.  ThecellsaresmallBlymphocyteswithprojectionscomingoffthemthatgivethema“hairy”appearance.Theyaretypicallyfoundinthebonemarrow,spleen,andintheblood.  Hairycellleukemiaisslow-growing,andsomepeoplemayneverneedtreatment.Anenlargingspleenorlowbloodcellcounts(duetocancercellsinvadingthebonemarrow)aretheusualreasonstobegintreatment.Iftreatmentisneeded,it’susuallyveryeffective.  HairycellleukemiaisalsotalkedaboutinChronicLymphocyticLeukemia. Primarycentralnervoussystem(CNS)lymphoma Thislymphomainvolvesthebrainorspinalcord(thecentralnervoussystem,orCNS).Thelymphomaisalsosometimesfoundintissuesaroundthespinalcord.Overtime,ittendstobecomewidespreadinthecentralnervoussystem. PrimaryCNSlymphomaisrareoverall,butit’smorecommoninolderpeopleandinpeoplewithimmunesystemproblems,suchasthosewhohavehadanorgantransplantorwhohaveAIDS.Mostpeopledevelopheadachesandconfusion.Theycanalsohavevisionproblems;weaknessoralteredsensationintheface,arms,orlegs;andinsomecases,seizures. TheoutlookforpatientswithprimaryCNSlymphomahasimprovedovertheyearsmainlyduetoadvancesintreatment. Primaryintraocularlymphoma(lymphomaoftheeye) ThisisararetypeoflymphomathatstartsintheeyeballandisoftenseenalongwithprimaryCNSlymphoma.Itisthesecondmostcommoncanceroftheeyeinadults,withocularmelanoma(eyemelanoma)beingthefirst.MostpeoplewithprimaryintraocularlymphomaareelderlyorhaveimmunesystemproblemswhichmaybeduetoAIDSoranti-rejectiondrugsafteranorganortissuetransplant. Peoplemaynoticebulgingoftheeyeballwithoutpain,visionloss,orablurryvision.Manyofthetestsdonetodiagnoseocularmelanomaarethesameusedtodiagnoselymphomaoftheeye. Themaintreatmentforlymphomaoftheeyeisexternalradiationtherapyifthecancerislimitedtotheeye.Chemotherapy(chemo)orchemotherapyincombinationwithradiationmaybeuseddependingonthetypeoflymphomaandhowfarithasspreadoutsideoftheeye. Writtenby References TheAmericanCancerSocietymedicalandeditorialcontentteam Ourteamismadeupofdoctorsand oncologycertifiednurseswithdeepknowledgeofcancercareaswellasjournalists,editors,andtranslatorswithextensiveexperienceinmedicalwriting. DunleavyKandWilsonWH.PrimarymediastinalB-celllymphomaandmediastinalgrayzonelymphoma:dotheyrequireauniquetherapeuticapproach?Blood.2015;125:33-39. doi:https://doi.org/10.1182/blood-2014-05-575092. FreedmanAS,JacobsonCA,MauchP,AsterJC.Chapter103:Non-Hodgkin’slymphoma.In:DeVitaVT,LawrenceTS,RosenbergSA,eds.DeVita,Hellman,andRosenberg’sCancer:PrinciplesandPracticeofOncology.10thed.Philadelphia,Pa:LippincottWilliams&Wilkins;2015. GrimmSA,McCannelCA,OmuroAM,etal.PrimaryCNSlymphomawithintraocularinvolvement:InternationalPCNSLCollaborativeGroupReport.Neurology.2008;71:1355-1360. KarciogluZAandHaikBG.Chapter67:Eye,Orbit,andAdnexalStructures.In:NiederhuberJE,ArmitageJO,DoroshowJH,KastanMB,TepperJE,eds.Abeloff’sClinicalOncology.5thed.Philadelphia,Pa:Elsevier;2014. NationalComprehensiveCancerNetwork(NCCN)—B-CellLymphomas.V3.2018.AccessedApril26,2018fromhttps://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf NationalComprehensiveCancerNetwork(NCCN)—CentralNervousSystemCancers.V1.2018.AccessedApril26,2018fromhttps://www.nccn.org/professionals/physician_gls/pdf/cns.pdf OndrejkaSandJagadeeshD.Enteropathy-AssociatedT-CellLymphoma.CurrHematolMaligRep.2016;11(6):504-513.doi:10.1007/s11899-016-0357-7.   RoschewskiMJ,WilsonWH.Chapter106:Non-HodgkinLymphoma.In:NiederhuberJE,ArmitageJO,DoroshowJH,KastanMB,TepperJE,eds.Abeloff’sClinicalOncology.5thed.Philadelphia,Pa:Elsevier;2014. SwerdlowSH,Campo,E,PileriSAetal.The2016revisionoftheWorldHealthOrganizationclassificationoflymphoidneoplasms.Blood.2016;127:2375-2390;doi:https://doi.org/10.1182/blood-2016-01-643569.    References DunleavyKandWilsonWH.PrimarymediastinalB-celllymphomaandmediastinalgrayzonelymphoma:dotheyrequireauniquetherapeuticapproach?Blood.2015;125:33-39. doi:https://doi.org/10.1182/blood-2014-05-575092. FreedmanAS,JacobsonCA,MauchP,AsterJC.Chapter103:Non-Hodgkin’slymphoma.In:DeVitaVT,LawrenceTS,RosenbergSA,eds.DeVita,Hellman,andRosenberg’sCancer:PrinciplesandPracticeofOncology.10thed.Philadelphia,Pa:LippincottWilliams&Wilkins;2015. GrimmSA,McCannelCA,OmuroAM,etal.PrimaryCNSlymphomawithintraocularinvolvement:InternationalPCNSLCollaborativeGroupReport.Neurology.2008;71:1355-1360. KarciogluZAandHaikBG.Chapter67:Eye,Orbit,andAdnexalStructures.In:NiederhuberJE,ArmitageJO,DoroshowJH,KastanMB,TepperJE,eds.Abeloff’sClinicalOncology.5thed.Philadelphia,Pa:Elsevier;2014. NationalComprehensiveCancerNetwork(NCCN)—B-CellLymphomas.V3.2018.AccessedApril26,2018fromhttps://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf NationalComprehensiveCancerNetwork(NCCN)—CentralNervousSystemCancers.V1.2018.AccessedApril26,2018fromhttps://www.nccn.org/professionals/physician_gls/pdf/cns.pdf OndrejkaSandJagadeeshD.Enteropathy-AssociatedT-CellLymphoma.CurrHematolMaligRep.2016;11(6):504-513.doi:10.1007/s11899-016-0357-7.   RoschewskiMJ,WilsonWH.Chapter106:Non-HodgkinLymphoma.In:NiederhuberJE,ArmitageJO,DoroshowJH,KastanMB,TepperJE,eds.Abeloff’sClinicalOncology.5thed.Philadelphia,Pa:Elsevier;2014. SwerdlowSH,Campo,E,PileriSAetal.The2016revisionoftheWorldHealthOrganizationclassificationoflymphoidneoplasms.Blood.2016;127:2375-2390;doi:https://doi.org/10.1182/blood-2016-01-643569.    LastRevised:January29,2019 AmericanCancerSocietymedicalinformationiscopyrighted material.Forreprintrequests,pleaseseeourContentUsagePolicy. 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