Last update: 06/15/2007

Difference between NHL and HL? | Categories | Resources | Systems

Detailed background:  

	PATHOLOGY OF HODGKIN’S AND NON-HODGKIN’S LYMPHOMAS - medschool.pitt.edu pdf
	Lymphoma 101: Biology and Classification-Richard I. Fisher, MD Transcript or  Webcast | WebCast-help

Question: What is the difference between lymphoma and non-Hodgkins lymphoma? We have someone in our family who has been diagnosed in the past with non-Hodgkins lymphoma and would like to know the difference. Are the treatments and prognosis the same?

Answer: Lymphoma is the broadest category of a family of related blood cancers. That is it is any blood cancer that involves lymphocytes (the cell type of origin) that is found primarily in the lymphatic system. It includes all the subtypes or variations of lymphoma, about 40 different kinds.

The difference is in the type of lymphocytes involved - the so called cell of origin.

In Hodgkin's disease, the abnormal lymphocyte is the Reed-Sternberg cell (a B lymphocyte). This particular lymphocyte isn't found in other types of lymphomas.  All other types of lymphomas are called non-Hodgkin's (NHL).  There are about 30 subtypes of NHL.

Identifying the correct type of lymphoma is important because treatment for Hodgkin's and non-Hodgkin's can be very different. Pathologists can distinguish between Hodgkin's and non-Hodgkin's by examining the cell sample from a biopsy under a microscope.

Lymphomas

    Hodgkins (often curable)
        Nodular Sclerosis,  Mixed Cellularity,  Lymphocyte Depleted, Lymphocyte Predominant

    Non-Hodgkins
        Diffuse large b-cell (aggressive)
        Follicular (indolent) 
        Mantle Cell (aggressive or indolent)
        MALT (indolent)
        T-cell and NK-cell types
        . . . 

Other ways to categorize lymphomas are by the rate of growth: indolent, intermediate, and aggressive.

Another ways is by areas of presentation: such as CNS (central nervous system), which is rare, and MALT which presents in mucosal linings, such as the stomach.

Anther way to classify is by lymphocyte type: b-cell, t-cell, NK-cell. (B-cell is most common).

Treatments for the various subtypes of lymphoma can vary significantly.

This group supports all types of lymphoma. Or does it's best to find and post evidence-based information as questions comes in.

CATEGORIES OF LYMPHOMA - Based primarily on WHO		Incidence per year	Mortality per year	Percentage of NHL
Hodgkin's lymphomas - Reed-Sternberg cell		7,000	1,300	-
Non-Hodgkin's Lymphomas (NHL)  B-cell and T-cell types		54,000	24,000	100%
B-cell NHL		45,900		85%
T-cell NHL		6,885		15%
Aggressive (fast-growing)  - High or intermediate grade B-cell  or T- cell NHL		32,400		60%
Indolent (slow-growing)  - Low grade B-cell or T-cell NHL		21,600		40%
Most common NHL types:	Most Common Grade	Incidence per year	Mortality per year	Percentage of NHL
Diffuse large B-cell	High			31%
Follicular cell B-cell (Center cell)	Low			22%
Precursor B-cell and T-cell NHL:	Most Common Grade	Incidence per year	Mortality per year	Percentage of NHL
Lymphoblastic lymphoma - B-cell - can lead to CNS type *	High
Lymphoblastic lymphoma - T-cell	High
Mature B-cell NHL: Markers CD19, 20, 22, 23	Most Common Grade	Incidence per year	Mortality per year	Percentage of NHL
Burkitt's	High			2%
Chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL)	Low			6%
CNS (Central Nervous System) *	High
Diffuse large B-cell lymphoma	High
Follicular (center cell) lymphomas:	Low
large cell (Grade 3)	High
mixed large and small (Grade 2)	Low
small cleaved (Grade 1)	Low
Hairy cell leukemia	Low
Large Cell immunoblastic
Large B-cell lymphomas:	High
Follicular	High
Mediastinal (thymic)	High
Mantle cell lymphoma	High			6%
Marginal zone lymphomas
MALT - mucosa associated:	Low			5%
gastric, eye, skin, lung, salivary, orbit,
nasopharynx, larynx, breast
Nodal +/- Moncytotal b-cells	Low
Splenic with Villous Lymphocytes	Low
Plasma cell myeloma / plasmacytomas
Primary amyloidosis
Primary effusion lymphoma
Solitary plasmacytoma of bone
Waldenström’s Macroglobulinemia (Lymphoplasmacytic)				1%

 

T-cell and NK-cell NHL (Mature cell stage unless "precursor cell" is indicated) Markers CD2, 3, 4, 5, NK: CD16, 56	Most Common Grade	Incidence per year	Mortality per year	Percentage of NHL
Adult T-cell	High
Aggressive NK cell leukemia	High
Anaplastic large cell lymphoma - CD30 positive  Subtype: Ki-l-positive
Angioimmunoblastic T-cell lymphoma (13%)
Blastic NK cell lymphoma (precursor cell)
Enteropathy type T-cell lymphoma
Extranodal NK/T cell lymphoma, nasal type (Angiocentric)	High
Gamma-delta T-cell phenotype 1 - provisional subtype
Hepatosplenic T-cell lymphoma
Lymphomatoid papulosis (uncertain malignant status)
Mycosis fungoides - cutaneous (skin) t-cell lymphoma (CTCL) Subtype: Angiocentric	Low
Peripheral T-cell lymphomas, unspecified				15 -20%
Precursor T-cell lymphoma (precursor cell)
Primary cutaneous anaplastic large cell lymphoma  (favorable prognosis)
Sezary syndrome - leukemic form of Mycosis fungoides
Subcutaneous panniculitis-like T-cell lymphoma
T-cell Large granular lymphocytic leukemia
T-cell proliferation of uncertain malignant potential
T-cell prolymphocytic leukemia - T-cell CLL (1% of CLL)

"About 85% of non- Hodgkin's lymphomas arise in B-cells; the rest occur in T-cells. Activation of a gene called BCL-2 is believed to be partly responsible for many B-cell lymphomas. This defect prevents apoptosis in the lymphoma cells (a natural process whereby cells self- destruct)."   

"Lymphomas are also grouped by certain properties:  

    Size (large versus small).
 
    Shape (round versus irregular). 
 
    Whether they are or resemble blood plasma cells.
 
    Whether they are follicular (organized in round clusters) 
    or diffuse (spread evenly throughout the lymph node)."     - ucdavis.edu

	Rappaport: Based on morphology (how the cells look in the microscope) alone; used until the 1970s.
	Kiel: Based on morphologic and immunologic (what types of proteins are produced by the cell) characteristics; updated in 1992; used mainly in Europe
	National Cancer Institute's Working Formulation (IWF): Divided lymphomas into low-grade, intermediate-grade and high-grade, with ten sub-groups labeled A to J.
	Revised European-American Classification of Lymphoid Neoplasms (REAL): Describes the different types of lymphomas as entities, with each type classified according to cell origin, based on morphologic, immunologic and genetic characteristics; introduced in 1994.
	World Health Organization (WHO): Uses the latest information on the appearance and growth pattern of the cancerous cells and genetic features. It also offers a more accurate description of the different types of tumors and identifies several new categories of non-Hodgkin's lymphatic cancer; updated version of REAL. Introduced in 2001 as an international standard.

	Background information on NHL - FDA
	Table of contents-Lymphomas and Plasma cell neoplasms - pathologyoutlines
	WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues - Cancer.gov
	The Revised European-American Classification of Lymphoid Neoplasms (REAL classification) - umich.edu Pathology of Lymphomas - ncl.ac.uk