The Types of B-Cell Lymphoma
- Doctors divide B-cell lymphoma into different types, based on how quickly they grow
- Indolent lymphomas grow slowly, while aggressive lymphomas grow quickly and need treatment right away
- Diffuse large B-cell lymphoma, an aggressive lymphoma, is the most common type of lymphoma in the United States
Related: Blood Cancer Comes in More than 100 Varieties: How They Differ and What They Have in Common
Read MoreIs Your Lymphoma Low-Grade or Aggressive?
“Low-grade” and “aggressive” are terms doctors use to distinguish a slow-growing from a fast-growing lymphoma.Low-grade lymphomas, also known as “indolent” lymphomas, grow very slowly. If you have this type of cancer, you might not need to start on treatment right away. Instead, your doctor will watch you very carefully, which is called “watchful waiting” or “active surveillance.” Only when your cancer starts to grow or you develop symptoms such as fevers, night sweats, or significant unintentional weight loss (called B symptoms) will you need to start on a treatment.
Aggressive lymphomas grow quickly. Treatment usually starts within weeks of the diagnosis, and often involves intensive chemotherapy.
Types of Indolent Lymphomas
There are several different types of lymphomas. Some of the more common ones are follicular lymphoma, marginal zone lymphoma, and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).
Follicular lymphoma is the most common form of indolent lymphoma in the United States. About 1 in 5 people with lymphoma have follicular lymphoma. It usually starts in the lymph nodes and grows very slowly. People with this type may opt to wait for treatment until they develop symptoms.
Follicular lymphoma usually responds very well to treatments such as radiation, rituximab (Rituxan) – a monoclonal antibody against a marker on your lymphoma called CD20, or a combination of Rituxan and a chemotherapy drug such as bendamustine (Bendeka). Newer targeted therapies and treatments that affect your immune system (immunomodulatory agents) also work well against it.
The one concern with follicular lymphoma is that it can eventually turn into the more aggressive diffuse large B-cell lymphoma, so it needs to be watched carefully. If you develop symptoms such as rapidly growing lymph nodes or concerning B symptoms, then you may need another biopsy to see if your cancer has transformed into a more aggressive lymphoma.
Marginal zone lymphomas are a group of cancers that are characterized by the small size of the cancer cells. The most common type is known as extranodal marginal zone B-cell lymphoma. “Extranodal” means “outside the nodes.” Unlike some other lymphomas, this cancer starts in areas outside the lymph nodes, such as the stomach, lung, skin, or thyroid gland. Other marginal zone lymphomas start in the spleen or lymph nodes.
CLL/SLL are two names for what is essentially one cancer. They grow from the same kind of cancer cell, called a small lymphocyte. The only difference is in where the cancer starts. In CLL, cancer cells are in the blood and bone marrow, while in SLL they’re mostly in the lymph nodes and spleen. These cancers are treatable with chemotherapy, radiation, targeted drugs, and monoclonal antibodies.
Types of Aggressive Lymphomas
Diffuse large B-cell lymphoma Is the most common type of lymphoma overall. About 1 out of every 3 people with lymphoma in the United States has this type. It usually starts in a lymph node — either in an area where you can feel it, such as your neck or armpit, or deeper in your body, in your chest or belly. Although diffuse large B-cell lymphoma grows quickly, it responds well to chemotherapy and other treatments. About 3 in 4 people have no signs of disease after their first treatment, and many will be cured.
Mantle cell lymphoma often has spread to areas such as the bone marrow, spleen, and intestines by the time it’s diagnosed. Treatment usually involves a combination of chemotherapy and a monoclonal antibody. In younger people, high-dose chemotherapy followed by a stem cell transplant can lead to long-term remission.
“Sometimes you’ll see mantle cell grouped under indolent lymphoma as well, so that one can be a little tricky,” Dr. Chong tells SurvivorNet. In a subgroup of people, the disease grows more slowly, and they tend to have a longer survival time as a result.
Highly Aggressive Lymphoma — Burkitt Lymphoma or High-Grade B-Cell Lymphoma
“The third type of lymphoma is a highly aggressive lymphoma, and that is Burkitt lymphoma,” Dr. Chong tells SurvivorNet. Various types of this cancer appear in different parts of the world. The endemic variety is more common in Africa, while the nonendemic or sporadic form is more common in the United States. This type usually starts as a growth in the belly, but it can also start in other organs. High-grade B-cell lymphoma is another highly aggressive lymphoma that is a newer entity in the classification system.
Burkitt lymphoma and high-grade B-cell lymphoma need treatment with chemotherapy as quickly as possible because they do grow so quickly, but they’re often curable with high doses of chemotherapy drugs.
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