In the United States, approximately 90 percent of non-Hodgkin’s lymphomas (NHLs) begin in the B-cells. There are several subtypes of B-cell NHL. The most common subtypes are:
Together these two subtypes make up about half of all cases of non-Hodgkin’s lymphoma in the United States.
Less common subtypes of B-cell NHL include:
- Chronic lymphocytic leukemia/small lymphocytic lymphoma
- Mantle cell lymphoma
- Marginal zone B-cell lymphoma
- Burkitt lymphoma
- Waldenstrom’s macroglobulinemia (lymphoplasmacytic lymphoma)
- Hairy cell leukemia
- Primary central nervous system lymphoma
- Lymphomatoid granulomatosis
- Cutaneous B-cell lymphoma
Read more about these less common subtypes of B-cell NHL.
This is the most common subtype, accounting for about 30 percent of NHLs in this country. Diffuse large B-cell lymphoma (DLBCL) is an aggressive (fast-growing) lymphoma. It mainly affects adults in their 60s, but occasionally it may be found in children.
About one-third of these lymphomas are confined to one part of the body (localized) at diagnosis. Because DLBCL advances very quickly, it is usually treated right away with combination chemotherapy and the monoclonal antibody rituximab (Rituxan).
After initial treatment, most patients experience long-term remission or are cured. Patients who relapse or have disease that does not respond to treatment (refractory disease) may be treated with high-dose chemotherapy and stem cell transplant.
Different subtypes of DLBCL have different prognoses (outlooks) and responses to treatment.
- Primary mediastinal B-cell lymphoma, which accounts for about 2 percent of all lymphomas, is typically localized and starts in the chest in the space between the lungs (mediastinum). It affects women more often than men and is usually diagnosed in people between the ages of 30 and 40.
- Intravascular large B-cell lymphoma is a rare, aggressive subtype that is typically throughout the body (generalized) by the time it is found.
- Primary effusion lymphoma is a rare subtype that is associated with HIV/AIDS. This aggressive disease accounts for less than 2 percent of all NHL cases. It may be treated with combination chemotherapy and, for patients who are HIV-positive, antiretroviral therapy.
About 20 percent of NHLs are follicular lymphoma. Follicular lymphoma is often indolent (slow growing). Follicular means the cells tend to grow in a circular pattern. This subtype occurs in many lymph-node sites throughout the body as well as in the bone marrow. The average age for people with follicular lymphoma is 60. It is rare in children.
Since follicular lymphoma typically grows slowly, you and your doctor may decide to monitor the disease rather than treat it. This is known as watchful waiting. Treatments include single-agent or combination chemotherapy, radiation, or immunotherapy, which uses the body’s immune system to fight cancer. Many patients have long-term remission after treatment; however, most patients relapse or have disease that does not respond to treatment. For these patients, high-dose chemotherapy and stem cell transplant may be an option. In addition, a number of treatments are being tested in clinical studies.
Over time, about 30 percent of follicular lymphomas transform into aggressive diffuse B-cell lymphoma.