Types of B-cell Lymphoma

B-cell lymphomas make up most (about 85%) of the non-Hodgkin lymphomas (NHL) in the United States. These are types of lymphoma that affect B lymphocytes. The most common types of B-cell lymphomas are listed below.

Diffuse large B-cell lymphoma (DLBCL)

This is the most common type of NHL in the United States, accounting for about 1 out of every 3 lymphomas. The lymphoma cells look fairly large when seen with a microscope. 

DLBCL can affect people of any age, but it occurs mostly in older people. The average age at the time of diagnosis is mid-60s. It usually starts as a quickly growing mass in a lymph node deep inside the body, such as in the chest or abdomen, or in a lymph node you can feel, such as in the neck or armpit. It can also start in other areas such as the intestines, bones, or even the brain or spinal cord.

DLBCL tends to be a fast-growing (aggressive) lymphoma, but it often responds well to treatment. Overall, about 3 out of 4 people will have no signs of disease after the initial treatment, and many are cured.

A subtype of DLBCL is primary mediastinal B-cell lymphoma. This type of lymphoma occurs mostly in young women. It starts in the mediastinum (the area in the middle of the chest behind the breastbone). It can grow quite large and can cause trouble breathing because it often presses on the windpipe (trachea) leading into the lungs. It can also block the superior vena cava (the large vein that returns blood to the heart from the arms and head), which can make the arms and face swell. This is a fast-growing lymphoma, but it usually responds well to treatment. 

There are several other subtypes of DLBCL, but these are rare.

Follicular lymphoma

About 1 out of 5 lymphomas in the United States is a follicular lymphoma. This is usually a slow-growing (indolent) lymphoma, although some follicular lymphomas can grow quickly.

The average age for people with this lymphoma is about 60. It’s rare in very young people. Usually, this lymphoma occurs in many lymph node sites in the body, as well as in the bone marrow. 

Follicular lymphomas often respond well to treatment, but they are hard to cure. These lymphomas may not need to be treated when they are first diagnosed. Instead, treatment may be delayed until the lymphoma starts causing problems. Over time, some follicular lymphomas can turn into a fast-growing diffuse large B-cell lymphoma.

Chronic lymphocytic leukemia (CLL) /small lymphocytic lymphoma (SLL)

CLL and SLL are closely related diseases. In fact, many doctors consider them different versions of the same disease. The same type of cancer cell (known as a small lymphocyte) is seen in both CLL and SLL. The only difference is where the cancer cells are found. In CLL, most of the cancer cells are in the blood and bone marrow. In SLL, the cancer cells are mainly in the lymph nodes and spleen.

Both CLL and SLL are usually slow-growing (indolent) diseases, although CLL, which is much more common, tends to grow more slowly. Treatment is the same for CLL and SLL. They are usually not curable with standard treatments, but many people can live a long time (even decades) with them. Sometimes, these can turn into a more aggressive (fast-growing) type of lymphoma over time.

For more information, see  Chronic Lymphocytic Leukemia.

Mantle cell lymphoma (MCL)

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. When MCL is diagnosed, it is usually widespread in the lymph nodes, bone marrow, and often the spleen.

MCL can be challenging to treat. It tends to grow faster than indolent (slow-growing) lymphomas, but it doesn’t usually respond to treatment as well as aggressive (fast-growing) lymphomas. But newer treatments might offer a better chance for long-term survival for patients now being diagnosed.

Marginal zone lymphomas

Marginal zone lymphomas account for about 5% to 10% of lymphomas. They tend to be slow-growing (indolent). The cells in these lymphomas look small under the microscope. There are 3 main types of marginal zone lymphomas:

Extranodal marginal zone B-cell lymphoma, also known as mucosa-associated lymphoid tissue (MALT) lymphoma: This is the most common type of marginal zone lymphoma. It starts in places other than the lymph nodes (extranodal).

There are gastric and non-gastric MALT lymphomas. Gastric MALT lymphomas start in the stomach and are linked to infection by Helicobacter pylori (the bacteria that causes many stomach ulcers). MALT lymphoma might also start outside the stomach (non-gastric) in the lung, skin, thyroid, salivary glands, or tissues surrounding the eye. Usually the lymphoma stays in the area where it begins and is not widespread. Many of these other MALT lymphomas have also been linked to infections with bacteria (such as Chamydophila and Campylobacter) or viruses.

The average age of people with MALT lymphoma at the time of diagnosis is about 60. This lymphoma tends to grow slowly and is often curable if the amount of cancer is limited . Doctors often use antibiotics as the first treatment for MALT lymphoma of the stomach, because treating the Helicobacter pylori infection often cures the lymphoma.

Nodal marginal zone B-cell lymphoma: This is a rare disease. It starts and usually stays in the lymph nodes, although lymphoma cells can also sometimes be found in the bone marrow. 

This lymphoma tends to be slow-growing (although not usually as slow as MALT lymphoma), and is treated similarly to follicular lymphoma.

Splenic marginal zone B-cell lymphoma: This is a rare lymphoma. Often the lymphoma is found mainly in the spleen, blood, and bone marrow.

It can cause fatigue and discomfort due to an enlarged spleen. Because the disease is slow-growing, it might not need to be treated unless the symptoms become troublesome. This type of lymphoma has been linked hepatitis C infection. Sometimes treating the hepatitis C virus can also treat this lymphoma.

Burkitt lymphoma

This fast-growing lymphoma is named after the doctor who first described this disease in African children and young adults. It makes up about 1% to 2% of all adult lymphomas. It is rare in adults, but is more common in children. It’s also much more common in males than in females.

The cells in Burkitt lymphoma are medium-sized. A similar kind of lymphoma, Burkitt-like lymphoma , has slightly larger cells but different chromosome changes.

Different varieties of this lymphoma are seen in different parts of the world: 

• In the African (or endemic) variety, Burkitt lymphoma often starts as a tumor of the jaw or other facial bones. Most cases of this type are linked to infection with the Epstein-Barr virus (EBV, which can also cause infectious mononucleosis or “mono”). This type of Burkitt lymphoma is rare in the United States.
• In the type seen more often in the United States (nonendemic or sporadic), the lymphoma usually starts in the abdomen (belly), where it forms a large tumor. It can also start in the ovaries, testicles, or other organs, and can spread to the brain and spinal fluid. Some of these are linked to EBV infection.
• Another type (immunodeficiency-associated) of Burkitt lymphoma is associated with immune system problems, such as in people with HIV or AIDS or who have had an organ transplant.

Burkitt lymphoma grows very quickly, so it needs to be treated right away. But more than half of patients can be cured by intensive chemotherapy.

Lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)

This slow-growing lymphoma is not common, accounting for only 1% to 2% of lymphomas. The lymphoma cells are small and found mainly in the bone marrow, lymph nodes, and spleen. This lymphoma is discussed in detail in Waldenstrom Macroglobulinemia.

Hairy cell leukemia

Despite the name, hairy cell leukemia (HCL) is sometimes considered to be a type of lymphoma. It is rare – about 700 people in the United States are diagnosed with it each year. Men are much more likely to get HCL than women, and the average age at diagnosis is around 50. 

The cells are small B lymphocytes with projections coming off them that give them a “hairy” appearance. They are typically found in the bone marrow, spleen, and in the blood. 

Hairy cell leukemia is slow-growing, and some people may never need treatment. An enlarging spleen or low blood cell counts (due to cancer cells invading the bone marrow) are the usual reasons to begin treatment. If treatment is needed, it’s usually very effective.  

Hairy cell leukemia is also talked about in Chronic Lymphocytic Leukemia.

Primary central nervous system (CNS) lymphoma

This lymphoma involves the brain or spinal cord (the central nervous system, or CNS). The lymphoma is also sometimes found in tissues around the spinal cord. Over time, it tends to become widespread in the central nervous system.

Primary CNS lymphoma is rare overall, but it’s more common in older people and in people with immune system problems, such as those who have had an organ transplant or who have AIDS. Most people develop headaches and confusion. They can also have vision problems; weakness or altered sensation in the face, arms, or legs; and in some cases, seizures.

The outlook for patients with primary CNS lymphoma has improved over the years mainly due to advances in treatment.

Primary intraocular lymphoma (lymphoma of the eye)

This is a rare type of lymphoma that starts in the eyeball and is often seen along with primary CNS lymphoma. It is the second most common cancer of the eye in adults, with ocular melanoma (eye melanoma) being the first. Most people with primary intraocular lymphoma are elderly or have immune system problems which may be due to AIDS or anti-rejection drugs after an organ or tissue transplant.

People may notice bulging of the eyeball without pain, vision loss, or a blurry vision. Many of the tests done to diagnose ocular melanoma are the same used to diagnose lymphoma of the eye.

The main treatment for lymphoma of the eye is external radiation therapy if the cancer is limited to the eye. Chemotherapy (chemo) or chemotherapy in combination with radiation may be used depending on the type of lymphoma and how far it has spread outside of the eye.