Types of B-Cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL)

About 1 out of every 3 lymphomas is a diffuse large B-cell lymphoma (DLBCL). It is the most common type of non-Hodgkin lymphoma (NHL) in the United States.

DLBCL usually affects older adults. The average age at diagnosis is in the mid-60s.

It often starts as a fast-growing lump in a lymph node inside the chest or belly, or in a node you can feel in the neck, armpit, or groin. It can also start in any other organ in the body, including the intestines, bones, brain, or spinal cord.

This type of lymphoma grows quickly and is generally considered curable.

Treatment: The standard first-line treatment is a combination of rituximab with multiple chemotherapy drugs. For example, a regimen called R-CHOP. Newer options are improving outcomes for people whose cancer comes back or doesn't respond to initial treatment. These options include bispecific antibodies and CAR T-cell therapy. To learn more, see Treating B-Cell Non-Hodgkin Lymphoma.

Primary mediastinal B-cell lymphoma

Primary mediastinal B-cell lymphoma is a subtype of DLBCL. This is a fast-growing lymphoma, but it usually responds well to treatment. It happens mostly in young women.

This type of lymphoma starts in the mediastinum, the area in the middle of the chest behind the breastbone.

It can grow quite large, and it often presses on the windpipe (trachea) leading into the lungs. This can cause trouble breathing. It can also impair heart function or block blood vessels, which can cause swelling of the arms and face.

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. The average age at diagnosis is around 60. It is rare in young people.

Follicular lymphomas tend to appear in many lymph nodes at once, as well as in the bone marrow. This type of lymphoma usually grows slowly. It often responds to treatment, but it is hard to cure.

Treatment: Many people don’t need treatment right away. Instead, doctors might watch the lymphoma closely and begin treatment only if the cancer starts to cause problems. Studies show that starting treatment before the lymphoma causes symptoms does not help people live longer, and it exposes them to the side effects of treatment sooner. To learn more, see Treating B-Cell Non-Hodgkin Lymphoma.

If the lymphoma comes back after treatment: Newer treatments can often help. Newer treatments include immunotherapies, such as bispecific antibodies and CAR T-cell therapy. Other new treatments include drugs such as lenalidomide or zanubrutinib, which are given along with an antibody drug. 

Transformation: Over time, some follicular lymphomas can turn into DLBCL. This is called transformation. It usually happens several years after the original diagnosis. Signs of transformation can include a lymph node that suddenly grows quickly or new symptoms such as fever, night sweats, or weight loss. Transformed lymphoma needs to be treated right away, usually the same way as DLBCL.

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 cancerous B cell is seen in both CLL and SLL. The main 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.

CLL/SLL is usually a slow-growing (indolent) lymphoma, but it occasionally grows faster. These lymphomas sometimes turn into a more aggressive (fast-growing) type of lymphoma over time.

Treatment: These lymphomas are usually not curable, but they tend to grow slowly. They often don’t need to be treated when they are first found. When treatment is needed, it is often very helpful. Many people can live a long time, even decades, with CLL or SLL.

Treatment is the same for both CLL and SLL. It often involves only oral medicines (taken by mouth). Chemotherapy is used very rarely. To learn more, 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. It most often appears in people older than 60.

MCL can behave like either an indolent (slow-growing) or aggressive (fast-growing) lymphoma. When MCL is diagnosed, it is usually widespread in the lymph nodes, bone marrow, spleen, and often the intestines.

Some people can be watched closely without treatment at first, but most need treatment.

Treatment: Treatment options for MCL range from targeted drugs taken as pills to chemotherapy combined with immunotherapy. Some people get more intensive treatments, such as a stem cell transplant or CAR T-cell therapy. Treatment can often control MCL for a long time, but it cannot be cured in most people. To learn more, see Treating B-Cell Non-Hodgkin Lymphoma.

Marginal zone lymphomas

Marginal zone lymphomas make up about 5% to 10% of all lymphomas. They tend to grow slowly.

There are 3 main types:

Burkitt lymphoma

This lymphoma tends to grow extremely fast. In most cases, it is widespread in the body by the time it is recognized. It makes up only about 1% to 2% of all adult lymphomas, but it’s more common in children. It is also much more common in males than in females.

Burkitt lymphoma may happen more often in people who have HIV or AIDS, or in people who've had an organ transplant. In some cases, it may be linked to infection with the Epstein-Barr virus (EBV), which can also cause infectious mononucleosis or "mono."

High-grade B-cell lymphoma: This is a similar type of lymphoma. It used to be called Burkitt-like lymphoma. It behaves much the same way as Burkitt lymphoma, but the cells have different chromosome changes.

Treatment: These lymphomas grow very quickly, so they need to be treated right away. More than half of people with Burkitt lymphoma can be cured. However, treatment usually involves more intensive chemotherapy than for other lymphomas. To learn more, see Treating B-Cell Non-Hodgkin Lymphoma.

Lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)

This slow-growing lymphoma is not common. It accounts for only 1% to 2% of all lymphomas.

The lymphoma cells are small and found mainly in the bone marrow, lymph nodes, and spleen. To learn more, see Waldenstrom Macroglobulinemia.

Hairy cell leukemia (HCL)

Though it has leukemia in the name, this cancer is sometimes classified as a lymphoma.

HCL is very rare. Only about 700 people are diagnosed in the United States each year. It is much more common in men, with the average age at diagnosis around 50.

The cancer cells are B lymphocytes with a "hairy" appearance under the microscope. They are usually found in the bone marrow, spleen, and blood.

Treatment: HCL is slow-growing. Some people may not need treatment when it is discovered. If treatment is needed, it is usually because a person has an enlarging spleen or because cancer cells invade the bone marrow and cause low blood cell counts. Treatment is usually very effective. Hairy cell leukemia is also discussed in Chronic Lymphocytic Leukemia.

Primary central nervous system (CNS) lymphoma

Primary CNS lymphoma involves the brain or spinal cord. This area of the body is called the central nervous system, or CNS. Sometimes this lymphoma may be found in the fluid taken during a spinal tap.

Most people develop headaches and confusion. They might also have vision problems and weakness or altered sensation in the face, arms, or legs. In some cases, a person can have seizures.

Primary CNS lymphoma is rare overall. But it is more common in older people and in people with immune system problems, such as those who’ve had an organ transplant or have AIDS. The outlook for people with primary CNS lymphoma has improved over the years, mainly due to better treatments.

Treatment: Treatment typically involves chemotherapy in the hospital. To learn more, see Treating B-Cell Non-Hodgkin Lymphoma.

Primary intraocular lymphoma

Sometimes, primary CNS lymphoma starts inside the eye or involves both the brain and the eye. This is sometimes called primary intraocular lymphoma. It may be discovered by an eye doctor (ophthalmologist). Signs can include blurry vision, vision loss, or bulging of the eyeball. This lymphoma is typically treated in the same way as other primary CNS lymphomas. 

B-lymphoblastic lymphoma/leukemia

This type of lymphoma is similar to B-cell acute lymphoblastic leukemia (also called acute lymphocytic leukemia). It behaves and is treated in much the same way. It is very rare and grows very fast. It often involves the lymph nodes, spleen, and bone marrow.

This lymphoma is more common in children than adults. It is typically treated with intensive chemotherapy, which offers a chance of cure.