B-cell Non-Hodgkin’s Lymphomas
About 85% of all NHL begins in B-cells. Some of the subtypes of B-cell Non-Hodgkin’s Lymphomas and their major characteristics include:
Diffuse Large B-cell Lymphoma (DLBCL)
DLBCL comprises about 33% of NHL cases, making it the most common type in the United States. It mostly strikes older adults, aged 60 and up. DLBCL usually originates in a lymph node, although it may also start out in other tissues of the body that are heavily populated by lymphoid cells, such as the intestines, the bone, the brain or the spinal cord. As its name implies, DLBCL cells examined under a microscope appear quite large. Although generally fast growing, DLBCL tends to be localized, which aids in its treatment, and may account for its generally good response to therapies. The particulars of the genetic makeup of the DLBCL cells seem to influence the ultimate prognosis, and can help the provider tailor treatment choices. 75% of people treated go into remission, and about 50% are permanently cured.
Affecting about 20% of all people with lymphoma, mostly those in their 60s, this type of lymphoma grows in a characteristically circular pattern. Both the bone marrow and a variety of lymph nodes throughout the body are affected. An individual may go years without experiencing any symptoms, and treatment is sometimes delayed until the lymphoma reaches the point of causing problems. While slow-growing and reasonably treatment-responsive, these types of lymphoma can be resistant to cure. Additionally, about 33% of these types of lymphoma can morph into a faster-growing DBCL.
Primary Mediastinal B-cell Lymphoma
This fast-growing type of DLBCL has a tendency to strike young women in their thirties. It usually originates behind the breast bone (sternum). Because of its location, as it grows and expands it can cause shortness of breath by pushing on the airway, or cause swelling in the upper body by compressing veins that return blood to the heart. About 50% of those treated are permanently cured of the disease.
Chronic Lymphocytic Lymphoma
Comprising about 5-10% of all lymphomas, and believed to be either extremely closely related to or a variant of chronic lymphocytic leukemia, this type of NHL originates in the lymph nodes and spleen. This very slow-growing lymphoma has an extremely low cure rate, although treatment often allows patients to live for more than a decade with the disease. In some cases, this type of lymphoma may eventually transform into a faster-growing form of lymphoma.
Mantle Cell Lymphoma
About 5% of all NHL is of this variety. Usually striking men in their 60s, by the time mantle cell lymphoma is diagnosed, it is often present in multiple locations, including the lymph nodes, bone marrow, and spleen. This type of NHL is comprised of small-to-medium sized cells. Although not particularly fast-growing, it is somewhat treatment-resistant, although newer treatments hold great hope.
Hairy Cell Leukemia
Most often striking men around the age of 50, this type of malignancy is classified as a lymphoma by some and as a leukemia by others. It is a very rare, slow-growing B-cell cancer that resides in the bone marrow, spleen, and bloodstream. Treatment can be effective, although it can be postponed, sometimes indefinitely, if the malignancy is not causing untoward symptoms.
About 1-2% of all NHLs are this type of fast-growing, medium-cell lymphoma. Most patients are around 30 when diagnosed, and almost 90% are men. Strongly associated with infection with the Epstein-Barr virus, it often strikes abdominal organs, including the spleen, ovaries, and testicles, ultimately spreading to both brain and spinal fluid. In Africa, the tumors usually affect the jaw and facial bones. Despite the speed with which it grows and spread, aggressive chemotherapy can result in a cure for over 50% of Burkitt’s lymphoma patients.
Marginal Zone B-Cell Lymphomas
Making up 5-10% of all lymphomas, this small-cell NHL is subdivided into three specific varieties:
- Extranodal marginal zone B-cell lymphomas or mucosa-associated lymphoid tissue (MALT) lymphomas: Patients with MALT lymphoma tend to be around age 60. Rather than striking lymph nodes, this type of NHL usually originates in the stomach, or occasionally in the lung, skin, thyroid, salivary glands, or around the eye. Bacteria or viruses may be associated with MALT lymphomas. For example, those in the stomach may be linked to the ulcer-causing bacteria Helicobacter pylori. In fact, antibiotics are a first-line treatment for MALT lymphoma of the stomach, and may affect a cure. Thanks to their slow growth, many MALT lymphomas can be cured at early stages.
- Nodal marginal zone B-cell lymphoma: While not quite as slow growing as MALT lymphoma, this type of lymphoma is still reasonably leisurely in its growth patterns. This characteristic allows it to be cured at early stages. This type of NHL tends to be confined to the lymph nodes, or occasionally the bone marrow.
- Splenic marginal zone B-cell lymphoma: A more rare form of NHL that tends to strike elderly men, the abnormal cells are primarily located in the spleen and bone marrow. Very slow growing, treatment may be delayed unless the patient develops problematic symptoms.
Primary Central Nervous System Lymphoma
This type of lymphoma most commonly afflicts individuals with immune system disorders. Per its name, this rare lymphoma starts out in the brain, spinal cord, the tissues that surround the spinal cord or the eye (where it may be called intraocular lymphoma). It can spread throughout the CNS. With treatment, some patients may live for five or so years after diagnosis.
Reasonably uncommon (1-2% of NHL), this small cell lymphoma crops up in the bone marrow, lymph nodes, and spleen, growing slowly. The abnormal cells produce a large, protein antibody called immunoglobulin M (IgM) which thickens the blood, cutting down on blood flow to organs such as the eye (interfering with vision) or brain (causing headache, dizziness, confusion). Patients with this type of lymphoma often feel very fatigued, and may have an increased tendency to bleed. Treatment can prolong life, although it rarely cures this condition.