Non-Hodgkin lymphoma classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Overview

Non-Hodgkin lymphoma may be classified into subtypes according to updated WHO classification and rate of growth.

Classification

A. Updated WHO classification

• Non-Hodgkin lymphoma may be classified according to updated WHO classification into 2 groups:

• B-cell neoplasms
• T-cell and putative NK-cell neoplasms

Updated WHO classification of Non-Hodgkin lymphoma

B-cell neoplasms	T-cell and putative NK-cell neoplasms
Precursor B-cell neoplasm	Precursor T-cell neoplasm
Precursor B-acute lymphoblastic leukemia / lymphoblastic lymphoma (LBL)	Precursor T-acute lymphoblastic leukemia / lymphoblastic lymphoma (LBL)
Peripheral B-cell neoplasms	Peripheral T-cell and NK-cell neoplasms
B-cell CLL / small lymphocytic lymphoma	T-cell CLL / prolymphocytic leukemia
B-cell prolymphocytic leukemia	T-cell granular lymphocytic leukemia
Lymphoplasmacytic lymphoma / immunocytoma	Mycosis fungoides / Sézary syndrome
Mantle cell lymphoma	Peripheral T-cell lymphoma, not otherwise characterized
Follicular lymphoma	Hepatosplenic gamma / delta T-cell lymphoma
Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue (MALT) type	Subcutaneous panniculitis-like T-cell lymphoma
Nodal marginal zone B-cell lymphoma (± monocytoid B-cells)	Angioimmunoblastic T-cell lymphoma
Splenic marginal zone lymphoma (± villous lymphocytes)	Extranodal T-/NK-cell lymphoma, nasal type
Hairy cell leukemia	Enteropathy-type intestinal T-cell lymphoma
Plasmacytoma / plasma cell myeloma	Adult T-cell lymphoma / leukemia (human T-lymphotrophic virus [HTLV] 1+)
Diffuse large B-cell lymphoma	Anaplastic large cell lymphoma, primary systemic type
Burkitt lymphoma	Anaplastic large cell lymphoma, primary cutaneous type
	Aggressive NK-cell leukemia

B. Classification based on rate of growth

• Non-Hodgkin lymphoma may be classified based on rate of growth into 2 groups:

• Low-grade or Indolent lymphoma
• High-grade or Aggressive lymphoma

Non-Hodgkin lymphoma classification

Grade	Description
Low-grade or Indolent lymphoma	Tend to grow very slowly Tend to be widespread by the time they are diagnosed Often involving the bone marrow and spleen Often treated only when symptoms appear Can shrink or seem to disappear with treatment, but they tend to come back Can change into more aggressive lymphomas Have a fairly good prognosis
High-grade or Aggressive lymphoma	Grow quickly and tend to spread to lymph nodes or other organs throughout the body Cause symptoms and need treatment right away Can frequently be successfully treated with intensive chemotherapy treatment

Severity	Calcium concentration	Key Points
Mild hypercalcemia	<3.0 mmol/L	Often asymptomatic No urgent correction needed
Moderate hypercalcemia	3.0–3.5 mmol/L	Tolerated well if there is a slow rise Symptoms may be present Treatment indicated in symptomatic cases
Severe hypercalcemia	>3.5 mmol/L	Urgent correction is recommended Risk of dysrhythmia and coma if not corrected

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