High grade NHL
Doctors often group non-Hodgkin lymphoma (NHL) as either low grade or high grade. The grade depends on how quickly the NHL is likely to grow and spread.
High grade NHL tends to grow quite quickly. Doctors sometimes describe them as aggressive lymphomas. They grow faster than low grade lymphomas, which tend to grow slowly. Doctors call low grade lymphomas indolent lymphomas.
This page is about the different types of high grade NHL.
NHL begins in a type of white blood cell called a lymphocyte. There are different types of lymphocytes. These include B cells, T cells and natural killer (NK) cells. So you can develop a:
- B cell lymphoma
- T cell lymphoma
- NK cell lymphoma
There are different types of B cell and T cell lymphomas. Some of these are low grade, and some are high grade. In the UK, B cell lymphomas are more common than T cell or NK cell lymphomas.
Types of high grade NHL
The most common types of high grade NHL are:
- diffuse large B cell lymphoma (DLBCL)
- high grade B cell lymphoma
- Burkitt lymphoma
- peripheral T cell lymphoma
Rarer types of high grade NHL include:
- anaplastic large cell lymphoma (ALCL)
- angioimmunoblastic T-cell lymphoma (AITL)
- enteropathy associated T cell lymphoma (EATL)
- hepatosplenic gamma delta T cell lymphoma
- EBV positive NK / T cell lymphomas
Other rare types of high grade lymphomas include:
- lymphoblastic lymphoma
- treatment related lymphoma
Over time, a low grade lymphoma can sometimes change into a high grade type lymphoma. Doctors call this transformation.
Diffuse large B cell lymphoma
This is the most common type of NHL in the UK. Each year about 5,000 people are diagnosed with diffuse large B cell lymphoma (DLBCL) in the UK. This makes up more than 40 out of 100 cases (40%) of NHL in adults.
DLBCL grows quickly and treatment usually starts soon after diagnosis.
There are different sub types of DLBCL. Most people with DLBCL do not have a specific sub type. You might see this written as ‘DLBCL not otherwise specified’ or ‘DLBCL NOS’.
Other types of large B-cell lymphomas cause specific symptoms because of where they develop. For example, primary mediastinal (thymic) large B cell lymphoma. This causes enlarged lymph nodes in the central area of your chest (mediastinum).
Another example is primary 
. DLBCL can develop in the brain or spinal cord and cause symptoms such as headaches, vision changes or fits (seizures).
Burkitt Lymphoma
Burkitt lymphoma is a B cell lymphoma.
Each year around 260 people are diagnosed with Burkitt lymphoma in the UK. This makes up only 2 out of 100 cases (2%) of NHL. Burkitt lymphoma is the most common type of NHL in children in the UK. Adults can also be diagnosed, but it is more unusual. It is more common in males than females.
Burkitt lymphomas can affect people with low . For example, people who have had an organ transplant or who have AIDS. But it can also affect people who don't have any problems.
People with Burkitt lymphoma tend to develop symptoms quite quickly. It tends to progress rapidly.
Peripheral T cell lymphoma
These are a group of quickly growing lymphomas that develop from T cells. In the UK, around 500 people are diagnosed with this type of lymphoma each year.
Peripheral T cell lymphomas (PTCL) are divided into subtypes. They all have very different characteristics and behaviour.
Peripheral T cell lymphoma , not otherwise specified
The most common subtype is 'peripheral T cell lymphoma, not otherwise specified' (PTCL NOS). PTCL NOS includes all T cell lymphomas that don't fit into another group.
Most people with PTCL NOS have lymphoma cells only in the lymph nodes. But it can also develop in the liver, bone marrow, digestive system and skin.
EBV positive NK/T-cell lymphoma
This is a rare type of lymphoma. It can affect T cells or NK cells. NK stands for natural killer cells. NK cells are a type of lymphocyte, similar to B and T cells.
This type of lymphoma is linked to infection with the Epstein Barr virus (EBV). EBV is a common viral infection. In most people it doesn't cause a serious disease. But in rare cases it can lead to the development of some types of lymphoma.
You can get it:
- inside your lymph nodes and lymphatic system – this is called EBV positive nodal NK/T cell lymphoma
- outside your lymphatic system, for example in your nose – this is called extranodal NK/T cell
NK T cell lymphomas can be very difficult to treat.
Enteropathy associated T cell lymphoma
This is a very rare type of T cell lymphoma. It is also called enteropathy type T cell lymphoma (ETTL) or intestinal T cell lymphoma (ITCL).
EATL usually happens in the . It is most often in the middle part (jejunum) or the lower part closest to the large intestine (ileum). It can spread to the liver, spleen, lymph nodes, gallbladder, stomach, colon or skin.
Hepatosplenic gamma delta T cell lymphoma
This very rare type of lymphoma starts in the liver or . It tends to grow very quickly.
Hepatosplenic gamma delta T cell lymphoma can affect people with , who have a weak . It can also affect people with no previous medical problems.
Anaplastic large cell lymphoma (ALCL)
This is a type of lymphoma that starts in T cells. The term anaplastic means that under the microscope, the cancer cells look large and abnormal.
There are different types of ALCL. These are:
- ALK positive ALCL
- ALK negative ALCL
- breast implant associate ALCL
- primary cutaneous (skin) ALCL
Angioimmunoblastic T cell lymphoma (AITL)
Angioimmunoblastic T cell lymphoma is a high grade (aggressive) lymphoma that affects T cells. Around 140 people are diagnosed with AITL in the UK every year.
It usually affects older people, typically around the age of 70. But it can occur at any age. Unusually, AITL can undergo a change (transformation) to a B cell NHL.
Lymphoblastic lymphoma
Lymphoblastic lymphoma (LL) is a rare type of high-grade NHL. It usually develops from T cells but occasionally develops from B cells.
LL is very similar to acute lymphoblastic leukaemia (ALL). In lymphoblastic lymphoma, the abnormal white blood cells (lymphocytes) are generally in the chest lymph nodes or thymus gland. But in ALL the abnormal cells are mainly in the blood and bone marrow. The treatments for lymphoblastic lymphoma and ALL are similar.
Lymphoma after a transplant
Lymphomas can sometimes develop after:
- an
organ transplant - some types of
stem cell transplant
After transplants people take medicines that suppress their . This is to prevent rejection of their transplant. This can increase the risk of developing lymphoma.
Different types of lymphoma can develop. Diffuse large B cell lymphoma is the most common, but others include Burkitt lymphoma and rarer T cell lymphomas.
As part of your treatment, you usually reduce or stop taking the medicine that suppresses your immune system. This decision must be taken carefully. It usually involves discussions between your lymphoma specialist and your transplant team. Stopping these medicines can increase the chance of your body rejecting the transplant.
For some people, stopping these medicines is the only treatment you need. But some other patients need treatment with an drug (rituximab). You might have it together with (immunochemotherapy).
Transforming from low grade to high grade
Low grade lymphomas can sometimes change into a faster growing (high grade) lymphoma. Doctors call this transformation.
Transformation is more common in some types of NHL than others. So it does not always happen. Most low grade lymphomas do not transform. If lymphoma does transform it can happen any time. Sometimes, it can happen many years after you are first diagnosed with low grade NHL. But it can also happen early on in your disease.
Sometimes, you can have a low grade and high grade lymphoma at the same time. Your doctor might assume that your low grade lymphoma is in the process of transforming to the higher grade type.
After a low grade NHL has transformed, it has to be treated as high grade. Unfortunately, a transformed NHL can sometimes be harder to control than when it was low grade. And the treatment is more intense.
Treatment for high grade lymphomas
The type of treatment you have for high grade NHL depends on:
- the
stage and type of your lymphoma when it is diagnosed - the symptoms you have at the time
- your general health and fitness
The main types of treatment for high grade NHL are:
chemotherapy targeted cancer drugs radiotherapy stem cell transplant
You might have one or more of these treatments.
Chemotherapy can be combined with a targeted immunotherapy drug. This is called chemoimmunotherapy.
We have treatment information for some of the different types of high grade lymphoma. You can look for your lymphoma type at the link below.
