From the Guidelines
Lymphomas are broadly categorized into two main types: Hodgkin lymphoma and non-Hodgkin lymphoma, with Hodgkin lymphoma being characterized by the presence of Reed-Sternberg cells and having several subtypes, including classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma, as noted in the 2020 NCCN clinical practice guidelines 1.
Overview of Lymphoma Types
The main types of lymphoma include:
- Hodgkin lymphoma (HL), which is divided into classic Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) 1
- Non-Hodgkin lymphoma, which is more diverse and includes over 60 subtypes, such as diffuse large B-cell lymphoma, follicular lymphoma, and T-cell lymphomas 1
Subtypes of Hodgkin Lymphoma
The subtypes of Hodgkin lymphoma include:
- Classical Hodgkin lymphoma (CHL), which accounts for 95% of all HL cases in Western countries and is divided into four subtypes: nodular sclerosis CHL, mixed cellularity CHL, lymphocyte-depleted CHL, and lymphocyte-rich CHL 1
- Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), which lacks Reed-Sternberg cells but is characterized by the presence of lymphocyte-predominant cells, sometimes termed popcorn cells 1
Treatment Approaches
Treatment approaches for lymphoma vary significantly based on the specific type, stage, and aggressiveness of the lymphoma, ranging from watchful waiting for indolent cases to intensive chemotherapy regimens, immunotherapy, targeted therapies, radiation, and stem cell transplantation for more aggressive forms, with the goal of improving cure rates and reducing long-term toxicity, as emphasized in the 2020 NCCN clinical practice guidelines 1. The most effective treatment approach for Hodgkin lymphoma is a combined chemoradiotherapy, such as two cycles of ABVD followed by 30 Gy involved field radiotherapy, which has been shown to substantially reduce the number of relapses and is currently the treatment of choice for early favorable HL, as noted in the ESMO clinical recommendations 1.
From the Research
Types of Lymphomas
- Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy, representing approximately 10% of all lymphomas in the United States 2
- HL is composed of two distinct disease entities: classical HL and nodular lymphocyte predominant HL (NLPHL) 2, 3
- Classical HL has subgroups, including nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL 2
- NLPHL is a rare lymphoma entity with an incidence of 0.1 to 0.2/100 000/y, characterized by distinct pathological and clinical features 3
- Non-Hodgkin's lymphomas (NHL) are also a type of lymphoma, and recent observations indicate that HL and NHL may be more closely related than previously believed 4
Subtypes of Hodgkin Lymphoma
- Nodular sclerosis HL has a distinct epidemiology, clinical presentation, and histology, and may be related to primary mediastinal B-cell lymphoma and mediastinal gray-zone lymphomas 5
- Mixed cellularity and lymphocyte-depleted subtypes might be part of a biologic continuum 5
- Lymphocyte-rich HL is a subtype of classical HL 2
Diagnosis and Differentiation
- A reliable immune panel exists for the diagnosis of Hodgkin Lymphoma, but further research is required to discover more accurate and specific markers 6
- GATA3 immunohistochemical expression pattern can aid in differentiating between classical HL and NLPHL, as GATA3 expression is present in 63.3% of classic HL samples, while no expression is observed in NLPHL samples 6