Lymphoma subtypes:
Can you spot the difference?

Non-Hodgkin lymphoma (NHL) is a type of blood cancer that starts in the white blood cells, known as lymphocytes, which are a key component of the immune system.1
There are over 60 different types of NHL,2 which can also be classified as indolent (slow growing) or aggressive (fast growing), depending on how quickly the cancer grows.1 Two of the most common types, follicular lymphoma and diffuse large B-cell lymphoma (DLBCL), are very different in how, when and where they develop and how they are managed.

What are the most common subtypes of NHL?

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Follicular lymphoma
Diffuse large
B-cell lymphoma
DLBCL is the most common form of aggressive NHL, accounting for 30% of newly diagnosed NHL cases. Worldwide this is equivalent to approximately 120,000 people being diagnosed with this subtype each year.3,4
Follicular lymphoma is the most common indolent lymphoma, accounting for around 20% of newly diagnosed NHL cases. Worldwide this is equivalent to approximately 85,000 people being diagnosed with this subtype each year.3,4

How do cancer cells differ between subtypes?

Follicular lymphoma
Diffuse large
B-cell lymphoma
DLBCL is a type of B-cell lymphoma. It's called diffuse because cancer cells spread out within the tumour, destroying the normal structure of the lymph node.6
Follicular lymphoma is a type of B-cell lymphoma. It's called follicular because cancer cells tend to clump together in circles, known as follicles, in the lymph nodes.5

How quickly does the disease progress?

Follicular lymphoma
Diffuse large
B-cell lymphoma
DLBCL is characterised as aggressive because it advances rapidly and invariably becomes fatal without immediate treatment.8 If DLBCL is left untreated, median survival is less than one year.9
Follicular lymphoma is an indolent form of NHL, which means it grows slowly. Patients with follicular lymphoma can survive for many years and may not require immediate treatment if they do not display symptoms.7

When are patients usually diagnosed?

Follicular lymphoma
Diffuse large
B-cell lymphoma
Due to the aggressive nature of DLBCL, symptoms such as enlarged lymph nodes often become apparent early on. Around 40% of patients are diagnosed in the early stages of the disease, when prognosis is better.8
Symptoms of follicular lymphoma often appear gradually and therefore go unnoticed by patients, resulting in 80% of patients being diagnosed in the advanced stages of disease.10

What is the course of the disease?

Follicular lymphoma
Diffuse large
B-cell lymphoma
DLBCL is highly responsive initially and can be cured in over 60% of cases.12 Patients who relapse have poor survival, but those that respond to treatment and remain progression-free after two years have a similar life expectancy to healthy people of the same age.12,13
Although most patients respond to initial treatment, follicular lymphoma usually recurs and becomes more difficult to treat after each relapse.11 Relapse can occur at any time, even after years in remission.

What is the unmet clinical need?

Follicular lymphoma
Diffuse large
B-cell lymphoma
The aim of treatment in DLBCL is to cure patients. New treatment options are needed to increase initial cure rates and improve long-term outcomes for those who fail frontline therapy.15
There is currently no cure for follicular lymphoma. The aim of treatment is to prolong the time before a person’s disease returns. Treatment options that minimise symptoms and keep patients in remission longer are needed to improve long-term outcomes.14

References

  • 9. Rovira J, et al. Prognosis of patients with diffuse large B cell lymphoma not reaching complete response or relapsing after frontline chemotherapy or immunochemotherapy. Ann Hematol. 2015;94:803-12.
  • 10. Salles GA. Clinical features, prognosis and treatment of follicular lymphoma. Hematology Am Soc Hematol Educ Program. 2007;1:216-25.
  • 11. University of Maryland Medical Center. Non-Hodgkin’s lymphoma. Available at: http://umm.edu/health/medical/reports/articles/nonhodgkins-lymphoma. Last accessed November 2016.
  • 12. Maurer MJ, et al. Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. J Clin Oncol. 2014;32:1066-73.
  • 13. Vaidya R & Witzig TE. Prognostic factors for diffuse large B-cell lymphoma in the R(X)CHOP era. Ann Oncol. 2014;25:2124-33.
  • 14. Fowler N. Role of maintenance rituximab (Rituxan) therapy in the treatment of follicular lymphoma. Pharmacy and Therapeutics. 2011;36:590-8.
  • 15. Dotan E, et al. Impact of rituximab (Rituxan) on the treatment of B-cell non-hodgkin’s lymphoma. Pharmacy and Therapeutics. 2010;35:148-57.