Types of Hodgkin lymphoma

There are 2 types of Hodgkin lymphoma (HL) – classic Hodgkin lymphoma (cHL) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL).

Classic Hodgkin lymphoma is by far the most common type of HL, so it’s often just called HL. About 95% of all HLs are classic HL. It starts in abnormal B cells called Hodgkin and Reed-Sternberg (HRS) cells. HRS cells are a lot bigger than normal B cells and have 1 or more large nuclei.

Most cases of HL are diagnosed in adults between 20 and 40 years of age, though there is another increase in diagnosis in adults older than 50. Slightly more men than women are diagnosed with HL. We need more research and can’t say at this time how common HL is in transgender, non-binary and gender-diverse people.

There are 4 types of classic HL. They are identified by the presence of HRS cells found in tissues that are removed during a biopsy. All 4 types of classic HL may also cause B symptoms (fever, drenching night sweats and unexplained weight loss).

Nodular sclerosis HL is the most common type of classic HL in Canada. It usually starts in lymph nodes deep in the centre of the chest (called the mediastinum) or in the neck. The lymphoma often forms a tumour, or mass, which is called bulky disease if it is larger than 10 cm. About 40% of people with nodular sclerosis HL develop B symptoms.

Mixed cellularity HL is the second most common type of classic HL. It most often develops in people with HIV or people who are infected with the Epstein-Barr virus. Mixed cellularity HL usually develops in the upper half of the body and often affects lymph nodes in the abdomen and spleen. It usually causes B symptoms.

Lymphocyte-rich classic HL usually affects only a few lymph nodes in the neck, in the armpits and above the collarbone. When tissue samples are examined under a microscope, there are fewer HRS cells than with other types of HL. Lymphocyte-rich classic HL doesn’t usually cause B symptoms.

Lymphocyte-depleted HL is the least common but most aggressive type of classic HL. It usually affects lymph nodes in the chest and abdomen, as well as the spleen, liver and bone marrow. Most people with lymphocyte-depleted HL have B symptoms.

All 4 types of classic HL are treated the same way.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is very rare. It is different from other types of HL because it doesn’t have Hodgkin and Reed-Sternberg (HRS) cells. Instead, it has lymphocyte-predominant (LP) cells. LP cells are large abnormal B cells. They are sometimes called popcorn cells because they look large and puffy when viewed under a microscope. NLPHL is usually diagnosed at an early stage and grows slowly. Most people are between the ages of 30 and 60 when they are diagnosed.

NLPHL is more common in men than women. We need more research and can’t say at this time how common NLPHL is in transgender, non-binary and gender-diverse people.

The World Health Organization is in the process of reclassifying NLPHL. It will be considered a type of non-Hodgkin lymphoma and renamed nodular lymphocyte-predominant B-cell lymphoma (NLPBL).