B-cell lymphoma, also called B-cell non-Hodgkin lymphoma, is a type of blood cancer that develops in cells of the immune system. There are approximately 82,000 new cases of B-cell lymphoma in the United States each year. Diffuse large B-cell lymphoma (DLBCL) accounts for about one-quarter to one-third of all cases of non-Hodgkin lymphoma, making it the most common type of B-cell lymphoma.

Although B-cell lymphoma can occur at any age, it‘s more common in older people. Different kinds of B-cell lymphoma can affect different parts of the body and require different treatment regimens.

What Is B-Cell Lymphoma?

About 85 percent of all lymphomas in the U.S. are B-cell lymphomas. B-cell lymphomas develop from a type of white blood cells known as B cells or B lymphocytes. B cells work as part of the immune system to help the body recognize and fight infection. The development of genetic mutations in B cells can lead to lymphoma.

Types and Subtypes

Scientists have identified more than 70 types of B-cell lymphoma, including subtypes of DLBCL. Some types of B-cell lymphoma are fast-growing cancers, also described as aggressive or high grade. Other types are slow-growing cancers, known as indolent or low-grade.

Below we describe several types of B-cell lymphoma and subtypes of DLBCL.

1. Germinal Center B-Cell-Like DLBCL

DLBCL is an aggressive lymphoma that generally appears as a mass in the lymph node but can also originate in other parts of the body. However, two main subtypes of DLBCL are classified based on their molecular features. These distinctions are determined by gene expression profiling, which analyzes the cancer cell of origin (COO) — the original B cell that mutated (changed) into cancer.

The germinal center B-cell-like (GCB) subtype is the most common molecular subtype. GCB DLBCL is associated with better response to treatment and better overall survival.

2. Activated B-Cell-Like DLBCL

Activated B-cell-like (ABC) DLBCL has been found to be less responsive to treatment and generally has a worse clinical outcome. But according to research in the journal Oncologist, the five-year overall survival rate of people with this subtype of DLBCL has improved significantly in recent years due to improved treatment options.

Genetic testing is essential for assessing the COO and accurately diagnosing which subtype of DLBCL is present. Because DLBCL is a fast-growing cancer, treatment should be started quickly after diagnosis. The treatment approach will likely differ if the ABC-like subtype is identified.

3. Type 3 DLBCL

A third subtype, known as type 3 or unclassifiable, doesn’t have the molecular characteristics of either the GCB-like subtype or the ABC-like subtype. Cancer cells can be different from one another, so they are grouped into types that share similar features. This grouping forms a range, like a spectrum. When type 3 DLBCL is dominant (most noticeable), it responds to treatment better than the ABC subtype but not as well as the GBC subtype.

As genetic testing improves, scientists are likely to identify more detailed subtypes of DLBCL.

4. Primary Mediastinal B-Cell Lymphoma

Subtypes of DLBCL are also classified according to where in the body lymphoma develops. Primary mediastinal B-cell lymphoma (PMBCL) is another subtype of DLBCL. It occurs when lymphoma malignancies (cancer growths) form in the chest. PMBCL is molecularly distinctive from other types of DLBCL.

5. Primary Central Nervous System Lymphoma

Primary central nervous system lymphoma (PCNSL) occurs when lymphoma cancer cells develop in the central nervous system (CNS), including the brain, spinal cord, or tissues surrounding the eye. It is usually an ABC-like subtype. It’s uncommon and tends to develop in older people.

6. Follicular Lymphoma

Follicular lymphoma is named for the way it grows in round clusters called follicles. In contrast to DLBCL, follicular lymphoma is a slow-growing type of cancer and is generally not curable.

7. Mantle Cell Lymphoma

Mantle cell lymphoma (MCL) is a fast-growing disease that often forms in the gastrointestinal tract and bone marrow. MCL is rare and often is not diagnosed until it is in its late stages. Some cases of this type of lymphoma are much slower-growing.

8. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are two very closely related types of cancer. Both diseases have the same cancer cells originating in B cells, but SLL forms in the lymph nodes, whereas CLL forms primarily in the bone marrow and spleen.

9. Marginal Zone Lymphoma

Marginal zone lymphoma (MZL) is slow-growing cancer that can be further categorized into three distinct subtypes, depending on where the cancer forms:

• Mucosa-associated lymphoid tissue lymphoma (MALT), also called extranodal marginal zone B-cell lymphoma
• Nodal marginal zone B-cell lymphoma (NMZL)
• Splenic marginal zone B-cell lymphoma (SMZL)

MALT is the most common type of MZL. MALT occurs outside of the lymph nodes, usually in the stomach, and it’s often associated with infection of the bacterium Helicobacter pylori (H. pylori). NMZL occurs in the lymph nodes and bone marrow, whereas SMZL occurs in the spleen and bone marrow.

10. Burkitt Lymphoma

Burkitt lymphoma is an aggressive B-cell lymphoma that occurs in children as well as older adults. It is associated with Epstein-Barr virus infection and HIV infection.

11. Hairy Cell Leukemia

Although the name might indicate otherwise, hairy cell leukemia (HCL) is a type of B-cell lymphoma. It grows slowly and is more common in older adults, particularly in men, according to the journal Leukemia & Lymphoma.

12. Lymphoplasmacytic Lymphoma

Lymphoplasmacytic lymphoma, often associated with Waldenstrom macroglobulinemia, is a very rare B-cell lymphoma characterized by small lymphocytes. It is a generally slow-growing cancer that affects older adults. Due to its rarity and lack of defining features, it can typically only be diagnosed after ruling out other more common types of B-cell lymphoma.

Treatments for B-Cell Lymphoma

The type of treatment recommended varies depending on the specific type of B-cell lymphoma or subtype of DLBCL and how advanced it is. Other factors that may influence treatment options are whether the B-cell lymphoma or DLBCL is relapsed (recurring) or refractory (resistant to treatment). If you are diagnosed with B-cell lymphoma, your doctor will discuss treatment options and potential side effects in detail so that you can make informed decisions about your treatment plan.

Treatment options available for B-cell lymphoma include:

• Chemotherapy — Commonly taken as a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone, also known as CHOP — or R-CHOP when prescribed with the drug rituximab (Rituxan)
• Radiation therapy — Uses energy beams such as X-rays to kill cancer cells
• Antibiotics — May be prescribed to people with MALT-type marginal zone lymphoma due to its association with H. pylori infection
• Bone marrow transplant — Replaces unhealthy bone marrow and is combined with high-dose chemotherapy
• Immunotherapy — Boosts the immune system with therapies such as biologic drugs, antibodies, or chimeric antigen receptor (CAR) T-cell therapy
• Targeted drug therapy — Blocks specific proteins that enable cancer cell growth

You may also want to ask your oncology team about clinical trials, which can sometimes provide access to new treatments before they are available to the general public.

Prognosis of B-Cell Lymphoma

Different types and subtypes of B-cell lymphoma can affect different parts of the body and develop from different cell types. Therefore, disease prognosis (outlook) differs depending on the particular type of disease.

Although they are aggressive diseases, fast-growing cancers such as some subtypes of DLBCL and Burkitt lymphoma are generally responsive to treatment, and most people can be cured. Read more about DLBCL prognosis.

Slow-growing cancers such as follicular lymphoma, CLL/SLL, lymphoplasmacytic lymphoma, and hairy cell leukemia may be harder to fully cure with treatment. However, because they are slow-growing types of cancer, doctors often opt to keep an eye on progression of the disease and may or may not recommend treatment. Most people can live for many years with these types of cancer.

Outcomes for people with marginal zone lymphoma can vary due to the different subtypes within the disease. MALT-type MZL, the most common, is most responsive to treatment and has higher survival rates. NMZL and SMZL are rarer and, although somewhat responsive to treatment, more research is needed to identify more effective treatments for these diseases.

Mantle cell lymphoma doesn’t generally respond well to treatment, and rates of long-term survival are low. Newer, more effective treatments are being explored to improve the survival of people living with MCL.

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