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Intermediate Grade/Aggressive Grade NHL


Intermediate grade non-Hodgkin lymphomas are the most common of all lymphomas, and are considered aggressive in nature. The most common is diffuse large B-cell lymphoma, which accounts for over 30% of all lymphomas. Lymphomas classified according to the REAL or IWF system are listed below. Patients with the following non-Hodgkin lymphoma classifications are all treated in a similar fashion and are described in this section.

International Working Formulation:
Intermediate Grade: Diffuse Large Cell
Follicular Large Cell
Diffuse Small Cleaved Cell
Diffuse Mixed Small and Large Cell
High Grade: Immunoblastic
Revised European American Lymphoma Classification:
Diffuse Large B-Cell Peripheral T-Cell
Anaplastic Large Cell Follicle Center Lymphoma (grade 3)

In addition to the histologic classification of non-Hodgkin’s lymphoma, it is important to determine the stage or where the cancer has spread in the body. All new treatment information is categorized and discussed by the stage, or extent, of the disease. Determining the extent of the spread or the stage of the cancer requires a number of procedures including computerized tomography (CT) and/or magnetic resonance imaging (MRI) scans and blood tests. The goal of staging lymphoma is to determine which patients have early and which have advanced stage cancer. To learn more about the treatment of a lymphoma listed in the table, select the appropriate stage.

Stage I: Cancer is found only in a single lymph node, in the area immediately surrounding that node, or in a single organ.

Stage II: Cancer involves more than one lymph node area on one side of the diaphragm (the breathing muscle separating the abdomen from the chest).

Stage III: The cancer involves lymph node regions above and below the diaphragm. For example, there may be swollen lymph nodes under the arm and in the abdomen.

Stage IV: Cancer involves one or more organs outside the lymph system or a single organ and a distant lymph node site.

In some patients the lymphoma may grow out of the lymph system into adjacent organs. This is referred to as extranodal extension and designated by an “E” following the stage. For example, a stage II lymphoma that extended into the lungs would be referred to as stage IIE.

Patients with non-Hodgkin lymphoma may also experience general symptoms from their disease. Patients with fever, night sweats or significant weight loss are said to have “B” symptoms. If these specific symptoms are not present, patients are further classified as “A”.

Relapsed/Refractory: The cancer has persisted or returned (recurred/relapsed) following treatment.

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