Non-Hodgkin vs. Hodgkin's Lymphoma: What's the Difference?

Both Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are cancers of the lymphocytes. The two most common types of lymphocytes are B cells and T cells, and lymphomas are an abnormal growth of those cells. However, these two diseases differ from one another in several ways.

“The main difference is in the specific lymphocytes each involves,” said Rashmi Khanal, MD, assistant professor, Department of Bone Marrow Transplant and Cellular Therapies at Fox Chase-Temple University Hospital Bone Marrow Transplant Program in Philadelphia. “If a specific type of abnormal cells, called Reed Sternberg, is identified, the lymphoma is [HL].”

“[NHL] can arise from B lymphocytes and T lymphocytes or natural killer cells,” she said. “There is a histological difference and definitely a difference in treatment and patient outcomes.”

HL is also more homogeneous than NHL, with six different types. Patients diagnosed with HL tend to be younger – about a third are between the ages of 20-34 years old – and the average age of patient diagnosed with the disease is 39 years. HL is also a rare disease, and accounts for only about 5% of all cancers that are diagnosed.

In contrast, NHL is much more common and is the seventh most diagnosed cancer in the U.S. It is also much more heterogeneous, with more than 70 different types. In addition, the age of people diagnosed with NHL tend to be much older than those with HL. About three-quarters of patients diagnosed with NHL are ages 55 or older. The average age of those diagnosed with the disease is 66 years old.

The symptoms are similar, explained Dr. Khanal. “We are able to distinguish between the two lymphomas upon biopsy only,” she said.

Both lymphoma types can cause a variety of symptoms, which may vary depending on the particular type of lymphoma you have and how advanced the disease is. Common symptoms include extreme fatigue, swollen lymph nodes, unintentional weight loss and loss of appetite, fever, rash, and night sweats.

In general, lymphoma can occur when the immune system is weakened. Certain viruses such as Epstein Barr viruses, HIV, HTLV-1 can also predispose a person to certain types of lymphoma, Dr. Khanal said. Immunosuppressant medications also can give rise to lymphoma, aging in general, and gender, as men may be more likely to develop specific lymphomas. In the U.S., white people are more affected, and NHL is more common in the U.S. and Europe than in non-industrialized countries.

“Some lymphomas can be endemic, and this is seen in China and Africa,” said Dr. Khanal. “Having a first degree relative with NHL increases your risk and so does exposure to certain drugs and chemicals. Some types of chemotherapy and radiation therapy may increase the risk for lymphoma in the future.”

In addition, genetic factors may also make a person more vulnerable to the disease. “Some patients with the genetic disorder Wiskott-Aldrich syndrome may have a higher risk for developing NHL,” said Dr. Khanal. “Certain autoimmune conditions such as rheumatoid arthritis and systemic lupus erythematosus may be linked with an increased risk for lymphoma.”

Finally, certain viruses and bacterial infections have been linked specific types of NHL. “The Epstein-Barr virus has been associated with a particular type of NHL called Burkitt’s lymphoma, which is most common in children living in Africa,” said Dr. Khanal. Other viruses linked to the development of some specific types of NHL include chronic hepatitis C, HIV, human T-cell lymphotropic virus, and human herpesvirus 8.

Bacterial infections that are linked to development of NHL include Campylobacter jejuni, Chlamydophila psittaci, and Helicobacter pylori.

Treatment for both NHL and HL depends on many factors, including the stage of the disease, symptoms, your age, and if other health conditions are present.

“Initial treatment for Hodgkin and NHL may be different in terms of variable dose/combination of the same or similar sub classes of chemotherapy,” said Dr. Khanal. “Biological therapy such as B-cell monoclonal antibodies is the backbone of NHL treatment whereas that is not the case for Hodgkin’s lymphoma.”

For HL, chemotherapy remains the most common treatment, although researchers are actively investigating other options.

“Salvage chemotherapy at relapse and conditioning regimens during autologous stem cell transplant is the same for both lymphoma types,” said Dr. Khanal. “However, newer therapies such as CART-cell therapy, BiTE therapy as well as immunotherapies may be options for specific types of lymphoma.”

“Overall, patients have good prognoses with lymphoma in general, as compared to other types of cancer,” said Dr. Khanal. “Outlook is improving even in multiple relapsed lymphoma, given the advent of newer and ground breaking therapies such as CAR-T, BiTE, and targeted therapies.”