Hodgkin’s lymphoma is a type of cancer that starts growing in the white blood cells of the immune system. There are two different types and five subtypes, each with different characteristics.

Hodgkin’s lymphoma usually starts in the B cells, or lymphocytes. These are cells of the immune system that defend against bacteria and viruses by making proteins called antibodies. They travel through the body using a system of lymph nodes and lymph vessels.

The main types of Hodgkin’s lymphoma are classical Hodgkin’s lymphoma (cHL) and nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL). The different types account for varying features of the changes to B cells, as well as different processes of growth and spread. The treatments for each type also vary.

Read on to learn more about the types of Hodgkin’s lymphoma. This article also looks at symptoms, diagnosis, and more.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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There are four subtypes of cHL:

Together, these account for at least 90% of Hodgkin’s lymphoma cases in developed countries.

The presence of Reed-Sternberg cells, along with Hodgkin cells, defines cHL. Reed-Sternberg cells are large cells that often have more than one nucleus, which is the center of a cell that contains its genetic information.

NLPHL is a separate type of Hodkin’s lymphoma. It is less common.

Nodular sclerosis Hodgkin’s lymphoma (NSCHL)

Lymph nodes with NSCHL have bands of scar tissue and tumors that grow as nodules. This subtype of Hodgkin’s lymphoma is very treatable. It usually starts developing in the lymph nodes of the neck or chest.

Around 70% of people with cHL have NSCHL. Males and females have a similar risk of developing this subtype. Likewise, people of any age can develop NSCHL. However, it occurs most often in young adults and teenagers.

Mixed cellularity Hodgkin’s lymphoma (MCCHL)

In MCCHL, the lymph node tumors have Reed-Sternberg cells as well as other types. It is the second most common type, occurring in around 20–40% of people with Hodgkin’s lymphoma.

MCCHL is most common in the following groups:

  • males
  • children
  • older adults
  • people living with human immunodeficiency virus (HIV)

Lymphocyte-rich Hodgkin’s lymphoma

This is a rare subtype of cHL, developing in around 5% of people with cHL.

Lymph nodes with lymphocyte-rich Hodgkin’s lymphoma have a number of healthy B cells. It usually develops in just a few lymph nodes in the upper half of the body and is more common in males than females.

As people with this type often receive an early diagnosis, the outlook for people with lymphocyte-rich Hodgkin’s lymphoma is excellent, according to a 2023 review article.

Lymphocyte-depleted Hodgkin’s lymphoma

This is the rarest subtype of cHL. Lymph nodes with lymphocyte-depleted Hodgkin’s lymphoma do not have many healthy B cells. Instead, they have a high number of Reed-Sternberg cells.

Older adults and people living with HIV have a higher risk of this subtype. It also has links to the Epstein-Barr virus (EBV), a herpes virus that can cause mononucleosis, or mono. Most often, physicians find lymphocyte-depleted Hodgkin’s lymphoma in the abdomen, as well as in the bone marrow, liver, and spleen.

Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL)

This slow-growing type of Hodgkin’s lymphoma leads to variants of Reed-Sternberg cells called popcorn cells. It occurs in around 5% of people with Hodgkin’s lymphoma. It usually starts in the lymph nodes of the neck and underarms.

People who are 30–50 years of age have the highest risk of NLPHL, and it is more common in males than females.

Due to its slow growth, NLPHL can reoccur many years after treatment. It is highly treatable, but it can convert to the more aggressive non-Hodgkin’s lymphoma in around 7% of people who have it.

In developed countries, the most common type of Hodgkin’s lymphoma is cHL. According to the American Cancer Society, it accounts for 9 in 10 cases of this cancer.

NSCHL is the most common subtype. Around 7 in 10 people with Hodgkin’s lymphoma have this subtype.

Lymphocyte-depleted Hodgkin’s lymphoma is the most aggressive subtype of Hodgkin’s lymphoma. Physicians often find it at an advanced stage.

Different subtypes of Hodgkin’s lymphoma might be more likely in people of different sexes, age groups, and medical histories.

However, the general risk factors for Hodgkin’s lymphoma include:

  • having had mono
  • being age 20–30 years or older than 55 years
  • being male
  • having siblings who have had Hodgkin’s lymphoma
  • having a compromised immune system, such as due to HIV, an autoimmune disease, or immune-suppressing medications after a transplant

It is best to contact a doctor if a person has concerns about the risk factors for Hodgkin’s lymphoma.

A group of symptoms known as “B symptoms” play a key role in diagnosing Hodgkin’s lymphoma. These include:

B symptoms become more likely in people with different subtypes, as follows:

  • About 4 in 10 people with NSCHL will have B symptoms.
  • B symptoms are common in people with MCCHL and lymphocyte-depleted Hodgkin’s lymphoma.
  • These symptoms are rare in those with lymphocyte-rich Hodgkin’s lymphoma.

Doctors usually diagnose Hodgkin’s lymphoma using a biopsy. They will remove part or all of a lymph node and send it to a lab for testing.

During lab testing, healthcare professionals examine the sample under a microscope. This is usually enough to identify the type. However, they will sometimes look for specific proteins that occur on the surfaces of Reed-Sternberg cells or other proteins that point to NLPHL.

Learn more about how a biopsy works.

An individual’s overall health, the subtype of Hodgkin’s lymphoma, and the cancer’s aggressiveness can affect treatment choices. A doctor specializing in cancer treatment can provide more information on the best way to treat the condition.

Most people with Hodgkin’s lymphoma receive chemotherapy and radiation therapy. In chemotherapy, a cancer care team administers drugs that attack and kill cancer cells. In radiation therapy, cancer specialists use radioactive materials or lasers to destroy cancerous tissue.

Some people with Hodgkin’s lymphoma also receive immunotherapy treatments or stem cell transplants. Immunotherapy helps the immune system by targeting specific proteins on the surface of Hodgkin’s cells or turning off safeguards that prevent the immune system from attacking certain cancer cells.

Particularly hard-to-treat Hodgkin’s lymphoma may respond to higher dose chemotherapy. However, this can destroy bone marrow, where blood cells develop. Stem cell transplants help cancer doctors give higher chemotherapy doses while giving bone marrow the chance to regrow.

Learn more about chemotherapy for lymphoma.

The two types of Hodgkin’s lymphoma are classic and nodular lymphocyte-predominant. The classic type has four subtypes that vary depending on where they develop, who gets them, what symptoms they cause, and how aggressively they spread. The most common type is NSCHL. The most aggressive type is lymphocyte-depleted Hodgkin’s lymphoma.

Many types are diagnosable under a microscope after a biopsy, but further lab testing is sometimes necessary. This will help guide treatment among several other factors, including overall health and the stage of the cancer.

A person’s doctor can provide information about a person’s treatment plan, which typically involves chemotherapy and radiation therapy.