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Photo by: Miles Harris

Microsoft co-founder Paul Allen fought cancer since the early 1980s, when he was first diagnosed with Hodgkin disease. But it was complications with the more difficult to treat non-Hodgkin lymphoma that lead to his death on Oct. 15.

Despite being in remission since 2009, Allen announced that his non-Hodgkin lymphoma returned this year. While both cancers are cancers of lymphocytes, certain blood cells that are part of our immune system, non-Hodgkin lymphomas present more challenges.

Dr. Michael Jain, hematology specialist at Moffitt Cancer Center

According to Dr. Michael Jain, a hematology specialist at Moffitt Cancer Center, it is not uncommon to be diagnosed with both non-Hodgkin and Hodgkin lymphoma. Both are cancers of the lymphatic system, but subtle differences makes their treatment and outcomes very different and a patient encountering both in his or her lifetime is more common than one might think.

“Honestly the naming of Hodgkin and non-Hodgkin is historical and nothing more,” explained Dr. Jain. “It’s not uncommon for patients to be diagnosed with more than one type of lymphoma. It’s important to point out that the terms used here are a way to wrangle a class of cancers. But tumors don’t read textbooks and can sometimes overlap. For example, a slow-growing cancer, with enough time, can transform into an aggressive type, or a lymphoma can be in a gray zone between two different types at the same time.”

To understand the difference between Hodgkin and non-Hodgkin, one must first have a basic understanding of lymphocytes.

“There are different types of normal lymphocytes in the body, such as T lymphocytes, NK lymphocytes, and the most common type, B cells,” Jain said. “B-cell lymphomas are derived from mature cells turning into cancer.”

Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells, which are mature B cells that have become malignant and are unusually large. Non-Hodgkin lymphoma is a set of more than 60 subtypes of lymphoma.

The first sign of the Hodgkin disease is often the appearance of enlarged lymph nodes in the upper body. Non-Hodgkin lymphoma, by contrast, can be derived from B cells or T cells and can arise in the lymph nodes as well as other organs. Both B cells and T cells are part of the body’s immune response to diseases.

Regardless of the name of the cancer, Jain said, treatment for lymphomas varies based on a variety of factors. It is important for patients to be as specific as possible about the name used to describe their diagnosis, and not to think of all lymphomas as being the same.

“Treatment can be very different for each type of lymphoma” Jain stressed. “A lot of detail goes into assessing each patient. Biologically, each patient and their tumor is unique. A lymphoma specialist can help navigate and recommend the best treatment for each patient.”

Non-Hodgkin Hodgkin
More common Less common
Most patients are diagnosed at 55 or older  Median age of diagnosis is 39
Can affect lymph nodes anywhere Usually affects upper body's lymph nodes (chest, neck, armpits)
Absence of Reed-Sternberg Cells Presence of Reed-Sternberg Cells
Many different types with very different treatments Subtypes are treated similarly