Non-Hodgkin Lymphoma

Synonyms

1

Overview

Non Hodgkin Lymphoma (NHL) are a diverse group of blood cancers that include any type of Lymphoma except Hodgkin Lymphoma.
The main common feature is absence of the giant Reed-Sternberg cells (which are characteristic of Hodgkin lymphoma). Types of NHL vary significantly in their severity, ranging from indolent (slow growing) to very aggressive (fast growing) and they can be formed by either B cells or T cells. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease.

Symptoms

Signs and symptoms may include:

  • Painless swelling/enlargement of one or more peripheral lymph nodes: the most common points for swelling are neck, armpit, and groin 
  • Fever (B symptom)
  • Weight loss of more than 10% of your weight (B symptom)
  • Heavy night sweats (B symptom)
  • Unexplained itching 
  • Low red blood cell counts (anemia) causing tiredness and sometimes breathlessness
  • Low white blood cell counts, increasing your risk of getting infections
  • Low platelet counts, causing bleeding problems such as very heavy periods, nosebleeds, or rash of tiny blood spots underneath the skin
  • Enlarged tonsils
  • Liver enlargement
  • Spleen enlargement
  • Abdominal lump
  • Feeling of breathlessness if affected lymph nodes are in the chest 
  • Other symptoms can arise if affected lymph nodes are pressing on organs or nerves 

Causes

There are many different forms of lymphoma and they are likely to have different causes. There are a few risk factors associated with lymphoma: 

  • Infectious agent llike Epstein-Barr virus, Human T-cell leukemia virus, Heliobacter pylori, HHV-8, and HIV infection
  • chemical exposure: diphenylhydantoin, dioxin, phenoxyherbicides
  • medical treatments such as radiation or chemotherapy
  • genetic diseases: Klinefelters syndrome, Chediak-Higashi syndrome, ataxia telangiectasia syndrome
  • autoimmune diseases like Sjogrens syndrome, celiac sprue, rheumatoid arthritis, systemic lupus erythematosus

Prevention

Not known

Diagnosis

If you have any of these symptoms you must have them checked by your GP. But remember, they can all be caused by other medical conditions. Everyone's glands come up when they have a throat infection, for example. Most people with these symptoms will not have a lymphoma.

Prognosis

The prognosis of NHL can be good but is linked to the type of lymphoma, the extent of spread (staging), and response to therapy.

Treatment

If one has a slow-growing non-Hodgkin's lymphoma without symptoms, one may not require treatment for the cancer right away. The individual will be watched closely by a health-care team. These cancers might not require treatment for years, although close follow-up is necessary. If the indolent lymphoma produces symptoms, therapy will usually consist of chemotherapy and biological therapy. Stage I and II often require radiation therapy.

For an aggressive type of lymphoma, a combination of chemotherapy and biological therapy is usually indicated, and sometimes radiation therapy will be added.

If treatment is required, there are several options that are utilized alone or in combination:

Chemotherapy: This is a drug treatment either as an injection or oral form that kills cancer cells. This treatment can involve one medication or multiple medications and be given alone or in conjunction with other therapies. This therapy is given in cycles, alternating treatment periods and non-treatment periods. The repetition of these cycles and the number of cycles will be determined by an oncologist based on the staging of the cancer and the medications used. Chemotherapy also harms normal cells that divide rapidly. This can lead to hair loss, GI symptoms, and difficulty with the immune system.

Radiation therapy: High doses of radiation are used to kill cancer cells and shrink tumors. This modality can be used alone or in conjunction with other therapies. Side effects usually depend on the type and dosage of the therapy as well as the area undergoing radiation therapy. Universally, patients tend to get tired during radiation therapy, especially toward the later stages of treatment.

Stem cell transplant: This procedure allows a patient to receive large doses of chemotherapy or radiation therapy to kill the lymphoma cells that might not be killed with standard levels of therapy. This therapy is used if the lymphoma returns after treatment. For this therapy, one needs to be admitted to the hospital. After the therapy, healthy stem cells (that were either taken from you before the therapy or from a donor) are injected to form a new immune system.

Biological drugs: These are medications that enhance the immune system's ability to fight cancers. In NHL, monoclonal antibodies are used for treatment. The therapy is administered via an IV, and the monoclonal antibodies bind to the cancer cells and augment the immune system's ability to destroy cancer cells. Rituximab (Rituxan) is such a drug used in the treatment of B cell lymphoma. Side effects for this treatment are usually flu-like symptoms. Rarely, a person can have a severe reaction, including a drop in blood pressure or difficulty breathing.

Radio immunotherapy medications: These are made of monoclonal antibodies that transport radioactive materials directly to cancer cells. Because the radioactive material is traveling and binding directly to the cancer cell, more radiation is delivered to the cancer cell and less to the normal tissue.

Ibritumomab (Zevalin) and tositumomab (Bexxar) are two drugs approved for non-Hodgkin's lymphoma, with and without transformation, whose disease is refractory to Rituximab and has relapsed following chemotherapy. 

Vorinostat is a FDA approved drug for the treatment of T-cell non-Hodgkin's lymphoma, more specifically for the treatment  of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL) who have progressive, persistant or recurrent disease on or following two systemic therapies.

Resources

Refer to Research Publications.