Non-Hodgkin lymphoma (NHL) is a cancer that begins with lymphocytes, a type of white blood cell that helps fight infection. Lymphocytes are found in the bloodstream, as well as in the lymphatic system and throughout the body. NHL most often affects adults and is more common than the other major category of lymphoma, Hodgkin lymphoma .
NHL refers to many different types of lymphoma that share some characteristics. However, different types of NHL can behave differently. The most common type is diffuse large B-cell lymphoma (LDCBG) , an aggressive lymphoma. Other types can be lazier or slower growing. Some of them can be cured, while others cannot. Treatments for NHL can include any number of agents, such as chemotherapy, radiation, monoclonal antibodies, small molecules, cell therapy, or stem cell transplantation.
The signs and symptoms of non-Hodgkin lymphoma can include:
- Painless enlarged lymph nodes
- Discomfort or feeling of fullness in the abdomen.
- Chest pain, shortness of breath, or cough
- Easy bruising or bleeding
- Fever, night sweats, or unexplained weight loss.
Systemic symptoms arising from inflammation, or B symptoms , sometimes occur in NHL and include unexplained fever, severe night sweats, and involuntary weight loss of more than 10 percent of normal body weight in six months. Group B symptoms are no longer used in the standard system for staging NHL, as such symptoms generally do not provide independent information about your prognosis .
The cause of most lymphomas is unknown; However, over the past 15 years, scientists have made tremendous strides in understanding the role of certain genes in certain types of NHL, and new targeted therapies have emerged as a result.
In addition, several risk factors for NHL are known, including advanced age, a weakened immune system, certain autoimmune diseases, certain infections, and exposure to radiation, certain chemicals, or certain medications.
Although personal and family medical history can be important, NHL is diagnosed not just by symptoms or history. Several tests are used to diagnose non-Hodgkin lymphoma, including the following:
- A physical exam checks the neck, armpits, and groin for swollen lymph nodes and the abdomen for swollen spleen or liver.
- Blood and urine tests can be used to rule out other causes that may be causing the same symptoms, such as an infection causing fever and swollen lymph nodes instead of lymphoma.
- Imaging tests such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) can be done to determine the extent of the disease, if any. Radiologists who interpret CT scans follow specific guidelines about what constitutes normal lymph node size; Fluorodeoxyglucose scanning PET (FDG-PET) can be used to detect disease sites in the body based on increased glucose uptake or avidity .
- A lymph node biopsy may be recommended to obtain a sample of a suspicious lymph node for laboratory examination. The samples are evaluated by pathologists, and tests done in the laboratory can show if you have NHL and, if so, which.
- In some cases, additional tests may be done on the genetic profile of your specific type of NHL to help you understand your level of risk and plan treatment.
- A bone marrow biopsy and aspiration procedure may be performed to take a sample of the bone marrow. The sample is tested for the presence of NHL cells.
- Other tests and procedures may be used depending on your situation.
The staging system, called the Lugano classification, is the current staging system used for NHL patients. However, this staging system is often less helpful for NHL than for Hodgkin lymphoma, the latter of which tends to spread more methodically from the originally affected lymph node.
Most patients with aggressive NHL at the time of diagnosis have an advanced stage of the disease (ie, stage III / IV). Therefore, staging is performed in NHL to identify a small number of early-stage patients and help, combined with other factors, to understand the prognosis and determine the likely impact of treatment.
The prognosis of NHL largely depends on the type of NHL and its specific characteristics , including microscopic, molecular, and genetic characteristics. For example, diffuse large B-cell lymphoma, follicular lymphoma, and peripheral T-cell lymphoma are three different types of NHL, and each has important differences in the factors used to determine prognosis or prognostic index .
A person's age and general health, as well as whether the lymphoma is inside or outside the lymph nodes (extranodal), are also predictive factors. Although the number and location of pain points in the body (which are important for staging in Lugano) do not necessarily affect prognosis, the total amount of NHL or tumor burden may be an important factor in prognosis and treatment.
In the various types of NHL, what the pathologist describes as high to moderate-grade lymphoma usually grows rapidly in the body, which is why these two types are considered aggressive NHL. In contrast, low-grade NHL grows slowly and therefore these lymphomas are called lazy NHL. Compared to aggressive NHL, indolent NHL usually does not cause many symptoms, but they are also more difficult to eradicate and are less likely to be cured. The most common type of indolent lymphoma is follicular lymphoma. A small group of indolent lymphomas, such as follicular lymphoma, develop into aggressive lymphomas over time.
The appropriate treatment of a person with NHL depends not only on the disease itself, but also on the person being treated and their age, general health, preferences, and treatment goals.
When lymphoma is slow growing or painless, you can sometimes refuse treatment or wait and wait . Painless lymphomas that do not cause signs or symptoms may not require treatment for many years. When you can watch and wait, it is usually because the data shows that for your particular condition at your point of travel, it is just as good, if not better, to delay treatment and its potential side effects than to refuse treatment. Get started right away, and that expectation doesn't sacrifice your long-term results.
Currently, there are several agents available for the treatment of NHL and they can be used alone or in combination, as appropriate. Any of the following can be part of an NHL regimen:
Chemotherapeutic agents can be administered alone, in combination with other chemotherapeutic agents , or in combination with other treatments. Cytoxan (cyclophosphamide) is an example of a chemotherapeutic agent that is used to treat certain NHL. Not all patients are candidates for chemotherapy in their full dosing schedule due to toxicity concerns.
Radiation therapy can be used alone or in combination with other cancer treatments. Radiation can be directed to the affected lymph nodes and nearby areas of the nodes where the disease can progress. Radiation therapy is generally only offered to certain people with certain types of NHL.
New agents include monoclonal antibodies that target lymphocytes and small molecules that target specific pathways that cancer cells depend on. Newer agents are often not as toxic as chemotherapy, but they have toxic effects that are considered part of the risks and benefits of treatment.
- Rituxan (rituximab) and obinutuzumab are examples of monoclonal antibodies and are used to attack B lymphocytes in combination with other agents to treat certain types of NHL.
- Imbruvica (ibrutinib) and Venclexta (venetoclax) are examples of small molecules that target cellular signals and important steps for B lymphocytes. These agents are used to treat some patients with chronic lymphocytic leukemia (CLL) and its cousin, lymphoma. small lymphocytic (SLL), which is a type of NHL. Many people consider CLL and SLL to be the same disease, except for the location of the main part of the disease in the body. Imbruvica is also approved for the treatment of marginal zone lymphoma and mantle cell lymphoma.
Bone marrow or stem cell transplantation is an option for some patients with certain types of NHL.
Clinical trials exploring new therapies and new treatment regimens often attract NHL patients and may also be considered.
Get the word of drug information
Regardless of the type of lymphoma that has affected your life, it is important to learn about the disease and understand your treatment options. Doctors and patients are on the same team, and diagnosis is only the first step on a potentially long lymphoma journey.
NHL is a diverse collection of different lymphomas. In some cases, such as those with a low risk for small lymphocytic lymphoma, treatment may never be necessary. Others, like the typically aggressive cases of mantle cell lymphoma, may require early aggressive treatment to try to protect a person's lifespan. DLBCL, the most common NHL, is an example of aggressive NHL that is potentially curable with current therapies.