From the Guidelines
Staging in non-Hodgkin lymphoma (NHL) is primarily based on the Ann Arbor staging system, which categorizes the disease into four stages, taking into account the location and extent of the disease, as well as the presence of symptoms or bulky disease, as recommended by the most recent guidelines 1. The Ann Arbor staging system is a crucial tool for determining the prognosis and guiding treatment decisions in NHL. According to this system:
- Stage I indicates cancer in a single lymph node region or a single non-lymphatic site.
- Stage II involves two or more lymph node regions on the same side of the diaphragm.
- Stage III means lymph node involvement on both sides of the diaphragm.
- Stage IV indicates widespread disease with involvement of one or more extralymphatic organs such as bone marrow, liver, or lungs. Additional modifiers are often used to provide more detailed information about the disease:
- "A" indicates absence of symptoms.
- "B" denotes presence of symptoms like fever, night sweats, or weight loss.
- "E" signifies extension to adjacent organs.
- "X" indicates bulky disease (typically masses greater than 10 cm). The staging process also incorporates modern imaging techniques like CT scans, PET scans, and sometimes bone marrow biopsies to accurately assess the extent of the disease 1. The International Prognostic Index (IPI) is also an essential tool for establishing the prognosis and guiding treatment decisions in NHL, as it takes into account factors such as age, performance status, stage, lactate dehydrogenase levels, and the number of extralymphatic sites involved 1. In clinical practice, accurate staging and assessment of the IPI are critical for determining the best course of treatment and predicting patient outcomes in NHL.
From the Research
Staging in Non-Hodgkin Lymphoma
- The Ann Arbor system is typically used for the staging of Non-Hodgkin's lymphomas 2, 3, 4, 5.
- This classification system assigns an anatomic stage to patients with non-Hodgkin lymphoma 2.
- However, the Ann Arbor staging system has limitations, particularly in cases with extralymphatic involvement or primary extranodal lymphomas, which are relatively common in non-Hodgkin's lymphomas 3.
- To address these limitations, a draft for a Non-Hodgkin's lymphomas staging system was proposed, taking into account the involvement of extralymphatic organs/tissues 3.
- Extranodal organs were divided into "major" (liver, lungs, bones, mesothelium, and soft tissues) and "minor" organs to facilitate staging and treatment decisions 3.
- The International Prognostic Index is also used in conjunction with the Ann Arbor staging system to define prognostic subgroups and guide treatment decisions 2, 4, 5.
- Recent studies have identified molecular and genetic markers of prognosis that may be used to further refine treatment decisions in the future 4.
- The Lugano classification system is also used to stage lymphoma, incorporating symptoms and the extent of the disease as shown on positron emission tomography/computed tomography 6.