What is non-Hodgkin's lymphoma (NHL)?

From the Guidelines

Non-Hodgkin's lymphoma (NHL) is a heterogeneous group of lymphoproliferative malignancies with differing patterns of behavior and treatment responses, and its management should be guided by the most recent and highest quality evidence, prioritizing morbidity, mortality, and quality of life as the outcome.

Overview of Non-Hodgkin's Lymphoma

NHL comprises various subtypes, with diffuse large B-cell lymphoma and follicular lymphoma being the most common, and its clinical course can be described as aggressive or indolent 1. The majority of NHL cases (85%) are of B-cell origin, and the prognosis depends on histologic type, stage, age, and treatment 1.

Diagnosis and Treatment

Diagnosis involves lymph node biopsy, imaging tests like CT scans or PET scans, and blood tests. Treatment depends on the specific subtype, stage, and aggressiveness of the disease, often including chemotherapy regimens like R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), radiation therapy, immunotherapy, targeted therapy, or stem cell transplantation 1.

Prognosis and Follow-up Care

The prognosis varies widely based on the subtype and stage at diagnosis, with some indolent (slow-growing) forms having survival rates of many years, while aggressive types require immediate treatment but may be curable 1. Regular follow-up care is essential after treatment to monitor for recurrence and manage any long-term effects of therapy.

Recent Advances in Treatment

The recent development of radioimmunotherapy (RIT) has provided an important advance in the treatment of advanced or refractory NHL, which is an inherently radiosensitive malignancy 1. 90Y-Ibritumomab tiuxetan (Zevalin) is a RIT that has been approved for use in relapsed/refractory indolent NHL, and its use has been recommended by a European consensus workshop 1.

Regional Specificities and Management

Regional specificities in the incidence of lymphomas have been reported, and management of malignant lymphomas in developing countries is variable and largely depends on the availability of diagnostic and therapeutic resources 1. Therefore, the management of NHL should be individualized and guided by the most recent and highest quality evidence, taking into account the specific subtype, stage, and aggressiveness of the disease, as well as the availability of diagnostic and therapeutic resources.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1. 1 Non–Hodgkin's Lymphoma (NHL) RITUXAN is indicated for the treatment of adult patients with: Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent Previously untreated follicular, CD20-positive, B-cell NHL in combination with first line chemotherapy and, in patients achieving a complete or partial response to a rituximab product in combination with chemotherapy, as single-agent maintenance therapy Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy. Previously untreated diffuse large B-cell, CD20-positive NHL in combination with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or other anthracycline-based chemotherapy regimens RITUXAN is indicated for the treatment of pediatric patients aged 6 months and older with: Previously untreated, advanced stage, CD20-positive diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), Burkitt-like lymphoma (BLL) or mature B-cell acute leukemia (B-AL) in combination with chemotherapy.

Non-Hodgkin's Lymphoma (NHL) is a type of cancer that can be treated with Rituximab. The drug is indicated for the treatment of adult patients with:

• Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent
• Previously untreated follicular, CD20-positive, B-cell NHL in combination with first line chemotherapy
• Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy
• Previously untreated diffuse large B-cell, CD20-positive NHL in combination with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or other anthracycline-based chemotherapy regimens The treatment is also indicated for pediatric patients aged 6 months and older with previously untreated, advanced stage, CD20-positive diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), Burkitt-like lymphoma (BLL) or mature B-cell acute leukemia (B-AL) in combination with chemotherapy 2.

From the Research

Non-Hodgkin's Lymphoma Overview

• Non-Hodgkin's lymphoma (NHL) comprises a heterogeneous collection of lymphoproliferative malignancies, most common in people aged over 55 years 3
• The incidence of NHL is increasing steadily, with a rise of 3-4% per year in the 1970s and 1980s, and 1-2% per year in the 1990s 3

Types of Non-Hodgkin's Lymphoma

• Diffuse large B-cell lymphoma (DLBCL) is the most common type of NHL, accounting for approximately 30% of all new patients 3
• Follicular lymphoma (FL) is the second most common NHL sub-type, accounting for a further 22% of cases 3

Treatment of Non-Hodgkin's Lymphoma

• Rituximab, an anti-CD20 monoclonal antibody, has radically changed the treatment of B-cell NHL 3
• Rituximab is effective in patients with relapsed or refractory indolent NHL, and as a standard first-line treatment option when combined with CHOP chemotherapy in elderly patients with diffuse large B-cell lymphoma 4
• The combination of rituximab with chemotherapy is more effective than chemotherapy alone in providing tumor remission and patient survival in patients with indolent or aggressive B-cell NHL 5

Mechanism of Action of Rituximab

• Rituximab binds to the transmembrane antigen CD20, located on pre-B and mature B lymphocytes, and recruits immune effector functions to mediate B cell lysis 3
• Possible mechanisms of cytotoxicity include complement-dependent cytotoxicity, antibody-dependent cellular cytotoxicity, and induction of apoptosis 3

Clinical Use of Rituximab

• Rituximab is recommended for the treatment of patients with diffuse large B-cell lymphoma, follicular lymphoma, and other indolent B-cell lymphomas 6
• The drug is generally well tolerated, with most adverse events being infusion-associated, including chills, fever, and rigor related to the release of cytokines 7