What are the main types of lymphoma and their treatments?

Main Types of Lymphoma and Their Treatments

Lymphoma is broadly classified into two main types: Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL), with distinct subtypes requiring different treatment approaches based on histology, staging, and risk factors. 1

Hodgkin Lymphoma

Types of Hodgkin Lymphoma

1. Classical Hodgkin Lymphoma (CHL - 95% of HL cases) 2

   • Characterized by Reed-Sternberg cells in an inflammatory background
   • Subtypes include:
     • Nodular sclerosis (most common)
     • Mixed cellularity
     • Lymphocyte-rich
     • Lymphocyte-depleted
     • Unclassifiable

2. Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL - 5% of HL cases) 2

   • Characterized by "popcorn cells" (lymphocyte-predominant cells)
   • Different immunophenotype than classical HL (CD15-/CD30-/CD20+)

Staging and Risk Assessment for Hodgkin Lymphoma

• Based on the Ann Arbor staging system with Cotswolds modification 2
• Risk groups:
  • Early favorable (Stage I-II without risk factors)
  • Early unfavorable (Stage I-II with risk factors)
  • Advanced (Stage III-IV and IIB with large mediastinal mass or extranodal involvement) 2

Treatment of Hodgkin Lymphoma

• Early favorable HL: Combined modality therapy with 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) followed by 30 Gy involved field radiotherapy 2
• Advanced HL: ABVD, Stanford V, or BEACOPP chemotherapy regimens 3
• Refractory/Relapsed HL: High-dose therapy with autologous stem cell rescue (HDT/ASCR) 2
• Novel therapies: Brentuximab vedotin (CD30-directed antibody-drug conjugate) for relapsed/refractory disease 2

Non-Hodgkin Lymphoma

Types of Non-Hodgkin Lymphoma

1. B-cell lymphomas (80-85% of NHL) 1

   • Diffuse Large B-Cell Lymphoma (DLBCL)
   • Follicular Lymphoma
   • Mantle Cell Lymphoma
   • Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia (SLL/CLL)
   • MALT Lymphoma
   • Burkitt Lymphoma

2. T-cell lymphomas (15-20% of NHL) 1

   • Peripheral T-cell Lymphoma
   • Anaplastic Large Cell Lymphoma
   • Adult T-cell Leukemia/Lymphoma (HTLV-1 associated)
   • Mycosis Fungoides (cutaneous T-cell lymphoma)

3. NK-cell lymphomas (rare) 1

Treatment of Non-Hodgkin Lymphoma

• Aggressive B-cell NHL: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) 3
• Indolent NHL: May use "watch and wait" approach for asymptomatic patients 1
• Advanced NHL: Bendamustine, lenalidomide, or other targeted therapies 3

Diagnostic Approach

1. Excisional lymph node biopsy (core needle biopsy may be adequate) 2
2. Immunohistochemistry to determine lymphoma type and subtype 2
3. Staging workup:
   • PET/CT scan
   • Bone marrow biopsy for advanced stages
   • Laboratory tests (CBC, ESR, LDH, liver/kidney function) 2

Treatment Considerations and Complications

• Treatment toxicities: Neuropathy, cardiotoxicity, secondary cancers (lung and breast) 3
• Long-term follow-up: Essential after completion of treatment to monitor for late effects 2
• Vaccination: Patients should receive pneumococcal vaccines and other age-appropriate immunizations due to immunosuppression 3

Prognosis

• Hodgkin Lymphoma: Curable in at least 80% of patients 2
• Non-Hodgkin Lymphoma: Prognosis varies by subtype:
  • Indolent lymphomas (like follicular lymphoma): Generally favorable prognosis
  • Aggressive lymphomas (like DLBCL): Variable prognosis depending on stage and treatment response
  • Some subtypes like CLL/SLL: 5-year survival rates >80% 1

Treatment decisions should be based on lymphoma subtype, stage, patient factors, and risk assessment to optimize outcomes while minimizing long-term toxicities.