What is Non-Hodgkin's Lymphoma (NHL)?

From the Guidelines

Non-Hodgkin's Lymphoma (NHL) is a heterogeneous group of lymphoproliferative disorders originating in B lymphocytes, T lymphocytes, or natural killer cells, with follicular lymphoma (FL) being the most common subtype of indolent NHL, accounting for approximately 22% of all newly diagnosed cases of NHL.

Key Characteristics of NHL

• NHLs are a diverse group of cancers that arise from the lymphatic system 1.
• The most common subtype of indolent NHL is follicular lymphoma (FL), which accounts for approximately 20-25% of all cases of NHL 1.
• FL is considered incurable in the majority of patients with current standard therapeutic approaches, although outcomes have improved in recent decades 1.

Diagnosis and Management

• Diagnosis of NHL typically involves a combination of clinical evaluation, imaging studies, and biopsy 1.
• Treatment of NHL depends on the specific subtype, stage, and patient factors, and may include chemotherapy, radiation therapy, and targeted therapies 1.
• The incorporation of rituximab into chemotherapy regimens has become a widely accepted standard of care for first-line therapy for patients with FL 1.

Prognosis and Quality of Life

• Prognosis for NHL varies widely depending on the specific subtype, stage at diagnosis, age, and other health factors 1.
• Some indolent forms of NHL have excellent long-term survival rates, while aggressive subtypes require prompt treatment 1.
• Regular follow-up with PET/CT scans is essential to monitor response to treatment and adjust therapy as needed 1.

From the FDA Drug Label

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

Non-Hodgkin's Lymphoma (NHL) is a type of cancer that affects the immune system, specifically B-cells. It is characterized by the presence of CD20-positive B-cells. The provided drug label indicates that Rituxan is used to treat various types of NHL, including:

• Relapsed or refractory low-grade or follicular NHL
• Previously untreated follicular NHL
• Non-progressing low-grade NHL
• Previously untreated diffuse large B-cell NHL 2

From the Research

Definition and Classification of Non-Hodgkin's Lymphoma (NHL)

• Non-Hodgkin's Lymphoma (NHL) is a group of malignant neoplasms of lymphocytes with more than 90 subtypes 3
• NHL is traditionally classified broadly as non-Hodgkin or Hodgkin lymphoma 3
• New patients with non-Hodgkin Lymphoma should have their tumors classified using the World Health Organization classification 4

Diagnosis and Staging of NHL

• Lymphoma typically presents as painless adenopathy, with systemic symptoms of fever, unexplained weight loss, and night sweats occurring in more advanced stages of the disease 3
• An open lymph node biopsy is preferred for diagnosis 3
• The Lugano classification system incorporates symptoms and the extent of the disease as shown on positron emission tomography/computed tomography to stage lymphoma 3
• Patients with non-Hodgkin Lymphoma are assigned an anatomic stage using the Ann Arbor system 4
• Patients should also be classified using the International Prognostic Index 4

Treatment and Prognosis of NHL

• Non-Hodgkin lymphoma is treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 3
• High-dose CHOP as initial therapy for patients with poor-prognosis aggressive non-Hodgkin's lymphoma may be an effective alternative 5
• Most patients respond well to treatment, but relapses are frequent and additional therapies including stem cell transplant are often needed 6
• Because many subtypes of lymphoma remain incurable with current management strategies, clinical trials are in progress to identify novel therapies with promising activity in this disease 6

Additional Considerations

• Bone marrow biopsy (BMB) is recommended as a part of the workup diagnosis in all patients with non-Hodgkin's lymphoma (NHL), but it may not be mandatory in every patient 7
• The clinician needs to weigh up the potential benefit of this procedure in each case in terms of changing therapeutic approach and prognosis 7