What are the characteristics of Non-Hodgkin Lymphoma (NHL)?

From the Guidelines

Non-Hodgkin lymphoma (NHL) is a heterogeneous group of lymphoproliferative disorders originating in B lymphocytes, T lymphocytes, or natural killer cells, with characteristics including swollen lymph nodes, fatigue, weight loss, night sweats, and fever, and is classified into many subtypes based on cell of origin and growth pattern. The key characteristics of NHL include swollen, painless lymph nodes in the neck, armpits, or groin; persistent fatigue; unexplained weight loss; night sweats; and fever without infection 1. Unlike Hodgkin lymphoma, NHL lacks Reed-Sternberg cells and can arise in various lymphatic tissues throughout the body. NHL is classified into many subtypes based on the cell of origin (B-cell or T-cell), growth pattern (indolent/slow-growing or aggressive/fast-growing), and molecular features.

Key Characteristics of NHL

• Swollen, painless lymph nodes in the neck, armpits, or groin
• Persistent fatigue
• Unexplained weight loss
• Night sweats
• Fever without infection B-cell lymphomas account for about 85% of cases, with diffuse large B-cell lymphoma being the most common aggressive subtype, while follicular lymphoma is the most common indolent form 1. Risk factors include advanced age, immune system suppression, certain infections like HIV or Epstein-Barr virus, and exposure to certain chemicals.

Risk Factors for NHL

• Advanced age
• Immune system suppression
• Certain infections like HIV or Epstein-Barr virus
• Exposure to certain chemicals Treatment approaches vary widely depending on the specific subtype, stage, and patient factors, ranging from watchful waiting for indolent cases to combinations of chemotherapy, immunotherapy (like rituximab), radiation therapy, and stem cell transplantation for aggressive forms 1. The prognosis varies significantly based on the subtype, stage at diagnosis, and response to treatment. The most recent guidelines recommend rituximab-based chemoimmunotherapy followed by high-dose therapy and autologous stem cell rescue (HDT/ASCR) for patients presenting with advanced-stage disease 1.

From the FDA Drug Label

Patients with previously untreated diffuse large B-cell NHL received RITUXAN in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or other anthracycline-based chemotherapy regimens Among all enrolled patients, 62% had centrally confirmed DLBCL histology, 73% had Stage III–IV disease, 56% had IPI scores greater than or equal to 2,86% had ECOG performance status of < 2,57% had elevated LDH levels, and 30% had two or more extranodal disease sites involved Thirty-seven percent of the study population was greater than 60 years of age, 99% had Stage III or IV disease, and 63% had an IPI score greater than or equal to 2. Advanced stage is defined as Stage III with elevated lactose dehydrogenase (LDH) level [LDH greater than twice the institutional upper limit of the adult normal values] or stage IV B-cell NHL or B-AL Disease Type B-AL37%34% Burkitt or Burkitt-like NHL55%56% DLBCL8%8% Bone marrow involvement45%45% CNS involvement27%27%

The characteristics of Non-Hodgkin Lymphoma (NHL) include:

• Advanced stage: Stage III with elevated lactose dehydrogenase (LDH) level or stage IV B-cell NHL or B-AL
• Age: 37% of patients were greater than 60 years of age
• Disease type:
  • B-AL: 37%
  • Burkitt or Burkitt-like NHL: 55%
  • DLBCL: 8%
• Stage:
  • Stage III: with elevated LDH level
  • Stage IV: B-cell NHL or B-AL
• IPI score: 63% had an IPI score greater than or equal to 2
• ECOG performance status: 86% had ECOG performance status of < 2
• LDH levels: 57% had elevated LDH levels
• Extranodal disease sites: 30% had two or more extranodal disease sites involved
• Bone marrow involvement: 45%
• CNS involvement: 27% 2

From the Research

Characteristics of Non-Hodgkin Lymphoma (NHL)

• Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of lymphoid neoplasms with different biological characteristics 3, 4.
• About 90% of all lymphomas in the United States originate from B lymphocytes, while the remaining originate from T cells 3, 4.
• NHL is a diverse collection of malignant neoplasms with lymphoid-cell origin which includes all the malignant lymphomas that are not classified as Hodgkin lymphoma 5.
• Lymphoma is a group of malignant neoplasms of lymphocytes with more than 90 subtypes 6.

Staging of Lymphoma

• The American Cancer Society describes the staging of lymphoma as follows:
  • Stage I is lymphoma in a single node or area.
  • Stage II is when that lymphoma has spread to another node or organ tissue.
  • Stage III is when it has spread to lymph nodes on two sides of the diaphragm.
  • Stage IV is when cancer has significantly spread to organs outside the lymph system 3, 4.
• The Lugano classification system incorporates symptoms and the extent of the disease as shown on positron emission tomography/computed tomography to stage lymphoma, which is then used to determine treatment 6.

Treatment of NHL

• The treatment of NHLs depends on the neoplastic histology and stage of the tumor, which will indicate whether radiotherapy, chemotherapy, or a combination is the best suitable treatment 3, 4.
• Radiation therapy is the traditional therapeutic route for localized follicular and mucosa-associated lymphomas.
• Chemotherapy is utilized for the treatment of large-cell lymphomas and high-grade lymphomas 3, 4.
• Non-Hodgkin lymphoma is treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 6.