From the Guidelines
There is no specific lab test to definitively rule out non-Hodgkin lymphoma (NHL) in a patient with a family history of the disease, but a comprehensive approach including a complete blood count (CBC) with differential, comprehensive metabolic panel, lactate dehydrogenase (LDH), and serum protein electrophoresis can help identify potential concerns. Elevated LDH levels can suggest lymphoma activity, while abnormal white blood cell counts or the presence of abnormal lymphocytes may raise suspicion 1. If these initial tests show concerning results or if the patient has symptoms like persistent lymphadenopathy, night sweats, unexplained weight loss, or fatigue, further evaluation with imaging studies (CT, PET scan) and ultimately a lymph node biopsy would be necessary for definitive diagnosis.
Key Considerations
- Having a first-degree relative with NHL slightly increases risk, but most cases are not strongly hereditary 1.
- Regular monitoring is reasonable, but extensive testing without symptoms isn't typically warranted.
- The patient should be educated about reporting any persistent lymph node enlargement, unexplained fevers, night sweats, or weight loss promptly.
Diagnostic Approach
- Initial tests: CBC with differential, comprehensive metabolic panel, LDH, and serum protein electrophoresis.
- Imaging studies: CT, PET scan if initial tests are concerning or if symptoms are present.
- Lymph node biopsy for definitive diagnosis if necessary.
- Flow cytometry and immunohistochemistry may be used for diagnosis and to establish immunophenotyping 1.
Patient Education
- Report any persistent lymph node enlargement, unexplained fevers, night sweats, or weight loss promptly.
- Regular monitoring and follow-up appointments to assess for any changes in symptoms or test results.
From the Research
Labs to Rule Out Non-Hodgkin's Lymphoma
To determine if a patient has non-Hodgkin's lymphoma, several lab tests and procedures can be used, including:
- Complete blood count (CBC) to check for abnormal blood cell counts 2
- Serum lactate dehydrogenase (LDH) test to check for elevated LDH levels, which can be a prognostic marker for non-Hodgkin's lymphoma 3
- Imaging tests such as positron emission tomography/computed tomography (PET/CT) to stage the disease and determine the extent of the lymphoma 4
- Lymph node biopsy to confirm the diagnosis of lymphoma 4
Family History and Risk of Non-Hodgkin's Lymphoma
A family history of non-Hodgkin's lymphoma or other cancers may increase a person's risk of developing the disease. Studies have shown that:
- Having a first-degree relative with non-Hodgkin's lymphoma increases the risk of developing the disease 5
- The risk of non-Hodgkin's lymphoma is higher in siblings and male relatives of patients with the disease 5
- A family history of other cancers, such as melanoma, pancreatic cancer, and prostate cancer, may also increase the risk of non-Hodgkin's lymphoma 5
Diagnosis and Treatment of Non-Hodgkin's Lymphoma
Non-Hodgkin's lymphoma is a heterogeneous group of malignancies that can be classified into different types based on the World Health Organization classification of hematological and lymphoid tumors. Treatment options include:
- Chemotherapy, such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP) 4
- Radiation therapy for early-stage disease 6
- Immunotherapy or radioimmunotherapy for patients with follicular lymphomas 6
- High-dose therapy with stem cell support for patients with relapsed or refractory disease 6