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Non-Hodgkin lymphoma 

Non-Hodgkin lymphoma
Chapter:
Non-Hodgkin lymphoma
Author(s):

Vijaya Raj Bhatt

, and James O. Armitage

DOI:
10.1093/med/9780198746690.003.0525
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date: 07 March 2021

Non-Hodgkin’s lymphomas comprise precursor lymphoid neoplasms, mature B-cell neoplasms, and mature T-cell neoplasms. The aetiology of most cases is unknown, but increased risk is associated with immune deficiencies, agricultural chemicals, autoimmune disorders, treated Hodgkin’s disease, and some infectious agents. Incidence varies from 10 to 22 cases per 100 000 per year in different populations. Patients with non-Hodgkin’s lymphoma most commonly present with lymphadenopathy, but other presentations include systemic symptoms or those attributable to mediastinal or retroperitoneal masses or involvement. Diagnosis is typically based on expert evaluation of an adequate lymph node biopsy. Staging depends largely on determining the anatomical extent of disease, with FDG positron emission tomography/CT scanning generally the preferable imaging modality. For most patients, the goal of therapy is to achieve a complete remission. Patients with definitely curable lymphomas, such as diffuse large B-cell lymphoma and Burkitt’s lymphoma, are almost always treated promptly with intensive regimens, for example, chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine (Oncovin), and prednisone) plus the anti-CD20 monoclonal antibody rituximab. By contrast, follicular lymphoma is often not curable and the best treatment is not clear, with many physicians favouring no initial therapy in an asymptomatic patient. Patients who are not cured with initial therapy are candidates for what has been termed ‘salvage therapy’. For most patients, the only curative approach in this setting is haematopoietic stem cell transplantation, the toxicity of which means that it is only sensibly offered to carefully selected patients. Various new agents, such as small molecule kinase and BCL-2 inhibitors, and immune checkpoint inhibitors, offer hope for the future.

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