Lymphoma - Non-Hodgkin (NHL) in Adults

Lymphoma - Non-Hodgkin (NHL) in Adults

What is the Lymphatic System?

The lymphatic system is a network of lymph nodes, lymphatic organs, and lymphatic vessels that helps the body fight infections and diseases. It transports lymph, a colorless fluid containing lymphocytes (white blood cells) vital for immune responses.

Types of Lymphocytes:

• B cells (B-lymphocytes): Produce antibodies to fight bacteria and infections.

• T cells (T-lymphocytes): Destroy bacteria and fungi and trigger B cells to produce antibodies.

• Natural Killer (NK) cells: Attack viruses, infected cells, and some cancer cells.

Key components of the lymphatic system:

• Lymph nodes: Bean-shaped glands located throughout the body, including the neck, armpits, chest, abdomen, and groin.

• Spleen: Filters blood and produces lymphocytes.

• Thymus: Located behind the breastbone, essential for T-cell development.

• Tonsils: Located in the throat, these glands trap bacteria entering through the mouth or nose.

• Bone Marrow: The spongy tissue inside bones that produces WBCs, RBCs, and platelets.

What is Non-Hodgkin Lymphoma (NHL)?

NHL is a cancer of the lymphatic system where abnormal B cells, T cells, or NK cells grow uncontrollably, forming tumors. Since lymphatic tissue is present throughout the body, NHL can begin anywhere and spread to other organs, including the liver, spleen, bone marrow, intestines, skin, and brain.

Statistics

• 35,828 cases of NHL are reported annually in India.

• It is the 9th most common cancer in India and accounts for 20,390 deaths per year.

Survival Rate

The 5-year survival rate for NHL in the United States is 74%.

Risk Factors for NHL

Though the exact cause of NHL is unknown, the following factors can increase the risk:

• Age: The risk of NHL increases with age, especially after 60-70 years.

• Gender: Men are slightly more likely to develop NHL than women.

• Bacterial infections: For example, Helicobacter pylori infection is associated with MALT lymphoma in the stomach.

• Viruses: Epstein-Barr virus (EBV) is linked to Burkitt lymphoma, while hepatitis C can increase the risk of splenic marginal zone lymphomas.

• Immune Deficiency Disorders: Conditions such as AIDS increase the risk.

• Autoimmune Diseases: Disorders like rheumatoid arthritis or Sjögren’s syndrome may increase susceptibility.

• Organ Transplants: Immunosuppressive medications used after transplantation raise the risk of NHL.

• Previous Cancer Treatments: Chemotherapy for other cancers can contribute to NHL development.

• Chemical Exposure: Prolonged exposure to pesticides, herbicides, or petrochemicals.

Symptoms of NHL in Adults

General Symptoms:

• Painless swelling in the neck, armpits, abdomen, or groin

• Enlarged liver or spleen

• Unexplained fever

• Weight loss

• Night sweats

• Chills

• Fatigue

• Itching

Organ-specific Symptoms:

• Abdomen: Swelling, back pain, or abdominal discomfort

• Spleen: Persistent fullness in the abdomen or back pain

• Groin: Swelling or fluid retention in the legs

• Chest: Shortness of breath, chest pain, or coughing

• Brain: Stroke-like symptoms if the brain is affected

Diagnosis of NHL

• Physical Examination

• Blood Tests: Including CBC, ESR, liver function tests (LFT), and kidney function tests.

• Biopsy: A sample of the affected tissue is examined under a microscope. Core needle biopsy or surgical excision may be performed on lymph nodes or affected areas like the abdomen or chest.

• Bone Marrow Aspiration and Biopsy: To detect if cancer has spread to the bone marrow.

• Biomarker Testing: Identifies genetic or molecular changes to guide treatment. Techniques include:

• Cytogenetics

• Fluorescence in Situ Hybridization (FISH)

• Flow Cytometry

• Immunohistochemistry (IHC)

• Molecular Profiling / Gene Sequencing

• Imaging Tests: CT scan, PET-CT, MRI, and X-rays are used to assess the extent of cancer spread.

Types of NHL by Cell Origin

• B-cell lymphoma: Found in 90% of NHL cases.

• T-cell lymphoma: Accounts for 10% of cases.

• NK-cell lymphoma: Rare, affecting fewer than 1%.

NHL Treatment in Adults

1. Watchful Waiting

• For slow-growing NHL without symptoms, immediate treatment may not be necessary. Regular physical exams, blood tests, and imaging help monitor the cancer’s progression.

2. Chemotherapy

• Chemotherapy uses drugs to destroy cancer cells. A common regimen for NHL is CHOP:

• Cyclophosphamide

• Doxorubicin

• Prednisone

• Vincristine

• For B-cell lymphomas, rituximab (Rituxan) or obinutuzumab (Gazyva) may be added to CHOP.

• Side Effects: Fatigue, nausea, hair loss, diarrhea, and infections.

3. Targeted Therapy

• Targets specific genes or proteins involved in cancer growth. Some targeted drugs used for NHL:

• Ibrutinib (Imbruvica)

• Acalabrutinib (Calquence)

• Venetoclax (Venclexta)

• Tazemetostat (Tazverik)

• Selinexor (Xpovio)

4. Immunotherapy

• Uses the body’s immune system to fight cancer. Common immunotherapy drugs for NHL include:

• Rituximab (Rituxan)

• Brentuximab vedotin (Adcetris)

• CAR-T Cell Therapy: A personalized treatment that reprograms the patient’s T-cells to attack cancer cells.

5. Radiation Therapy

• High-energy beams are used to destroy cancer cells. Radiation is often combined with chemotherapy for localized tumors or used to relieve symptoms in advanced cases.

• Side Effects: Fatigue, nausea, skin irritation, and hair loss in the treated area.

6. Bone Marrow / Stem Cell Transplantation

• Used if the cancer relapses or does not respond to initial treatment. Hematopoietic stem cells are transplanted to restore healthy bone marrow.

• Types:

• Autologous Transplant: Uses the patient’s own stem cells.

• Allogeneic Transplant: Uses stem cells from a donor.

Follow-Care

After treatment, regular follow-up tests are essential to monitor for relapse and manage side effects. Follow-up care includes:

• Physical exams

• Blood tests

• Imaging scans (CT, PET, or MRI)

Non-Hodgkin lymphoma (NHL) is a complex cancer with many subtypes and varying treatment strategies. Advances in chemotherapy, targeted therapy, and immunotherapy have improved survival rates. With proper follow-up care, patients can manage their condition and enhance their quality of life.

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