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Non-Hodgkin's lymphoma (clinical) — Clinical Guidelines

Overview

Non-Hodgkin's lymphoma (NHL) is a heterogeneous group of lymphoid malignancies characterized by the uncontrolled proliferation of lymphocytes, excluding Hodgkin's lymphoma. 3 7

Diagnosis

Clinical Presentation: Variable, including lymphadenopathy, systemic symptoms, and extranodal involvement. 7 20 21

Imaging: CT, MRI, FDG-PET/CT for staging and assessing transformation. 8 17

Biopsy: Essential for definitive diagnosis; immunohistochemistry crucial for subtype classification. 22 23

Molecular Testing: Considered for specific subtypes and prognostic stratification. 9

Management

First-Line Treatments:

- Chemotherapy: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is a standard regimen. 3 - Autologous Stem Cell Transplantation: Considered for high-risk patients post-remission. 3

Adjunctive Treatments:

- Radiation Therapy: Used for localized disease or consolidation. 7 - Novel Agents: Incorporation based on histology and risk stratification. 3

Special Populations

Elderly Patients: Treatment decisions influenced by comorbidities; less aggressive regimens often preferred. 4

Comorbidities: Impact treatment choice; careful consideration of patient fitness is crucial. 4

Key Recommendations

Use R-CHOP as a first-line therapy for most NHL patients (Evidence: Strong 3).

Consider autologous stem cell transplantation for high-risk patients achieving remission (Evidence: Moderate 3).

Tailor treatment intensity based on patient age and comorbidities (Evidence: Moderate 4).

References

1 Mosteller LJ, Yang AW, Tolisano AM. Her Legacy Lives On: Celebrating the Women Behind Head and Neck Eponyms. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2024. link 2 Kabat GC, Price WJ, Tarone RE. On recent meta-analyses of exposure to glyphosate and risk of non-Hodgkin's lymphoma in humans. Cancer causes & control : CCC 2021. link 3 Stiff P. What is the role of autologous transplant for lymphoma in the current era?. Hematology. American Society of Hematology. Education Program 2015. link 4 van der Poel MW, Mulder WJ, Ossenkoppele GJ, Maartense E, Wijermans P, Hoogendoorn M et al.. Comorbidity and treatment decision-making in elderly non-Hodgkin's lymphoma patients: a survey among haematologists. The Netherlands journal of medicine 2014. link 5 Griffith A. Cancer leads to calling. Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship 2011. link 6 Vestergaard H, Westergaard T, Wohlfahrt J, Hjalgrim H, Melbye M. Tonsillitis, tonsillectomy and Hodgkin's lymphoma. International journal of cancer 2010. link 7 Zinzani PL, Martelli M, Poletti V, Vitolo U, Gobbi PG, Chisesi T et al.. Practice guidelines for the management of extranodal non-Hodgkin's lymphomas of adult non-immunodeficient patients. Part I: primary lung and mediastinal lymphomas. A project of the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica 2008. link 8 Bodet-Milin C, Kraeber-Bodéré F, Moreau P, Campion L, Dupas B, Le Gouill S. Investigation of FDG-PET/CT imaging to guide biopsies in the detection of histological transformation of indolent lymphoma. Haematologica 2008. link 9 Heinmöller E, Renke B, Beyser K, Dietmaier W, Langner C, Rüschoff J. Piffalls in diagnostic molecular pathology--significance of sampling error. Virchows Archiv : an international journal of pathology 2001. link 10 Bonnefoix T, Bonnefoix P, Callanan M, Verdiel P, Sotto JJ. Graphical representation of a generalized linear model-based statistical test estimating the fit of the single-hit Poisson model to limiting dilution assays. Journal of immunology (Baltimore, Md. : 1950) 2001. link 11 Lynch HT. Anticipation in familial Hodgkin's lymphoma. Human genetics 2000. link 12 Yu RY. Cutaneous cryptococcosis. Mycoses 1996. link 13 Yellin SA, Weiss MH, Kraus DH, Papadopoulos EB. Tonsil lymphoma presenting as tonsillitis after bone marrow transplantation. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1995. link 14 Alba D, Lobato SD, Alvarez-Sala R, Villasante C, Echevarría C. Tracheoesophageal fistula as the presenting manifestation of Hodgkin's lymphoma. Postgraduate medical journal 1994. link 15 Bavitz JB, Patterson DW, Sorensen S. Non-Hodgkin's lymphoma disguised as odontogenic pain. Journal of the American Dental Association (1939) 1992. link 16 Drut R, Larregina A. Angiofollicular lymph node transformation in Hodgkin's lymphoma. Pediatric pathology 1991. link 17 Jochelson MS. The treated thorax. Radiologic clinics of North America 1990. link 18 Morabito F, Callea V, Brugiatelli M, D'Ascola D, Palazzolo A, Neri A. Non-Hodgkin's lymphoma associated with sickle cell disease: a case report. Tumori 1987. link 19 Nanba K, Yamamoto H, Kamada N, Kikuchi M, Suchi T, Frizzera G et al.. Agreement rates and American-Japanese pathologists' comparability of a modified Working Formulation for non-Hodgkin's lymphomas. An analysis of the cases collected for the Fifth International Workshop on Chromosomes in Leukemia-Lymphoma. Cancer 1987. link59:8<1463::aid-cncr2820590812>3.0.co;2-f) 20 Wilson TG, Wright JM. Non-Hodgkin's lymphoma of the gingiva: review of the literature. Report of a case. Journal of periodontology 1986. link 21 Barek L, Orron D. Non-Hodgkin's lymphoma presenting as periampullary mass with obstructive jaundice. The Journal of computed tomography 1986. link90019-6) 22 Marchevsky A, Gil J, Silage D. Computerized interactive morphometry as a potentially useful tool for the classification of non-Hodgkin's lymphomas. Cancer 1986. link57:8<1544::aid-cncr2820570818>3.0.co;2-4) 23 Ho FC, Loke SL, Hui PK, Todd D. Immunohistological subtypes of non-Hodgkin's lymphoma in Hong Kong Chinese. Pathology 1986. link 24 Matsuura H, Saito R, Nakajima S, Yoshihara W, Enomoto T. Non-Hodgkin's lymphoma of the esophagus. The American journal of gastroenterology 1985. link 25 Huhn D, Wochinger G, Darsow M. Mitochondrial changes in malignant lymphoma cells. Acta haematologica 1984. link 26 Portalez D, Song MY, Marty MH, Joffre F. Ultrasonographic patterns of testicular non-Hodgkin's lymphoma: a report of five cases. European journal of radiology 1982. link 27 Boulton AJ, Slater DN, Hancock BW. Herpesvirus colitis: a new cause of diarrhoea in a patient with Hodgkin's disease. Gut 1982. link 28 Nagaratnam N, Bhuvanendran N, Jiffry AJ, Ramachandra V. Lymphoma-like syndrome following para-aminosalicylic acid. Postgraduate medical journal 1982. link 29 Loizou LA, Rokos J. Central pontine myelinolysis in association with Hodgkin's lymphoma. Postgraduate medical journal 1981. link 30 Mahood JM, Sneddon IB. Pyoderma gangrenosum complicating non-Hodgkin's lymphoma. The British journal of dermatology 1980. link 31 Scharifker D, Chalasani A. Ureteral involvement by malignant lymphoma. Ten years' experience. Archives of pathology & laboratory medicine 1978. link 32 Nilsen KH. Malignant lymphoma and rheumatic symptoms. The New Zealand medical journal 1976. link

Non-Hodgkin's lymphoma (clinical)