Non Hodgkin's Lymphoma

What is Non-Hodgkin’s Lymphoma (NHL)?

Lymphoma begins when B cells, T cells, or NK cells in the lymphatic system change and grow uncontrollably, which sometimes may form a tumor. Hodgkin lymphoma is a specific type of lymphoma that is covered in another section of this website. Non-Hodgkin lymphoma (NHL) is a term that refers to the many other types of cancer of the lymphatic system, which can have different symptoms and signs, physical findings, and treatments.

Because lymphatic tissue is found in most parts of the body, NHL can start almost anywhere and can spread to almost any organ. It most often begins in the lymph nodes, liver, spleen, or bone marrow, but it can also involve the stomach, intestines, skin, thyroid gland, brain, or any other part of the body.

It is very important to know which type and subtype has been diagnosed because this information helps doctors determine the best treatment and a patient’s prognosis (chance of recovery).

Non-Hodgkin’s Lymphoma is more common in adults than children.

What Causes Non-Hodgkin’s Lymphoma and what are the risk factors?

Certain types of Non-Hodgkin’s Lymphoma are caused or triggered by Infections. Most common causes are as under :-
  • Hepatitis C
  • HIV infection increases the incidence of high grade lymphomas
  • Long term intake of drugs suppressing the immune system as after solid organ transplants
  • Primary immunodeficiency and autoimmune diseases
  • Chemicals
  • Medical treatments: like radiation therapy and chemotherapy
  • Genetic diseases
  • Autoimmune diseases

What are the risk factors for Non-Hodgkin’s Lymphoma?

  • Being male: Non-Hodgkin’s Lymphoma is more common in men than in women.
  • Age: Likelihood of getting Non-Hodgkin’s Lymphoma increases with age.
  • Impaired immune system: NHL is most common among those who have an impaired immune system, an autoimmune disease, or HIV or AIDS. It also occurs among those who take immunosuppressant medicines, such as medicines following an organ transplant.
  • Viral infections: A viral infection, such as Epstein-Barr virus, increases the risk of developing NHL.
  • Bacterial infections: Infection with Helicobacter pylori increases the risk of lymphoma involving the stomach.
  • Environmental exposure: Exposure to agricultural pesticides or fertilizers, solvents, and other chemicals may increase the risk of developing NHL.

What are the Symptoms?

The symptoms are protean. They range from painless lymph node enlargement to fits and paralysis. Most patients have ‘B symptoms’ defined by
  • A painless swelling of the lymph nodes in the neck, underarms, or groin. This is the most common symptom.
  • Fever above 380C (100.4 F)
  • Drenching Night sweats.
  • Feeling very tired.
  • weight loss > 10% of baseline body weight
  • Itchy skin.
  • Reddened patches on the skin.
  • A cough or shortness of breath.
  • Pain in the belly or back.

Role of BMT in the treatment of Non-Hodgkin’s Lymphoma

What to do when Non-Hodgkin’s Lymphoma recurs?

About 30% patients with advanced disease and 10% patients with Limited disease relapse.

Once Non-Hodgkin’s Lymphoma relapses, the treatment is well-defined and as follows:
  • Salvage Chemotherapy
  • Autologous Peripheral Blood Stem Cell Collection
  • High Dose Chemotherapy and Autologous BMT
What is the cure rate with Autologous BMT?

If the patient is PET negative before BMT, 80% of the patients are cured. If the patient is PET positive before BMT, only 50% patients are cured.

When is upfront BMT required?
  • Patients with more advanced disease
  • T cell NHL
  • MantleCell Lymhoma
When is Allogeneic BMT needed for Non-Hodgkin’s Lymphoma?
  • When the disease recurs after Autologous BMT
  • When Peripheral Blood Stem Cells cannot be mobilised for Autologous BMT
  • T cell NHL
  • Relapsed Low Grade NHL
  • Relapsed Mantle Cell Lymphoma
There is a strong Graft versus Tumour effect against NHL in the setting of Allogeneic BMT

In the setting of High Risk and Relapsed NHL, best results are obtained with HAPLOIDENTICAL DONOR and REDUCED INTENSITY CONDITIONING.

70% patients are cured with this procedure.

The children have more aggressive varieties of NHL. The cure rates in children are much higher.