Non-Hodgkin's lymphoma (NHL) is a group of heterogeneous malignant tumors that develop from lymphoid tissue. The main feature of NHL is their diversity in both clinical manifestations and morphological characteristics. Unlike Hodgkin's lymphoma, NHL does not include a specific cell population - Reed-Sternberg cells. The disease covers a wide range of lymphomas, from highly aggressive to low-aggressive forms, and can affect both lymph nodes and extralymphatic organs. The main pathogenetic mechanism is the proliferation of abnormal lymphocytes, which is often associated with various genetic changes and mutations.
History of the disease and interesting historical facts
Non-Hodgkin's lymphoma was described in the scientific literature more than a century ago, but its diagnosis and classification have become much more accurate only in recent decades. In 1956, the world-famous American pathologist, Dr. M.K. Creson, first used the term "non-Hodgkin's lymphoma" to refer to various lymphoproliferative diseases other than Hodgkin's. In subsequent years, foreign and Russian oncologists developed classifications of NHL, such as the WHO classification, which is still being worked on today. It includes about 80 different subtypes, each with its own clinical picture and prognosis. One of the significant milestones was the creation of the International Organization for the Study of Lymphoma in 1999, the purpose of which was to coordinate research and disseminate knowledge about lymphomas.
Epidemiology
According to the World Health Organization, non-Hodgkin's lymphoma is one of the most common malignant tumors. In recent years, there has been an increase in the incidence rate, and according to statistics, more than 500,000 new cases of NHL are registered worldwide every year. In Russia, the incidence of NHL is approximately 5-7 cases per 100,000 population per year, with an upward trend. Men over 60 are most susceptible to this disease. According to various studies, in 2018, NHL became the third most common tumor in the adult population after lung cancer and colorectal cancer. Studies show that rates vary in different countries, which may be due to both environmental factors and differences in diagnosis and recording of cases of the disease.
Genetic predisposition to this disease
Genetic changes play a major role in the pathogenesis of non-Hodgkin's lymphomas. Studies have shown that various genetic mutations are associated with the development of the disease. The most common mutations are associated with the BCL2, BCL6, and MYC genes, which are involved in the regulation of the cell cycle and apoptosis. Disruption of their functioning can lead to the immortality of lymphocytes and their uncontrolled proliferation. For example, translocation of the BCL2 and MYC genes is observed in 70% cases of follicular lymphoma and indicates a high risk of disease progression. Genetic predisposition may also include mutations in other genes, such as TP53, which indicates a more aggressive course of the disease. It is important to note that the presence of these mutations is not always the only risk factor, and their necessity for the development of NHL requires further research.
Risk factors for the development of this disease
There are physiological, environmental, and chemical risk factors that contribute to the development of non-Hodgkin's lymphoma. The main risk factors include:
- Exposure to chemicals such as pesticides, solvents, and some anticancer drugs.
- Immunodeficiency states including HIV/AIDS, organ transplantation, and hereditary immune syndromes.
- Exposure to radiation, including exposure during treatment for other diseases.
- Infectious agents: Some viruses (eg, Epstein-Barr virus, cytomegalovirus) are associated with the development of NHL.
- Age and gender: Men over 60 are at significantly higher risk.
Understanding these risk factors can help develop early detection and prevention programs.
Diagnosis of this disease
Diagnosis of non-Hodgkin's lymphoma involves a comprehensive approach, encompassing clinical, laboratory and instrumental methods. The main symptoms may include:
- Enlarged lymph nodes, especially in the neck, armpits and groin.
- Night sweats.
- Loss of appetite and weight.
- Fatigue.
- Fever.
Laboratory tests may include a complete blood count, biochemistry, and tumor marker tests. Radiological examinations such as CT and PET-CT can assess the extent of the process. Other diagnostics may include lymph node puncture for morphological examination, as well as biopsy. Differential diagnosis should be made with diseases such as infectious lymphadenitis and other malignancies.
Treatment
Treatment for non-Hodgkin's lymphoma depends on the stage of the disease, its subtype, and the patient's overall condition. Treatment includes several key components:
- General treatment: targeted therapy and immunotherapy.
- Pharmacological treatment: chemotherapy, which can use different regimens such as R-CHOP (rituximab, cyclophosphamide, docetaxel, adriablastin, prednisolone).
- Surgical treatment: possible in localized forms where tumor removal may be necessary surgically, but this is less common for NHL.
- Other types of treatment: radiotherapy, which can be used as the main treatment or in combination with chemotherapy.
Treatment of NHL requires an individual approach and is prescribed taking into account all risk factors and characteristics of the disease.
List of medications used to treat this disease
The main drugs used in the treatment of non-Hodgkin's lymphoma include:
- Rituximab (Rituxan)
- Cyclophosphamide
- Doxorubicin (Adriamycin)
- Vincristine
- Prednisolone
- Bendamustine
- Ifosfamide
- Obinutuzumab (Gazivita)
- Carfilzomib
The use of these medications depends on the subtype of NHL, as well as the stage of the disease.
Disease monitoring
Monitoring of patients with non-Hodgkin lymphoma includes regular follow-up examinations and functional assessments. Prognosis depends on the NHL subtype, stage of disease, and response to treatment.
- Control stages include clinical examinations every 3-6 months in the first three years after treatment, then annually.
- The prognosis for low-aggressive forms is generally more favorable, while highly aggressive forms require more intensive treatment and monitoring.
- Complications may include relapses of the disease and side effects from medications.
Age-related features of the disease
Non-Hodgkin lymphoma may present differently in different age groups. In childhood, NHL is less common and is more often highly aggressive, such as lymphoblastic lymphoma. In contrast, older people may have more inert but obviously more difficult to treat forms with a high risk of comorbidities.
Questions and Answers
- What is non-Hodgkin lymphoma?
Non-Hodgkin's lymphoma is a group of malignant tumors arising from lymphoid tissue, characterized by a number of clinical and morphological characteristics. - What are the main symptoms of non-Hodgkin lymphoma?
The main symptoms include swollen lymph nodes, night sweats, weight loss and fatigue. - How is the disease diagnosed?
Diagnosis includes clinical examination, laboratory tests, radiological examination and lymph node biopsy. - What treatment is used for patients with non-Hodgkin lymphoma?
Treatment includes chemotherapy, immunotherapy, targeted therapy, and, in some cases, radiation therapy. - What is the prognosis and possible complications?
The prognosis depends on the type and stage of the disease, but relapses and side effects of treatment are possible, which requires regular monitoring.
