Talk:Non-Hodgkin lymphoma

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The[edit]

The original version of this article was edited down from the wab page http://www.cancer.gov/cancerinfo/wyntk/non-hodgkins-lymphoma As a work of an agency of the U.S. Federal Government, this should be a public domain resource that can be used as source material for Wikipedia.

I think it would help to distinuish between Hodgkins and Non-Hodgkins lymphoma, I dont really see a comparison between the two in the article. This distinction should probably be in the introduction. --ShaunMacPherson 12:02, 12 Aug 2004 (UTC)

Can't promise I'll do it soon, but the distinction is mainly made on histopathology of affected lymph nodes. Reed-Sternberg cells imply Hodgkin's. Clinically, Hodgkin's occurs more often in young adults and then again in the elderly, while NHL occurs in all age groups with higher rates in the elderly. JFW | T@lk 16:17, 12 Aug 2004 (UTC)

Some edits and additional info[edit]

I've added some new info to fill in one of the places where the NCI info was lacking: staging. Specifically, they didn't lay out what the individual types and stages are.

This leaves us with no PD resource to cut and paste from, so I'm reading and learning from various proprietary resources and once I've got a better understanding, I'll finish the writeup. If anyone is willing to help, I still need to add information about bulk, grade, type a, type b, and agressive and indolent lymphomas.

This page is great, but copyright of cancerhelp.org.uk, so I can't just take it http://www.cancerhelp.org.uk/help/default.asp?page=3044

Glitch010101 04:47, 25 Apr 2005 (UTC)

This article has lots of duplicate information. Examples are the cancer and lymphatic system introduction that could be better maintained in its own pages. What do you think? 80.58.1.42

Waffle[edit]

Why does this article state so confidently that lymphoma develops in the lymphatic system? Cutaneous lymphomas anyone, or primary cerebral lymphomas? It's much better called a tumor of lymphocytes. JFW | T@lk 03:12, 29 November 2005 (UTC)

I could not resist the temptation. More work coming, although my exams are coming. JFW | T@lk 03:34, 29 November 2005 (UTC)


Prognosis[edit]

This section has nothing to do with Non-Hodgkins Lymphoma and very little to do with the word "prognosis". Some actual information on the prognosis for this particular disease would much better serve the article. 70.137.149.55 05:20, 25 January 2006 (UTC)

I've revised the section on Prognosis in an attempt to make it more useful. I put in a little about the IPI/FLIPI. Also added a section on assessing the response to treatment. 68.166.14.179 04:33, 2 August 2006 (UTC)

Non-Hodgkin or Non-Hodgkin's[edit]

Given that we have Hodgkin's lymphoma rather than Hodgkin lymphoma (and Burkitt's lymphoma rather than Burkitt lymphoma), wouldn't it be sensible to rename this article Non-Hodgkin's lymphoma? Google (and the medical world) seems split about 50:50 in each case. I don't care which we use, but consistency seems desirable. Gnusmas 09:10, 6 November 2006 (UTC)

Medical professionals use Non-Hodgkin without the ['s]. JFW | T@lk 21:42, 5 April 2007 (UTC)
I also noticed that within this article, there are inconsistencies. Sometimes, the apostrophe and "s" are used, and other times not. (JosephASpadaro 14:53, 13 June 2007 (UTC))
True, it's inconsistent. At some point we should change them all to non-Hodgkin. I've been meaning to sink some time into overhauling this article for awhile, but haven't got around to it yet. MastCell Talk 16:14, 13 June 2007 (UTC)

Family[edit]

doi:10.1182/blood-2006-06-031948 explores risk to family members of NHL patients. Small but increased risk, unsurprisingly. JFW | T@lk 21:42, 5 April 2007 (UTC)

List of prominent NHL patients[edit]

What about splitting off the "list of people with NHL" into a separate list article, such as list of prominent people with non-Hodgkin lymphoma? It seems a bit out of place here. MastCell Talk 03:08, 9 April 2007 (UTC)

I tend to agree and such a list would need some strict criteria for inclusion Mikebar 16:37, 14 October 2007 (UTC)
I'd be happy to see the list disappear from the article. Actually, I'd be happy to see the list disappear altogether, because I can't imagine why anyone would care. ("Gosh, somebody famous died from this disease! My friends will all be so excited!") I guess I really don't do the celebrity culture nonsense.
What I do care about is that the item about Elmo Russell Zumwalt III (who is not a notable person in his own right) not be restored unless the multiple typos get fixed first. Surely we can do better than 'the 0Vietnam War' and 'both {{Hodgkin's lymphoma]].' WhatamIdoing 10:51, 9 November 2007 (UTC)
He keeps being reverted back in when the spam gets on, I agree and I'll make sure that doesn't happen in the future. Sorry Mikebar 12:59, 9 November 2007 (UTC)

Introduction[edit]

"Non-Hodgkin's lymphoma is a cancer arising from lymphocytes, a type of white blood cell."

Think introduction needs to be reworked. this statememnt though not untrue, general reader may confuse with leukemia. whether both are part of a same spectrum is a differrent issue.--Countincr ( T@lk ) 18:12, 14 April 2007 (UTC)

Alcohol[edit]

The long section on alcohol as a possible cause of NHL was a cut-and-paste job from Alcohol and cancer. I think a simple link to that article is a better solution: it reduces information maintenance hassles, and it avoids undue weight issues. WhatamIdoing (talk) 22:34, 2 March 2008 (UTC)

Wikipedia:Transcluded content/Let's get rid of the NHL

Technical note: this discussion is transcluded in Talk:lymphoma, Talk:Non-Hodgkin lymphoma, Talk:Cancer, Wikipedia talk:WikiProject Pathology. Comments posted here will be shown in all.

Survival[edit]

Survival of NHL continues to improve - especially in younger patient, but for some reason black people are lagging behind - http://archinte.ama-assn.org/cgi/content/abstract/168/5/469 JFW | T@lk 05:55, 8 May 2008 (UTC)

Eeeeww[edit]

I have just realized that this long article about a major disease category contains a whopping two references. Surely we can do better than this. Anyone have a particular place in the article that they think is in most need of refs? WhatamIdoing (talk) 17:21, 24 June 2008 (UTC)

I have another suggestion: shorten this article about a defunct disease category to the point where two references would be enough. Emmanuelm (talk) 01:51, 25 June 2008 (UTC)
That would take a lot of work, beginning with collecting all the real names for the multiple diseases, so that people could get out of this page and to the "correct" one. I wonder if we could get support for merging it to Lymphoma? WhatamIdoing (talk) 06:03, 26 June 2008 (UTC)
I support Emmanuelm's position (shorten NHL, rather than provide more refs). The collection of real names is available in Template:Hematological malignancy histology. --Arcadian (talk) 10:39, 26 June 2008 (UTC)
What do you think about redirecting it to Lymphoma? It seems silly to have a short article that lists all the lymphomas except Hodgkin's, when we should already have an article that lists the same thing plus Hodgkin's, and this one would then just duplicate that article, minus one or two paragraphs. WhatamIdoing (talk) 00:34, 28 June 2008 (UTC)
I could support that as well (though the NHL content is better than the content at lymphoma, so it might be appropriate to salvage some of the content before redirecting.) --Arcadian (talk) 05:02, 28 June 2008 (UTC)
I raised this issue here in April and Jellytussle disagreed. I understand that we now have a consensus to i) keep the article, ii) shorten it, focusing it on the 1982 Working Formulation, and iii) move the bulk of its contents to Lymphoma. Do you agree? Emmanuelm (talk) 02:51, 29 June 2008 (UTC)
I'd support either a reduction or redirection. I think that a reduction is slightly better, because that's what MeSH does, and because so many people would expect to see a NHL page, and it would confuse them if such a page were not present. If we do a redirection instead of a reduction, then we should make sure to clearly define the usage of the term NHL in the introduction of lymphoma. --Arcadian (talk) 17:29, 29 June 2008 (UTC)

NHL redirected to Lymphoma[edit]

Arcadian, in a bold move, completely deleted Non-Hodgkin Lymphoma and redirected it to Lymphoma. As stated above, I agree something needed to be done, but feel a completed deletion is too much: too many people, especially statisticians, still use NHL in 2008. I rewrote the article as a short, historical summary. Emmanuelm (talk) 14:51, 21 July 2008 (UTC)

NHL should not be redirected to Lymphoma. Although Non-hodgkins lymphomas make up a majority of lymphomas, they are still a subset with Hodgkin's Lymphoma being the other predominant group. Also under lymphoma are some conditions which researchers have not classified as either. Good editing on the articles can better make distinctions but if someone is to be bold enough for a redirect they should discuss it thoroughly first. Mikebar (talk) 08:17, 23 July 2008 (UTC)
HL being the other "group"? NHL literally means "all the lymphomas in the world except for one." Given the number of lymphomas, this is not a materially important distinction compared to "all the lymphomas in the world", which is why it is being abandoned in the real world. It's like saying "all the cars in the world except for the Yugo."
Having said that, I don't mind having a page that describes this term. WhatamIdoing (talk) 18:33, 23 July 2008 (UTC)
I'm confused by the treatment of the term "non-hodgkin lymphoma" which seems to say that it's obsolete. I still see it in NEJM, JAMA, Harrison's, and ASCO -- and it's in the link to Dorland's in the definition.
Can someone provide a source, preferably open-source on the web, for the current usage? It seems as if some authorities use "non-hodgkin lymphoma," and some don't. Is there one final authority on nomenclature? --Nbauman (talk) 17:39, 12 August 2009 (UTC)
I don't have a good source handy, but my experience is that NHL is typically used either for statistical purposes (in which case, the recent trend is to refer to the "non-Hodgkin's lymphomas, to show that you've learned something since the early 1980s) or in imprecise consumer-grade writing.
Nobody actually has "NHL", since it's a class of diseases instead of a real disease: rather than "one of the NHLs", patients should be told things like "you have DLBL." Saying you have NHL would be like saying you have "B-cell-mediated autoimmunity", instead of rheumatoid arthritis (or whichever of the hundred-plus specific B-cell-mediated autoimmune diseases you actually have). WhatamIdoing (talk) 22:39, 12 August 2009 (UTC)

I support the idea of Redirecting this article to Lymphoma,and unless there is objection intend to do it.My reasoning behind this is that the term non-hodgkin lymphoma is uninformative,out of favor with most scientific sources,and is decreasing in popularity among the general population.Immunize (talk) 17:11, 29 January 2010 (UTC)

This page currently describes the history and use of the name Non-Hodgkin lymphoma, not the diseases that were lumped together under those names. I think that Wikipedia needs to have a page about this widely used term, even though it is obsolete. We've got an article at Gay-related immune deficiency, too, even though no researcher would use that name for AIDS these days. WhatamIdoing (talk) 18:52, 29 January 2010 (UTC)

Although you are right that wikipedia needs to have information about an old medical term,this information could be added to the lymphoma article.There is no need to have an entire separate article devoted to an outdated medical term.Immunize (talk) 19:03, 29 January 2010 (UTC)

Sometimes a separate article is by far the best choice. See Category:Obsolete medical terms, for example. WhatamIdoing (talk) 19:06, 29 January 2010 (UTC)

Do you feel that,in this particular case,the best course of action is to maintain a separate page? Immunize (talk) 23:21, 29 January 2010 (UTC)

I would not object to a merge, but the comments above (from last year) indicate that some other editors would. WhatamIdoing (talk) 04:54, 1 March 2010 (UTC)
I have proposed a merge to lymphoma. Regards. Immunize (talk) 18:50, 3 June 2010 (UTC)

Rating[edit]

Why is this article only rated as mid importance when the scale definition clearly states that cancer is top priority? —Preceding unsigned comment added by 60.242.109.30 (talk) 09:25, 21 August 2008 (UTC)

Lymphoma is rated high. This article has been downgraded to reflect the obsolescence of the NHL concept. Emmanuelm (talk) 15:50, 21 August 2008 (UTC)
Emmanuelm is correct. The Cancer article itself is rated top-importance. That doesn't mean that every kind of neoplastic disease, or every classification scheme for neoplastic disease, should also be top-importance.
In general, if you dispute WikiProject Medicine's rating on an article, you are welcome to leave a note at Wikipedia:WikiProject Medicine/Assessment#Requesting an assessment or re-assessment. WhatamIdoing (talk) 00:21, 22 August 2008 (UTC)

Stale link[edit]

Apologies if this is not the correct method for reporting stale links, but the Patient information on non-Hodgkin lymphoma link is not working correctly any more.--Jduff72 (talk) 17:45, 28 November 2011 (UTC)

Which of the 16 subtypes are or can be indolent[edit]

The phrases indolent lymphoma and indolent non-hodgkin lymphomaare used elsewhere but what do they refer to ? (WP does have Indolent follicular lymphoma but not Indolent lymphoma). - Rod57 (talk) 19:02, 13 December 2012 (UTC)

Waldenström's macroglobulinemia says it is an indolent lymphoma. - Rod57 (talk) 06:47, 15 December 2012 (UTC)

New language for the Non-Hodgkin Lymphoma page[edit]

I recently tried to significantly expand the "Causes" section, but it has been pointed out to me that I have a conflict of interest here, since I am connected to a current lawsuit.

Still, the current version of the article is not neutral, and something should be done to improve that. (In fact, the current section largely reflects the edits of another editor with a conflict of interest, from last August.) I don’t insist that my additions/changes be included, but I do have three simpler suggestions that would give readers a more accurate understanding of the issue, until a more neutral version can be created by non-COI editors:

1. Revert the “Causes” section back to the August version (and incorporate a few minor updates that non-COI editors have made since);

2. Add a "{{POV-section}} tag to the "causes" section

3. Somebody else could address the most significant neutrality problem in the section. From my perspective, the most problematic sentence in the section is the following:

"Studies of PCB workers have uniformly shown no statistically significant increased rates of deaths from non-Hodgkin Lymphoma."

While that is factually accurate, it conveys a strong bias in the interpretation of the facts. To illustrate this point here is another accurate but non-neutral statement in favor of my own position:

"The human epidemiologic data supports the position that PCBs cause NHL and that persons with high levels of PCBs for their age are more likely than not to have had PCBs as a cause of their NHL."

If uninvolved editors could find an appropriate middle ground between those, I think that would address the issue.

Thoughts on any of the above options? -Kdelay13 (talk) 20:38, 23 April 2014 (UTC)

Suggestion #2 is not a solution. We do not use those tags to warn readers about the content. (We use them so that editors interested in cleaning up POV messes [there are unfortunately very few] can find the articles that need cleaning up.)
Suggestion #1 involves removing a large number of references, but most of them shouldn't be there anyway. Here's what we've got at the moment:

Some studies have shown an association between non-Hodgkin lymphoma and exposure to polychlorinated biphenyls (PCBs), a persistent organic pollutant now found throughout the natural environment.[1][2] However, other similar studies have found no such link.[3][4][5] Studies of PCB workers have uniformly shown no statistically significant increased rates of deaths from non-Hodgkin Lymphoma.[6][7][8] In 2013, The International Association for Research on Cancer (IARC) determined that the evidence that PCBs cause non-Hodgkin Lymphoma is “limited” and “not consistent.” [9]

  1. ^ Kramer, Shira; Hikel, Stephanie Moller; Adams, Kristen; Hinds, David; Moon, Katherine (2012). "Current Status of the Epidemiologic Evidence Linking Polychlorinated Biphenyls and Non-Hodgkin Lymphoma, and the Role of Immune Dysregulation". Environmental Health Perspectives 120 (8): 1067–75. doi:10.1289/ehp.1104652. PMC 3440083. PMID 22552995. 
  2. ^ Engel, Lawrence S.; Lan, Qing; Rothman, Nathaniel (2007). "Polychlorinated Biphenyls and Non-Hodgkin Lymphoma". Cancer Epidemiology Biomarkers & Prevention 16 (3): 373–6. doi:10.1158/1055-9965.EPI-07-0055. PMID 17337641. 
  3. ^ Bräuner, E. V.; M. Sørensen, E. Gaudreau, A. LeBlanc, K. T. Eriksen, A. Tjønneland, K. Overvad, O. Raaschou-Nielsen (2012). "A prospective study of organochlorines in adipose tissue and risk of non-Hodgkin lymphoma". Environmental Health Perspectives 120 (1): 105–111. PMID 22328999. 
  4. ^ Laden, F.; K. A. Bertrand, L. Altshul, J. C. Aster, S. A. Korrick, and S. K. Sagiv (2010). "Plasma organochlorine levels and risk of non-Hodgkin lymphoma in the Nurses’ Health Study". Cancer, Epidemiology, Biomarkers & Prevention 19 (5): 1381–1384. PMID 20406963. 
  5. ^ Cocco, P.; P. Brennan, A. Ibba, S de Sanjosé Llongueras, M. Maynadié, A. Nieters, N. Becker, M. G. Ennas, M. G. Tocco, and P. Boffetta (2008). "Plasma polychlorobiphenyl and organochlorine pesticide level and risk of major lymphoma subtypes". Occupational and Environmental Medicine 65 (2): 132–140. PMID 17699548. 
  6. ^ Ruder, A. M.; M. J. Hein, N. B. Hopf, and M. A. Waters (2013). "Mortality among 24,865 workers exposed to polychlorinated biphenyls (PCBs) in three electrical capacitor manufacturing plants: a ten-year update". International Journal of Hygiene and Environmental Health: 37. doi:10.1016/j.ijheh.2013.04.006. PMID 23707056. 
  7. ^ Pesatori, A. C.; P. Grillo, D. Consonni, M. Caironi, G. Sampietro, L. Olivari, S. Ghisleni, and P. A. Bertazzi. (2013). "Update of the mortality study of workers exposed to polychlorinated biphenyls (PCBs) in two Italian capacitor manufacturing plants". Medicina del Lavoro 104 (2): 107–114. PMID 23789517. 
  8. ^ Mallin, K.; K. McCann, A. D’Aloisio, S. Freels, J. Piorkowski, J. Dimos, and V. Persky (2004). "Cohort mortality study of capacitor manufacturing workers, 1944-2000". Journal of Occupational and Environmental Medicine 6 (46): 565‑576. PMID 15213519. 
  9. ^ Lauby-Secretan, B.; D. Loomis, Y. Grosse, F. El Ghissassi, V. Bouvard, L. Benbrahim-Tallaa, N. Guha, R. Baan, H. Mattock, and K. Straif (2013). "Carcinogenicity of polychlorinated biphenyls and polybrominated biphenyls". Lancet Oncology 14 (4): 287–288. PMID 23499544. 


The first two are reviews. The last is basically news—it's a report about what happened at a conference. But the six in between are primary sources, which WP:MEDRS dislikes. This should probably be re-written from scratch, using only recent review articles. WhatamIdoing (talk) 22:05, 25 April 2014 (UTC)
@WhatamIdoing: Thank you for your comments. Consistent with the “careful review” approach, while also relying on the most-recent review articles addressing the issue, I suggest the following for “Causes”:
"A recent review of the carcinogenicity of PCBs concluded that there is "some evidence for the role of PCBs in the development of NHL, although the inconsistent results of studies performed on highly polluted people and occupationally exposed workers do not allow a firm conclusion to be drawn.” http://www.ncbi.nlm.nih.gov/pubmed/?term=zani+2013+pcb Two other recent reviews have concluded that PCBs can cause NHL. http://www.hindawi.com/journals/jeph/2012/258981/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440083/"
I believe the Zani 2013 paper, the Freeman 2012 paper, and the Kramer 2012 paper are the most recent reviews that address this issue. Nonetheless, in light of my conflict of interest, I want to share in all candor that my group has funded the Kramer 2012 article, although the article was fully peer-reviewed at a top environmental health journal (Environmental Health Perspectives), published by the National Institute for Environmental Health Sciences (NIEHS). In addition, Dr. Freeman is also a paid expert on my group’s side, and much of the underlying work reported in his paper was originally done for purposes of litigation. However, my side did not fund the writing of his manuscript, and that paper was also fully peer-reviewed by independent scientists. -Kdelay13 (talk) 01:07, 29 April 2014 (UTC)
Thanks for the ping, Kdelay13.
My search at PubMed, using "pcb nhl", turns up four reviews on this subject in the last five years:
Strauss appears to be a review of testing methodologies rather than the main subject.
At a quick glance, all of them support the idea that PCBs probably cause NHL (in at least some people/some situations). Given the 100% agreement, I wouldn't want to frame it as "a [one] recent review". It's all of them. Kramer takes a stronger approach: "Overall, we conclude that the weight of evidence supports a causal role of PCBs in lymphomagenesis." Rather than a paragraph of explanation, it would probably make more sense to cite a couple of these and simply add it to the list along with the other probable causes. WhatamIdoing (talk) 04:04, 29 April 2014 (UTC)
@WhatamIdoing: thank you for your followup and additional research. -Kdelay13 (talk) 19:11, 29 April 2014 (UTC)

To the attention of WhatamIdoing and edgar181 -- We have previously advised Edgar181 that the alleged association between PCBs and non-Hodgkin’s Lymphoma is a key issue in controversy in an ongoing jury trial. Kdelay13 recently made edits to various Wikipedia entries that have been excerpted verbatim from court submissions authored by a paid witness for the parties and their lawyers claiming a connection between PCBs and NHL. Kdelay13 has acknowledged his or her role as a party to this ongoing litigation, but has nevertheless continued to make and/or suggest edits that further his or her interests in this case, including edits that refer to Dr. Kramer and her paper. Dr. Kramer is also a paid witness hired by the same parties, including kdelay13, and Dr. Kramer has been paid over $1.3 million by plaintiffs in this case. Kdelay13’s attempt to manipulate the content of Wikipedia has persisted, despite Edgar181’s efforts to present neutral, balanced and fair entries. We remain concerned that, although the Court in the jury trial in progress has admonished jurors to refrain from conducting any research into the issues of the case, including on-line research, jurors or members of their families might conduct research on line. The recent edits or suggestions by Kdelay13 can only be viewed as a clear attempt to improperly influence sitting jurors. The Wikipedia entries should be restored to the neutral and balanced approach settled on by Edgar181. (Note: I’ve left this same comment on the page for polychlorinated biphenyls.) Glynn Young — Preceding unsigned comment added by Glynn Young (talkcontribs) 13:49, 2 May 2014 (UTC)

I am not a lawyer, but if you are concerned about someone undermining a jury, then I suggest that you take your concerns to the judge.
To the best of my knowledge, this information meets the standards for inclusion that are set forth by the community's policies and guidelines on Wikipedia:Verifiability, giving Wikipedia:DUE weight to the views of academic secondary sources, and identifying reliable sources for medicine-related content. WhatamIdoing (talk) 14:55, 6 May 2014 (UTC)
Although I have removed some of the content which was the source of the original edit warring, I should make it clear that I do not necessarily endorse the current version of either of the articles as "neutral, balanced and fair" as stated above, nor have I "settled on" any version for them to be restored to. -- Ed (Edgar181) 17:41, 6 May 2014 (UTC)

The statement as written is simply not factually true. The reason it is not true is that the cited papers are not "studies" or "original research" but merely reviews or summary papers which discuss actual studies done by others. Nor do they establish "cause." The cited summary papers by Kramer and Freeman were paid for by plaintiffs' counsel for purposes of this pending litigation are the only writings on the subject that use the word "cause." Epidemiologists writing the results of their research are generally not medical doctors and therefore do not report the statistical results of their studies in terms of "cause"; rather they report their results as statistical "associations." A true statement would be that some epidemiology studies show an association between PCB exposure and NHL, and others do not show such an association.

I am posting this on the NHL talk page. Furthermore, this comment has been reproduced on the talk page of editor [WhatAmIDoing/Edgar181], both of whom have been involved in this discussion. User:Glynn Young — Preceding undated comment added 15:30, 20 May 2014 (UTC)

You are correct: those are review articles, or what we more broadly call secondary sources, rather than original research papers. The reason that we use those here is because our guidelines directly tell us to use secondary sources instead of original papers whenever possible. The "rules" for the English Wikipedia's sources are very, very different from the standards used in academic writing. WhatamIdoing (talk) 17:23, 20 May 2014 (UTC)