|Non-Hodgkin's Lymphomas (NHL)|
|Classification and external resources|
|Specialty||Hematology and oncology|
|Patient UK||Non-Hodgkin lymphoma|
Non-Hodgkin lymphomas (NHLs), also known as non-Hodgkin disease are diverse group of blood cancers that include any kind of lymphoma except Hodgkin's lymphomas. Types of NHL vary significantly in their severity, from slow growing to very aggressive types.
Lymphomas are types of cancer derived from lymphocytes, a type of white blood cell. Lymphomas are treated by combinations of chemotherapy, monoclonal antibodies (CD20), immunotherapy, radiation, and hematopoietic stem cell transplantation.
The 2008 WHO classification of lymphomas has five large groups, including a Hodgkin disease group. Other forms of lymphoma are over 80 different forms of lymphoma in an additional four broad groups. By comparison, the 1982 Working Formulation (which is now considered obsolete is commonly used primarily for statistical comparisons with previous decades) recognized just 16 types of non-Hodgkin lymphoma.
The many different forms of lymphoma likely have different causes. These possible causes and associations with at least some forms of NHL include the following:
- Infectious agents:
- Epstein-Barr virus – associated with Burkitt's lymphoma, Hodgkin's lymphoma, follicular dendritic cell sarcoma, extranodal NK-T-cell lymphoma
- Human T-cell leukemia virus – associated with adult T-cell lymphoma
- Helicobacter pylori – associated with gastric lymphoma
- HHV-8 – associated with primary effusion lymphoma, multicentric Castleman disease
- Hepatitis C virus – associated with splenic marginal zone lymphoma, lymphoplasmacytic lymphoma and diffuse large B-cell lymphoma
- HIV infection
- Some chemicals, like polychlorinated biphenyls (PCBs), diphenylhydantoin, dioxin, and phenoxy herbicides.
- Medical treatments, like radiation therapy and chemotherapy
- Genetic diseases, like Klinefelter's syndrome, Chédiak-Higashi syndrome, ataxia telangiectasia syndrome
- Autoimmune diseases, like Sjögren’s syndrome, celiac sprue, rheumatoid arthritis, and systemic lupus erythematosus.
In the US, data from 2007-2011 show that there were about 19.7 cases of NHL per 100,000 adults per year, 6.3 deaths per 100,000 adults per year. About 2.1 percent of men and women are diagnosed with NHL at some point during their lifetime, and there were around 530,919 people living with non-Hodgkin lymphoma.
Globally, as of 2010, there were 210,000 deaths globally, up from 143,000 in 1990.
Non-Hodgkin lymphoma increases with age steadily.
Up to 45 years NHL is more common among males than females.
NHL is the sixth most common cancer in the UK (around 12,800 people were diagnosed with the disease in 2011), and it is the eleventh most common cause of cancer death (around 4,700 people died in 2012).
|This section needs additional citations for verification. (June 2014)|
Hodgkin lymphoma (HL, Hodgkin disease), described by Thomas Hodgkin in 1832, was the first form of lymphoma described and defined. Other forms were later described and there was a need to classify them. Because Hodgkin lymphoma was much more radiation-sensitive than other forms, its diagnosis was important for oncologists and their patients. Thus, research originally focused on it. The first classification of Hodgkin lymphoma was proposed by Robert J. Luke in 1963.
While consensus was rapidly reached on the classification of Hodgkin lymphoma, there remained a large group of very different diseases requiring further classification. The Rappaport classification, proposed by Henry Rappaport in 1956 and 1966, became the first widely accepted classification of lymphomas other than Hodgkin. Following its publication in 1982, the Working Formulation became the standard classification for this group of diseases. It introduced the term non-Hodgkin lymphoma or NHL and defined three grades of lymphoma.
Subtypes of non-Hodgkin lymphoma
NHL consists of many different conditions that have little in common with each other. They are grouped by their aggressiveness. Less aggressive non-Hodgkin lymphomas are compatible with a long survival while more aggressive non-Hodgkin lymphomas can be rapidly fatal without treatment. Without further narrowing, the label is of limited usefulness for patients or doctors. The subtypes of lymphoma are listed there.
Modern usage of term
Nevertheless, the Working Formulation and the NHL category continue to be used by many. To this day, lymphoma statistics are compiled as Hodgkin's vs non-Hodgkin lymphomas by major cancer agencies, including the US National Cancer Institute in its SEER program, the Canadian Cancer Society and the IARC.
The Center for Disease Control and Prevention (CDC) included certain types of non-Hodgkin's lymphoma as AIDS-defining cancers in 1987. Immune suppression rather than HIV itself is implicated in the pathogenesis of this malignancy, with a clear correlation between the degree of immune suppression and the risk of developing NHL. Additionally, other retroviruses such as HTLV may be spread by the same mechanisms that spread HIV, leading to an increased rate of co-infection. The natural history of HIV infection has been greatly changed over time. As a consequence, the incidence of non-Hodgkin's lymphoma (NHL) in HIV infected patients has significantly declined in recent years.
- Lymphoma, for information about all forms of NHL as well as Hodgkin's lymphoma
- Chemotherapy, for information on the standard of care of all forms of non-Hodgkin lymphomas.
- CHOP-R for the most common chemotherapeutic regimen for non-Hodgkin lymphoma.
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- Health Agency Says Widely Used Herbicide Likely Carcinogenic; Herbicide, glyphosate, is sold by Monsanto under Roundup brand from the Wall Street Journal, March 20, 2015