Lymphoma

About half of the blood cancers that occur each year are lymphomas, or cancers of the
lymphatic system. This system - composed of lymph nodes in your neck, armpits, groin, chest,
and abdomen - removes excess fluids from your body and produces immune cells. Abnormal
lymphocytes, a type of white blood cell that fights infection, become lymphoma cells, which
multiply and collect in your lymph nodes. Over time, these cancerous cells impair your immune
system.(MacGill,et al.,2017)

Lymphomas are divided into two categories: Hodgkin lymphoma and non-Hodgkin
lymphoma. About 12 percent of people with lymphoma have Hodgkin lymphoma. Because
of breakthrough research, this once fatal diagnosis has been transformed into a curable
condition. Most non-Hodgkin lymphomas are B-cell lymphomas, and either grow quickly
(high-grade) or slowly (low-grade). There are over a dozen types of B-cell non-Hodgkin
lymphomas. The rest are T-cell lymphomas, named after a different cancerous white blood cell,
or lymphocyte. (MacGill,et al.,2017)

Hodgkin Lymphoma

Hodgkin lymphoma (HL) is one of the most frequent lymphomas in the Western world,
with an annual incidence of about 3 cases per 100,000 persons. This lymphoid malignancy
involves peripheral lymph nodes and can also affect organs such as liver, lung, and bone
marrow. About 40% of patients suffer from constitutional symptoms (“B-symptoms”). Based
on differences in the histological picture and the phenotype of the tumor cells, HL is
subclassified into nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte-depleted,
and nodular lymphocyte-predominant HL (NLPHL). The first four subtypes are collectively
called classical HL. The tumor cells of HL are very rare and usually account for only about
0.1%–2% of cells in the tissue. In classical HL, the malignant cells are referred to as Hodgkin
and Reed-Sternberg (HRS) cells, and in NLPHL they are lymphocyte-predominant (LP) cells.
These malignant cells are large, and in classical HL one may distinguish mononucleated
Hodgkin cells and bi- or multinucleated Reed-Sternberg cells. In classical HL, the tumor cells
are infected by EBV in about 40% of cases, which is of pathogenetic relevance. (Küppers, et
al., 2012)
Hodgkin lymphoma (HL), a B cell–derived cancer, is one of the most common
lymphomas. In HL, the tumor cells — Hodgkin and Reed-Sternberg (HRS) cells — are usually
very rare in the tissue. Although HRS cells are derived from mature B cells, they have largely
lost their B cell phenotype and show a very unusual co-expression of markers of various
hematopoietic cell types. HRS cells show deregulated activation of multiple signaling
pathways and transcription factors. The activation of these pathways and factors is partly
mediated through interactions of HRS cells with various other types of cells in the
microenvironment, but also through genetic lesions. The transforming events involved in the
pathogenesis of HL are only partly understood, but mutations affecting the NF-κB and
JAK/STAT pathways are frequent. The dependency of HRS cells on microenvironmental
interactions and deregulated signaling pathways may offer novel strategies for targeted
therapies. (Küppers, et al., 2012)

Non-Hodgkin Lymphoma

Non-Hodgkin's lymphomas (NHLs) represent a heterogeneous group of malignancies that arise

from the lymphoid system. Recent advances in molecular genetics have significantly deepened
our understanding of the biology of these diseases. The introduction of gene expression
profiling especially has led to the discovery of novel oncogenic pathways involved in the
process of malignant transformation. Equally important, these analyses have identified novel
molecular lymphoma subtypes that are histologically indistinguishable. In diffuse large B-cell
lymphoma (DLBCL), the distinction of the germinal center B-cell–like (GCB) DLBCL and
activated B-cell–like (ABC) DLBCL subtypes is beginning to translate into the clinic, as these
diagnostic categories have significantly different survival rates after standard treatment.
Similarly, the molecular distinction using gene expression profiling of DLBCL and Burkitt's
lymphoma (BL) is of major clinical importance, as BL requires more intensive treatment
strategies. These examples evidence that the routine application of gene expression profiling
will eventually lead to the establishment of a molecular classification of malignant lymphoma.
(Nogai,et al., 2011)

Signs and symptoms of lymphoma may include:

 Painless swelling of lymph nodes in your neck, armpits or groin

 Persistent fatigue

 Fever

 Night sweats
  Shortness of breath

 Unexplained weight loss

Treatment Options of Lymphoma

Many people treated for non-Hodgkin lymphoma will receive some form of chemotherapy,
radiation therapy, biologic therapy, immunotherapy, or a combination of these. Bone marrow,
stem cell transplantation, or CAR T-cell therapy may sometimes be used. Surgery may be used
under special circumstances, but primarily to obtain a biopsy for diagnostic purposes.(Nair,et
al.,2018)
Although “indolent” or slow growing forms of non-Hodgkin lymphoma are not
currently curable, the prognosis is still very good. Patients may live for 20 years or more
following an initial diagnosis. In certain patients with an indolent form of the disease, treatment
may not be necessary until there are signs of progression. Response to treatment can also
change over time. Treatment that worked initially may be ineffective the next time, making it
necessary to always keep abreast of the latest information on new or experimental treatment
options. (Nair,et al.,2018)
Types of treatment options for lymphoma include:

 CAR T-Cell Therapy

 Chemotherapy
 Clinical Trials
 Immunotherapy
 Oral Therapy
 Radiation
 Stem Cell Transplantation
Küppers, Ralf, and Martin-Leo Hansmann Andreas Engert. “Hodgkin Lymphoma.” The
Journal of Clinical Investigation, American Society for Clinical Investigation, 1 Oct. 2012,
www.jci.org/articles/view/61245.

MacGill, Markus, and Yamini Ramchod. “Lymphoma: Treatment, Symptoms, and

Causes.”Medical News Today, MediLexicon International, 24 Nov. 2017.

Nair, Reena, et al. “Management of Lymphomas: Consensus Document 2018 by an Indian

Expert Group.” Indian Journal of Hematology & Blood Transfusion : an Official Journal of
Indian Society of Hematology and Blood Transfusion, Springer India, July 2018,
www.ncbi.nlm.nih.gov/pmc/articles/PMC6081314/.

Nogai, Hendrik, et al. “Pathogenesis of Non-Hodgkin's Lymphoma.” Journal of Clinical

Oncology, American Society of Clinical Oncology, 2011,
ascopubs.org/doi/full/10.1200/JCO.2010.33.3252. Charité–Universitätsmedizin Berlin,
Berlin, Germany.