Non-Hodgkin's lymphoma is the most common type of lymphoma, and it appears in many types, most of which are outside the lymphatic system, and its diagnosis and treatment requires the best and most skilled hands of Turkish doctors.
What is lymphoma?
Cancerous lymphocytes can travel through the blood and lymph system and spread and grow in many parts of the body, including the lymph nodes, spleen, bone marrow and many other organs.
Non-Hodgkin lymphoma: It is the most common, and includes all tumors that do not fall under the classification of Hodgkin lymphoma.
Overview of the lymphatic system and lymphocytes
The lymphatic system is an important part of the immune system in the human body and it rids the body of many toxins and eliminates many pathogens that attack the body.
The lymphatic system consists of the lymph, lymph vessels, lymph nodes, bone marrow, spleen, thymus gland, and tonsils.
Mature cells express either CD4, in this case, helper T cells, or CD8, called killer or suppressor T cells.
How do doctors distinguish Hodgkin's lymphoma from non-Hodgkin's lymphoma?
Types of Non-Hodgkin's Lymphoma
Diffuse Large B Cell Lymphoma
Chronic lymphocytic leukemia/Small lymphocytic lymphoma (CLL/SLL)
- Endemic Burkitt: As we mentioned, it is spread in children and adolescents in Africa and is often associated with infection with the Epstein-Barr virus, and it often affects their jaw and facial bones, and it can also arise in the intestines, kidneys and other organs.
It needs immediate and intensive treatment due to its rapid spread and growth, although half of the patients recover after intensive chemotherapy.
Mantle Cell Lymphoma
Marginal Zone Lymphoma MZL
- Extra-Nodal MZL: the most common, It arises in areas outside the lymph nodes, often in MALT, where this type can be called MALT lymphoma, and it is either gastric or Intestinal, this type appears with a medical history of chronic infection (mostly with H.Pylori).
- Nodal MZL: it arises in the lymph nodes or bone marrow.
- Splenic MZL: it arises in the spleen, blood, or bone marrow.
Lymphoplasmacytic Non-Hodgkin's Lymphoma
T cell non-Hodgkin's lymphoma
Peripheral T-cell lymphoma
- Anaplastic Large Cell Lymphoma: ALCL can be systemic (occurring all over the body) or cutaneous (limited to the skin). Systemic ALCL is usually at an advanced stage when diagnosed and is fast-growing.
The systemic type is further categorized into two types based on ALK (Anaplastic Lymphoma Kinase) positivity or negativity. Systemic ALCL responds well to treatment, especially ALK-positive disease, but ALK-negative patients may require more aggressive treatments, and relapse occurs more frequently than ALK-positive disease. .
- Angioimmunoblastic T-cell lymphoma: It is a rare, severe type that accounts for about seven percent of all patients with T-cell lymphoma in the United States.
Most patients are middle-aged to elderly and are diagnosed at an advanced stage, and there is some evidence that AITL develops from a persistent immune response possibly due to an underlying viral infection (eg Epstein-Barr virus).
Initial symptoms often include fever, night sweats, rash, itching, some autoimmune disorders such as autoimmune hemolytic anemia and immune thrombocytopenia and with elevated levels of gamma globulin in the blood.
- Cutaneous T-cell Lymphoma: It is a general term that includes several under slow-growing types, most of which are specific to the skin, and one of these types is Mycosis Fungoides, which is the most common type and is characterized by the presence of papules, plaques, and itchy skin lesions on the course of the body. Another type is Sézary syndrome, a syndrome that affects the blood and skin and appears with red skin. Severely itchy in most parts of the body and tumor T cells called Sézary cells can be seen.
- Lymphoblastic lymphoma: It is rare and arises from lymphoblasts and is more common on the expense of T-cell lymphoblasts.
Causes and risk factors for non-Hodgkin lymphoma
- Age: The older the patient, the higher the incidence of Non-Hodgkin's lymphoma, as more than a third of cases were diagnosed in the elderly over 75 years.
- Gender: Where there is a slight tendency for lymphoma to occur in males more than in females.
- Race: It is believed that white people have a tendency to develop non-Hodgkin lymphoma more than people with black skin, but this belief needs more detailed studies.
- Family History: The incidence of Non-Hodgkin's lymphoma increases when there is a case among first-degree relatives (brother, father, son...).
- Obesity Recent studies have shown that obese people have an increased risk of some types of Hodgkin lymphoma.
- Hereditary Immune diseases: Such as hypogammaglobulinemia or Wiscott-Aldrich syndrome.
- History of previous exposure to radiation: Such as those who underwent previous radiotherapy or, rarely, survivors of nuclear and chemical disasters.
- Autoimmune diseases: Such as rheumatic fever, Sjögren's disease, systemic lupus erythematosus (SLE) or celiac disease have all been linked to non-Hodgkin's lymphoma, and AIDS, caused by HIV, may also have a role in this cancer.
- EBV and Human T-lymphotrophic Virus type I: It has been proven that they have a significant role in the occurrence of genetic mutations in patients with non-Hodgkin lymphoma.
- Chronic infections: Such as infection caused by H. pylori, hepatitis virus and Chlamydia psittaci.
Symptoms and Signs
Lymphoma may not have any symptoms until the tumor has grown to a certain size.
- Profuse night sweats
- Unexplained weight loss
- Rashes or lumps with itchy skin all over the body
- Unexplained fever
- Constant feeling of tiredness and fatigue
- Increased possibility of bleeding, such as nosebleeds and heavy menstruation
- Feeling full after eating a small amount of food
- Frequent infections
Diagnosis of Non-Hodgkin's Lymphoma in Turkey
- Medical-Based Imaging: Such as ultrasound, CT, positron emission tomography (PET-Scan), simple chest radiograph, and magnetic resonance imaging (MRI).
- Blood tests: Such as a complete blood count (CBC), and blood chemical tests, as well as titration of certain enzymes in case of suspicion of a particular type of non-Hodgkin's lymphoma.
- Bone Scan.
- biopsy: It is the most important and most accurate diagnostic method, but it is not requested until after other causes and their types are denied, and it includes bone marrow biopsy.
Classification of non-Hodgkin's lymphoma
The same classification in Hodgkin's Lymphoma is used here, and it's called Lugano classification.
Non-Hodgkin's Lymphoma Treatment in Turkey
It is not always necessary to resort to treatment if non-Hodgkin's lymphoma is diagnosed, as it can be monitored if there are no symptoms or the patient's life is not affected.
Among the most common treatments in Turkey:
Chemotherapy for non-Hodgkin's lymphoma
Chemo drugs target any cell that is constantly dividing in the body, including cancer cells, and as a result, they have many side effects. Cancer cells are not the only cells that renew quickly and constantly in the body (hair cells, skin, blood cells… are also constantly renewed).
Treatment is usually given in the form of drug combinations between several drugs to get a better result and includes many combinations of drugs used in Chemotherapy for non-Hodgkin's lymphoma include the monoclonal antibody rituximab (Rituxan), which is usually abbreviated with the letter R and placed at the beginning or end of the abbreviation for a co-administration, such as R-CHOP or CHOP-R consisting of cyclophosphamide, doxorubicin, vincristine, prednisone.
Intrathecal (into the spinal canal or subarachnoid space) chemotherapy may also be used to treat primary lymphomas that originate in the testicles or sinuses, diffuse large B-cell lymphoma, Burkitt's lymphoma, lymphoblastic lymphoma or some Aggressive (rapidly growing) T-cell lymphomas, given to reduce the spread of lymphoma cells to the brain and spinal cord.
Immune lymphoma treatment protocol
The field of Immunotherapy in Turkey has expanded significantly in recent times and new generations of drugs and synthetic molecules have appeared to reduce collateral damage, and studies on Immunotherapy methods are still being developed and conducted.
Immunotherapy is based mainly on strengthening the human body's natural immunity or using synthetic antibodies to eliminate deformed cancerous cells. The most common of these methods are:
They are synthetic proteins that attack cells with certain markers, which greatly reduces side effects, including:
- Antibodies that target the CD20 antigen: CD20 is a protein found on the surface of B cells. These drugs include rituximab (Rituxan), obinutuzumab (Gaziva), ofatumab (Azera) and ibritumumab tuxitan (Zevalin).
- Antibodies targeting the CD30 antigen: It is a protein found on the surface of T cells. An example of this drug is brentuximab vedotin (Adcetris).
- Antibodies targeting CD52 antigen: It is a protein found on the surface of T cells, and a drug that targets this antigen is alemtuzumab.
There are many other drugs, but they are not mentioned here for lack of usage.
Chimeric Antigen Receptor (CAR) T cells
This method is considered a quantum leap in the treatment of Non-Hodgkin's lymphoma and studies is still ongoing about this method.
In this method, T cells are taken from a person's blood and modified in the laboratory to have specific receptors on their surface. These chimeric receptors can attach to proteins on the surface of cancerous lymphoma cells, and this binding enables the T cells to destroy tumor cells.
ADC Antibody-Drug Conjugate
It is a monoclonal antibody loaded with a chemical drug, and after the monoclonal antibody binds with the cancer cell, it releases the chemical drug that works to kill and disrupt the tumor cell by a certain mechanism.
Approved antibody conjugates and drugs include:
- Brentuximab Vedotin (Adcetris)
- Loncastuximab Tesirine-lpyl (ZYNLONTA)
Targeted non-Hodgkin's lymphoma treatment
Targeted therapy is a type of specialized treatment that targets the proteins that control how cancer cells grow, divide, and spread, somewhat similar to immunotherapy. New studies emphasize the importance of this treatment in the treatment of non-Hodgkin's lymphoma, and some of the types of this treatment are:
- Biosimilars: They are similar to biological medicines.
- Bruton Tyrosine Kinase Inhibitors: Bruton Tyrosine Kinase is an enzyme necessary for the growth of neoplastic cells.
- PI3K Inhibitors: PI3K is a signaling molecule that helps B cells grow, move, divide, and survive, so PI3K inhibitors help stop or slow the growth of cancerous lymphoma cells.
- DNA Methyltransferase Inhibitors: Methylation enzymes have a significant impact on gene regulation and are a potential prognostic biomarker for genetic disorders and diseases. Inhibition of these enzymes helps stop cellular growth and activate programmed cell death.
Radiotherapy for non-Hodgkin lymphoma
Radiation therapy is a treatment that uses high-energy x-rays to destroy tumor cells and reduce the size of the local tumor, as it can be used in the treatment of some types of localized lymphoma or in the irradiation of some large tumors that have affected nearby organs.
The field of radiotherapy andInterventional radiotherapy has witnessed a quantum leap in Turkey, due to its importance in the treatment protocol for many common cancers around the world.
Treatment of non-Hodgkin's lymphoma with stem cell and bone marrow transplantation
Stem cell transplantation (injection) is a treatment used to replace the lack of cellular hematopoietic precursor cells after undergoing other therapies, especially high-dose intensive chemotherapy, as these treatments deplete hematopoietic cells and can enter the patient's body into catastrophic disorders.
This process takes place in two ways:
- Implantation of stem cells from the same person: In this method, we take healthy stem cells before undergoing other treatments (because they are depleted after treatment), and this type has two methods that can be followed depending on the place from which these cells were taken. In the first type, stem cells are taken from the blood, which is the most common and widely used method due to the ease of obtaining these cells and their abundance. In the other method, cells are taken from bone marrowthen the treatment is called bone marrow transplant.
- Transplanting stem cells from another person: It is often a relative of the patient as a brother or sister, and it can also be a stranger after the necessary cell-matching tests.
And because of the many treatments and their combinations, you can consult contact us Bimaristan Medical Center will help you choose the best treatment with the best experienced hands in Turkey.
Non-Hodgkin's Lymphoma Cancer Awareness Month
Hodgkin's and non-Hodgkin's lymphomas can occur in children, adults, and at any age.