Note: Separate summaries on AIDS-Related Lymphoma Treatment; Primary Central
Nervous System Lymphoma Treatment; and Non-Hodgkin’s Lymphoma During
Pregnancy Treatment are available.
Note: Estimated new cases and deaths from non-Hodgkin's lymphoma (NHL) in the United States in 2007:
- New cases: 63,190.
- Deaths: 18,660.
The NHLs are a heterogeneous group of lymphoproliferative
malignancies with differing patterns of behavior and responses to treatment.
Like Hodgkin’s lymphoma, NHL usually originates in lymphoid tissues and can
spread to other organs. NHL, however, is much less predictable than Hodgkin’s
lymphoma and has a far greater predilection to disseminate to extranodal sites.
The prognosis depends on the histologic type, stage, and treatment.
The NHLs can be divided into two prognostic groups: the indolent lymphomas and
the aggressive lymphomas. Indolent NHL types have a relatively good prognosis
with a median survival as long as 10 years, but they usually are not curable in
advanced clinical stages. Early stage (stage I and stage II) indolent NHL can be
effectively treated with radiation therapy alone. Most of the indolent types
are nodular (or follicular) in morphology. The aggressive type of NHL has a
shorter natural history, but a significant number of these patients can be
cured with intensive combination chemotherapy regimens. In general, with
modern treatment of patients with NHL, overall survival at 5 years is
approximately 50% to 60%. Of patients with aggressive
NHL, 30% to 60% can be cured. The vast majority of relapses occur in the first 2 years
after therapy. The risk of late relapse is higher in patients with a divergent
histology of both indolent and aggressive disease.
While indolent NHL is responsive to radiation therapy and chemotherapy, a
continuous rate of relapse is usually seen in advanced stages. Patients, however, can often be re-treated with considerable success as long as the
disease histology remains low grade. Patients who present with or convert to
aggressive forms of NHL may have sustained complete remissions with combination
chemotherapy regimens or aggressive consolidation with marrow or stem cell
Radiation techniques differ somewhat from those used in the treatment of
Hodgkin’s lymphoma. The dose of radiation therapy usually varies from 2,500 Gy to
5,000 Gy and is dependent on factors that include the histologic type of
lymphoma, the patient’s stage and overall condition, the goal of treatment
(curative or palliative), the proximity of sensitive surrounding organs, and
whether the patient is being treated with radiation therapy alone or in
combination with chemotherapy. Given the patterns of
disease presentations and relapse, treatment may need to include unusual sites
such as Waldeyer’s ring, epitrochlear, or mesenteric nodes. The
associated morbidity of the treatment must be considered carefully. The
majority of patients who receive radiation are usually treated on only one side
of the diaphragm. Localized presentations of extranodal NHL may be treated
with involved-field techniques with significant (>50%) success.