From discovery to differentiation: why subtypes matter in lymphoma
The history of lymphoma dates back to the 1600s
First described by Italian physician Marcello Malpighi as 'a disease of lymph nodes and spleen that was uniformly fatal',1 lymphoma was formally described by British physician Thomas Hodgkin in 1832.2 Beyond Hodgkin’s disease, other types of lymphoma, collectively known as non-Hodgkin lymphomas (NHL), have been identified.3
Over 500,000 new cases of NHL are diagnosed worldwide each year4
A group of different blood cancers that start in organs such as the lymph nodes, NHLs have key traits in common: they affect white blood cells known as lymphocytes and impair the body’s immune system over time.5
Understanding of lymphoma has dramatically advanced over the years
Development and use of classification systems has helped provide doctors and researchers with a framework to better understand NHL and has ultimately led to better outcomes for patients.
With more than 90 subtypes, NHL is a complex group of cancers
Classified into two distinct categories, depending on how fast or slowly the cancer grows, NHL can be either aggressive (fast-growing) or indolent (slow-growing).3
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma
Accounting for 30% of new NHL diagnoses,6 DLBCL occurs primarily in older people and requires prompt treatment due to its aggressive nature. The first sign is usually enlarged lymph nodes, but it can also affect organs outside of the lymphatic system and is characterised by symptoms including unexplained weight loss, fever and night sweats.
Follicular lymphoma is the most common indolent lymphoma
Follicular lymphoma accounts for approximately 20% of new diagnoses of NHL.7 Due to its slow-growing nature, many of the symptoms often only appear in later stages of the disease.8 As a result, it can spread unnoticed in the body, causing eight out of ten patients to have advanced stage disease at the time of diagnosis.9
Treatment goals differ by subtype
When treating patients with DLBCL, curing the disease is the ultimate goal.10 However, in as many as 40% of patients, DLBCL can return – at which point controlling the disease becomes the focus of treatment.11
For patients with follicular lymphoma, treatment goals include keeping the disease under control while maintaining a good quality of life. Although follicular lymphoma is generally considered incurable, treatment choices are improving and patients can remain in treatment-free remission for long periods of time.12
Continued understanding and innovation will help improve patients’ lives
Given the multitude of subtypes within lymphoma, continued research and understanding of this complex disease will ensure patients receive the best possible treatment.
- Cowan DH. Vera Peters and the curability of Hodgkin disease. Current Oncology. 2008; 15(5): 206-210.
- Hodgkin T. On Some Morbid Appearances of the absorbent glands and spleen. 1832.
- Lymphoma Research Foundation. About lymphoma. [Internet; cited November 2018]. Available at: http://www.lymphoma.org/site/pp.asp?c=bkLTKaOQLmK8E&b=6299689.
- Globocan 2018. World Fact Sheet. [Internet; cited November 2018]. Available at: http://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf.]
- American Society of Hematology. Lymphoma. [Internet; cited November 2018]. Available at: http://www.hematology.org/Patients/Cancers/Lymphoma.aspx.
- Lyon, France: IARC Press; 2008. World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissues.
- Shankland KR, Armitage JO, Hancock BW: Non-Hodgkin lymphoma. Lancet 380 (9844): 848-57, 2012
- MedicineNet, Inc. (2011) Non-Hodgkin's Lymphoma: What are symptoms and signs of non-Hodgkin's lymphoma? [Internet; cited November 2018]. Available at: www.medicinenet.com/non-hodgkins_lymphomas/page4.htm.
- National Institute for Health and Clinical Excellence Review of TA 110:rituximab for the first-line treatment of stage III-IV follicular lymphoma. [Internet; cited November 2018]. Available at: https://www.nice.org.uk/guidance/ta243/documents/follicular-lymphoma-rituximab-review-lymphoma-association2.
- Lymphoma action. Diffuse large B-cell lymphoma. [Internet; cited November 2018]. Available at: https://lymphoma-action.org.uk/types-lymphoma-non-hodgkin-lymphoma/diffuse-large-b-cell-lymphoma.
- Maurer, JM et al. (2014). Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. J Clin Oncol 32: 1066-73.
- Liu Q, et al. J Clin Oncol 24 (10): 1582-9, 2006