Non-Hodgkin’s Lymphoma (NHL)

Non-Hodgkin’s Lymphoma (NHL) is a classification of neoplastic diseases that include the fifth and sixth most common malignancies in men and women.  NHLs include multiple neoplastic disorders of the lymphoid system with overlapping features and are among the most rapidly increasing malignancies.  Clinically, immune suppression and stimulation are important cofactors for the development of NHL as their origins are found in the roots of the immune system, the white blood cells. Their course of presentation varies from indolent to aggressive and from curable to incurable.

The most common forms of NHLs are B-cell lymphomas which begin in the antibody-producing form of white blood cells, the B-lymphocytes. T-cell lymphomas begin in the T-lymphocytes which attack bacteria and viruses.  The natural killer or NK lymphocytes attack substances they consider foreign to the body and are the origin of NK-cell lymphomas, the least common forms of NHLs.

Classification of NHLs currently organizes them into groups with shared pathogenesis and clinical behavior to assist in guiding course of treatment.  This classification incorporates findings from the Revised European-American Classification of Lymphoid Neoplasms (REAL) and earlier World Health Organization (WHO) classifications and is published as the World Health Organization Classification of Neoplastic Diseases of Hematopoietic and Lymphoid Tissues.  The WHO classification is summarized in the following table.

World Health Organization Classification of Lymphomas

B-CELL NEOPLASMS

  Precursor B-cell

  Precursor B lymphoblastic leukemia/lymphoma

  Mature B-cell

  Chronic lymphocytic leukemia/small lymphocytic lymphoma

  Lymphoplasmacytic lymphoma

  Splenic marginal zone lymphoma

  Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)

  Nodal marginal zone B-cell lymphoma

  Follicular lymphoma

  Mantle cell lymphoma

  Diffuse large B-cell lymphoma

  Mediastinal (thymic) large B-cell lymphoma

  Intravascular large B-cell lymphoma

  Primary effusion lymphoma

  Burkitt's lymphoma/leukemia

  B-cell proliferations of uncertain malignant potential

  Lymphomatoid granulomatosis

  Post-transplant lymphoproliferative disorder, polymorphic

T-CELL AND NK-CELL NEOPLASMS

  Precursor T-cell

  Precursor T lymphoblastic leukemia/lymphoma

  Blastic NK cell lymphoma

  Mature T-cell and NK-cell

  Adult T-cell leukemia/lymphoma

  Extranodal NK/T cell lymphoma, nasal type

  Enteropathy-type T-cell lymphoma

  Hepatosplenic T-cell lymphoma

  Subcutaneous panniculitis-like T-cell lymphoma

  Mycosis fungoides

  Sézary syndrome

  Primary cutaneous anaplastic large cell lymphoma

  Peripheral T-cell lymphoma, unspecified

  Angioimmunoblastic T-cell lymphoma

  Anaplastic large cell lymphoma

Source

Wilson, W. H., & Armitage, J. O. (2008). Non-Hodgkin’s lymphoma. In M. D. Abeloff, J. O. Armitage, J. E. Niederhuber. M. B. Kastan & W. G. McKenna (Eds.), Abeloff’s clinical oncology (ch.112). Philadelphia: Churchill Livingstone Elsevier.

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