Non-Hodgkin lymphoma (NHL) is a cancer that starts in the lymphocytes and travels to the rest of the body by way of the lymphatic system.1 NHL is far less predictable than Hodgkin lymphoma, and is more likely to spread to parts of the body outside of the lymphatic system.2 NHL can be categorized into 2 prognostic groups: indolent lymphomas and aggressive lymphomas. Patients with indolent subtypes of NHL have a relatively good prognosis with a median survival as long as 20 years, although these subtypes of the disease are typically not curable in advanced stages.2 However, patients with early-stage indolent NHL can often be effectively treated with radiation therapy alone. Patients with aggressive subtypes of NHL have a shorter natural history of the disease, but a significant percentage of these patients can be cured with intense chemotherapy regimens.2
The American Cancer Society estimates that 74,680 cases of NHL will be diagnosed in the United States in 2018 and approximately 19,910 individuals will die from the disease in the same year.3 An estimated total of 385,700 individuals worldwide were diagnosed with some form of NHL in 2012, with the majority being diagnosed in developed countries such as the United States, Canada, and Australia, and in certain regions such as Western and Northern Europe. Survival rates, however, can vary depending on the region, with a 5-year relative survival rate among all ages at 69% in the United States versus 59% in Europe (range includes 44% in Poland to 74% in Iceland).4
NHL comprises 90% of all lymphomas. The most common subtypes of NHL include precursor B-cell, precursor T-cell, diffuse large B-cell lymphoma, follicular lymphoma, mantle-cell lymphoma, marginal-zone lymphoma, small lymphocytic lymphoma and chronic lymphocytic leukemia, Burkitt lymphoma, and peripheral T-cell lymphoma. Approximately 65% of all NHLs are either diffuse large B-cell lymphoma or follicular lymphoma.5
The treatment of diffuse large B-cell lymphoma, the most common NHL subtype, has been revolutionized by the introduction of rituximab, a monoclonal antibody that was approved by the FDA in February 2006 for the first-line treatment of patients with diffuse large B-cell, CD20-positive NHL in combination with a regimen of cyclophosphamide/doxorubicin/vincristine/prednisone.6 As researchers learn more about the biology and genetics of NHL, the treatment armamentarium continues to evolve, resulting in the development and approval of more effective, targeted therapies.
- American Cancer Society. What is non-Hodgkin lymphoma? www.cancer.org/cancer/non-hodgkin-lymphoma/about/what-is-non-hodgkin-lymphoma.html. Accessed June 24, 2018.
- National Cancer Institute. Adult non-Hodgkin lymphoma treatment (PDQ)-health professional version. Updated April 20, 2018. www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq. Accessed June 24, 2018.
- American Cancer Society. Key statistics for non-Hodgkin lymphoma. Updated May 31, 2016. www.cancer.org/content/dam/CRC/PDF/Public/8717.00.pdf. Accessed June 24, 2018.
- American Cancer Society. Global Cancer Facts & Figures. 3rd edition. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/global-cancer-facts-and-figures/global-cancer-facts-and-figures-3rd-edition.pdf. Accessed April 27, 2018.
- Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. Lancet. 2017;390:298-310. Epub ahead of print.
- 5National Cancer Institute. FDA approval for rituximab. Updated July 3, 2013. www.cancer.gov/about-cancer/treatment/drugs/fda-rituximab. Accessed April 27, 2018.