Non-Hodgkin’s Lymphoma

  • Hans T. Chung
  • Stephen L. Shiao
  • Naomi R. Schechter


Rising in incidence (2008 US incidence 66,120 and mortality 19,160); median age 60–65 years. Causative conditions: Immunodeficiency – congenital (SCID, ataxia telangiectasia), acquired (HIV, organ transplant), autoimmune (Sjogren’s, Hashimoto’s disease, rheumatoid arthritis, systemic lupus erythematosus). Environmental – chemicals (pesticides and solvents). Viral – EBV (Burkitt’s lymphoma and NK/T cell), HTLV-1 (human lymphotrophic virus, type I; adult T-cell leukemia in southern Japan and Caribbean, spread by breastfeeding, sex and blood products), HHV-8 (Kaposi’s sarcoma), HCV (extranodal B-cell NHL). Bacterial – Helicobacter pylori (MALT). Radiation – weak association. Chemo – alkylating agents.


Follicular Lymphoma Mantle Cell Lymphoma Mycosis Fungoides Follicular Lymphoma International Prognostic Index Testicular Lymphoma 


  1. Ardeshna KM, Smith P, Norton A, et al. Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: a randomised controlled trial. Lancet 2003;362:516-522.PubMedCrossRefGoogle Scholar
  2. Armitage JO. Defining the stages of aggressive non-Hodgkin’s lymphoma – a work in progress. N Engl J Med 2005;352:1250-1252.PubMedCrossRefGoogle Scholar
  3. Ballonoff A, McCammon R, Schwer A, et al. Increased overall survival in patients with stages i and ii diffuse large b-cell lymphoma treated with radiation therapy: a surveillance, epidemiology, and end results (SEER) analysis. Int J Radiat Oncol Biol Phys 2007;69S:S15-S16.CrossRefGoogle Scholar
  4. Bonnet C, Fillet G, Mounier N, et al. CHOP alone compared with CHOP plus radiotherapy for localized aggressive lymphoma in elderly patients: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 2007;25(7):787-792.PubMedCrossRefGoogle Scholar
  5. Brice P, Bastion Y, Lepage E, et al. Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: a randomized study from the Groupe d’Etude des Lymphomes Folliculaires. Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 1997;15:1110–1117.Google Scholar
  6. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579-586.PubMedCrossRefGoogle Scholar
  7. Coiffier B, Feugier P, Mounier N, et al. Long-term results of the GELA study comparing R-CHOP and CHOP chemotherapy in older patients with diffuse large B-cell lymphoma show good survival in poor-risk patients. J Clin Oncol 2007;25(suppl 18S):443s. Abstract 8009.Google Scholar
  8. Coiffier B, Lepage E, Briere J, et al. CHOP Chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-b-cell lymphoma. N Engl J Med 2002;346:235-242.PubMedCrossRefGoogle Scholar
  9. Feugier P et al. Long-term results of the r-chop study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 2005;23:4117-4126.PubMedCrossRefGoogle Scholar
  10. Fisher RI, Gaynor ER, Dahlberg S, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. N Engl J Med 1993;328:1002-1006.PubMedCrossRefGoogle Scholar
  11. Guglielmi C, Gomez F, Philip T, Hagenbeek A, Martelli M, Sebban C, et al. Time to relapse has prognostic value in patients with aggressive lymphoma enrolled onto the Parma trial. J Clin Oncol 1998;16:3264-3269.PubMedGoogle Scholar
  12. Haas R, Poortmans P, de Jong D, et al. High response rates and lasting remissions after low-dose involved field radiotherapy in indolent lymphomas. J Clin Oncol 2003;21(13):2474-2480.PubMedCrossRefGoogle Scholar
  13. Habermann T, Weller E, Morrison V, et al. Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol 2006;24:3121-3127.PubMedCrossRefGoogle Scholar
  14. Hagenbeek A, Eghbali H, Monfardini S, et al. Phase III intergroup study of fludarabine phosphate compared with cyclophosphamide, vincristine, and prednisone chemotherapy in newly diagnosed patients with stage iii and IV low-grade malignant non-Hodgkin’s lymphoma. J Clin Oncol 2006;24:1590-1596.PubMedCrossRefGoogle Scholar
  15. Hancock BW, Qian W, Linch D et al. Chlorambucil versus observation after anti-Helicobacter therapy in gastric MALT lymphomas: results of the international randomised LY03 trial. Br J Hematol 2009;144(3):367-375.CrossRefGoogle Scholar
  16. Hiddemann W, Kneba M, Dreyling M, et al. Frontline therapy with rituximab assed to the combination of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) significantly improves the outcome for patient with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German low-grade lymphoma study group. Blood 2005;106:3725-3732.PubMedCrossRefGoogle Scholar
  17. Horning SJ, Weller E, Kim K, et al. Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkin’s lymphoma: Eastern Cooperative Oncology Group Study 1484. J Clin Oncol 2004;22:3032-3038.PubMedCrossRefGoogle Scholar
  18. Hoster E, Dreyling M, Klapper W et al. A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma. Blood 2008;111:558-565.PubMedCrossRefGoogle Scholar
  19. Koch P, Probst A, Berdel WE et al. Treatment results in localized primary gastric lymphoma: data of patients registered within the German Multicenter Study (GIT NHL 02/96). J Clin Oncol 2005;23(28):7050-7059.PubMedCrossRefGoogle Scholar
  20. Mac Manus MP, Hoppe RT. Is radiotherapy curative for stage I and II low-grade follicular lymphoma? Results of a long-term follow-up study of patients treated at Stanford University. J Clin Oncol 1996;14:1282-1290.PubMedGoogle Scholar
  21. Marcus R, Imrie K, Solal-Celigny P, et al. Phase III study of R-CVP compared cyclophosphamide, vincristine and prednisone alone in patients with previously untreated advanced follicular lymphoma. J Clin Oncol 2008;26(28):4579-4586.PubMedCrossRefGoogle Scholar
  22. Miller TP, Dahlberg S, Cassady JR, et al. chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin’s lymphoma. N Engl J Med 1998;339:21-26.PubMedCrossRefGoogle Scholar
  23. Milpied N, Deconinck E, Gaillard F, et al. Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 2004;350:1287-1295.PubMedCrossRefGoogle Scholar
  24. Pfreundschuh M, Trümper L, Österborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 2006;7:379-391.PubMedCrossRefGoogle Scholar
  25. Morschhauser F, Radford J, Van Hoof A, et al. Phase II trial of consolidation therapy with yttrium-90-ibritumomab tiuxetan compared with no additional therapy after first remission in advanced follicular lymphoma. J Clin Oncol 2008;26(32):5156-5164.PubMedCrossRefGoogle Scholar
  26. Park SI, Press OW. Radioimmunotherapy for treatment of B-cell lymphomas and other hematologic malignancies. Curr Opin Hematol 2007;14(6):632-638.PubMedCrossRefGoogle Scholar
  27. Petersen PM, Gospodarowicz MK, Tsang RW, et al. Long-term outcome in stage I and II follicular lymphoma following treatment with involved field radiation therapy alone. J Clin Oncol 2004;22:6521.Google Scholar
  28. Pfreundschuh M, Schubert J, Ziepert M, et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 2008;9(2):105-116.PubMedCrossRefGoogle Scholar
  29. Pfreundschuh M, Trümper L, Ma D, et al. Randomized intergroup trial of first line treatment for patients <=60 years with diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL) with a CHOP-like regimen with or without the anti-CD20 antibody rituximab – early stopping after the first interim analysis. J Clin Oncol 2004;22:6500.Google Scholar
  30. Philip T, Guglielmi C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. N Engl J Med 1995;333:1540-1545.PubMedCrossRefGoogle Scholar
  31. Press OW, Unger JM, Braziel RM, et al. Phase II trail of CHOP chemotherapy followed by tositumomab/iodine I-131 tositumomab for previously untreated follicular non-Hodgkin’s lymphoma: fiver-year follow-up of Southwest Oncology Group Protocol S9911. J Clin Oncol 2006;24(25):4143-4149.PubMedCrossRefGoogle Scholar
  32. Reyes F, Lepage E, Ganem G, et al. ACVBP versus CHOP plus radiotherapy for localized aggressive lymphoma. N Engl J Med 2005;352:1197-1205.PubMedCrossRefGoogle Scholar
  33. Solal-Céligny P, Roy P, Colombat P, et al. Follicular lymphoma international prognostic index. Blood 2004;104(5):1258-1265.PubMedCrossRefGoogle Scholar
  34. Spier CM, LeBlanc M, Chase E, et al. Histologic subtypes do not confer unique outcomes in early-stage lymphoma: long-term follow-up of SWOG 8736. Blood 2004;104:abst 3263.Google Scholar
  35. Tsukamoto N, Kojima M, Hasegawa M et al. The usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and a comparison of (18)F-FDG-pet with (67)gallium scintigraphy in the evaluation of lymphoma: relation to histologic subtypes based on the World Health Organization classification. Cancer 2007;110(3):652-659.PubMedCrossRefGoogle Scholar
  36. Vaughan Hudson B, Vaughan Hudson G, MacLennan KA, et al. Clinical stage 1 non-Hodgkin’s lymphoma: long-term follow-up of patients treated by the British National Lymphoma Investigation with radiotherapy alone as initial therapy. Br J Cancer 1994;69:1088-1093.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York 2010

Authors and Affiliations

  • Hans T. Chung
    • 1
  • Stephen L. Shiao
    • 2
  • Naomi R. Schechter
    • 2
  1. 1.Radiation Oncology, Sunnybrook Odette Cancer CentreUniversity of TorontoTorontoCanada
  2. 2.Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA

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