What is non-Hodgkin lymphoma?

Within lymphomas there is a special type due to the cell that causes it and with clinical and prognosis differences. It is called Hodgkin's lymphoma or disease, all other lymphomas that are not of this special type receive the generic name of non-Hodgkin lymphomas.

Within the leukocytes We find different types, such as lymphocytes or monocytes, each of them with a specific function within the immune system. White blood cells originate in the bone marrow, from immature cells called blasts that are differentiated to create the various types of leukocytes. One of the types of leukocytes that are created are lymphocytes, which are the white blood cells responsible for the immune response through antibodies to an infection.

Lymphocytes

Lymphocytes, in order to recognize a harmful agent (bacteria, virus, ...), must come into contact with an antigen of said agent and create antibodies specific to be able to recognize it and activate the immune system in its presence. Lymphocytes come out of the bone marrow and they go through the lymph to the immune system structures distributed throughout the body that is where they come into contact with antigens, create antibodies and, from there, go into the blood to fight infection.

When there is an infection in our body there is a proliferation of lymphocytes, that is why our lymph nodes increase in size.

When lymph nodes become malignant

When for whatever reason the lymphocytes found in the lymph nodes become malignant, that is, they begin to proliferate uncontrollably, its structure is altered and are not sensitive to signals of programmed cell deathi.e. the natural death of cells that are defective or old, create a tumor in these lymph nodes, which is what is known as lymphoma.

How does non-Hodgkin lymphoma occur?

Non-Hodgkin's lymphomas are tumors mainly of type B lymphocytes, although there is a form of T-lymphocyte lymphoma, typical of Japan and the Caribbean, very aggressive and related to a type of retrovirus. Are more frequent non-Hodgkin's lymphomas than Hodgkin's disease, the former representing 2-3% of all cancers.

Unlike Hodgkin lymphomas, they have been determined risk factor's that may be involved in the appearance of these lymphatic tumors, such as:

• Already existing immunological disorders
• Previous radiation therapy or chemotherapy
• Certain viruses, such as Epstein-Barr virus or HTLV-I retrovirus

Genetic mutation

In several of the non-Hodgkin lymphomas there are mutations in certain genes, especially in those that control cell proliferation, (cell reproduction) as the programmed cell death, to make way for new cells. When one of these mutations occurs, the lymphocytes grow uncontrollably and, at the same time, stop carrying out programmed cell death, triggering lymphomas.

Lymphoma Classification Based on Cell Type

There are several classifications that allow, depending on the type of cells that make up lymphomas, catalog them in different typologies. The classification is important because it will determine the tumor aggressiveness, treatment and prognosis.

• The most aggressive non-Hodgkin lymphoma that exists is Burkitt lymphoma which is made up of type B lymphoblasts. The doubling time of the cells is approximately 3 days. Within Burkitt's lymphoma, the most aggressive one is related to Epstein-Barr virus infection, which is characterized by extralymphatic tumors in the jaw, abdominal organs, and meninges. On the other hand, it has also been seen that there is another form of Burkitt's lymphoma that is related to HIV.
• There is also a type of gastric mucosa-associated lymphoma and directly related to H.Pylori infection (causes chronic gastritis). This lymphoma may initially respond to antibiotic treatment, but must then be treated with chemotherapy.
• Similar lymphomas They can be seen in other mucous membranes, such as the, thymus, salivary glands, breast or thyroid.

Symptoms of non-Hodgkin lymphomas

One of the main symptoms is the presence of adenopathies, that is, enlarged lymph nodes without an apparent infectious cause that justifies them. The nodes that are usually most affected are:

• Supraclavicular and cervical nodes in 60%
• Axillary nodes in 54%
• Inguinal nodes in 40%
• Mediastinal nodes in 20%
• The retroperitoneal and mesenteric nodes can also be affected unlike Hodgkin lymphomas. .

There are other differences in the clinic of non-Hodgkin lymphomas with respect to Hodgkin lymphomas, such as:

• Increased frequency of bone marrow involvement
• Extralymphatic metastases
• Hepatic involvement without the need for splenic involvement
• Existence of associated leukemia
• Abnormal immunoglobulins (antibodies) in the blood
• Lower frequency of B symptoms

Both high and low aggressive non-Hodgkin lymphomas can compress the lymphatic vessels and cause the lymph to be lost to the surrounding tissues by pressure, creating what is known as lymphedema in different locations.

Low aggressiveness

Tumors with low aggressiveness tend to behave as if they were benign non-cancerous cells, reason for which they circulate freely through the lymph and present a easier to spread.

They are tumors that grow very slowly, reproduce at a very low rate, which is why they do not respond excessively to the, which is more effective on cells that proliferate at a high rate.

High aggressiveness

Non-Hodgkin lymphoma cells considered highly aggressive multiply at a high rate and tend to spread through the blood, being able to give distant metastasis in other organs easily. If it is not to prevent its growth through chemotherapy quickly, the prognosis of these lymphomas may be poor. However, chemotherapy achieves up to 80% cures.

Diagnosis

Lymphoma of any type should be suspected in a patient with palpable lymphadenopathy without an infectious cause that justifies it and blood test altered for the following studies:

• Anemia secondary to chronic disease
• Decrease in the number of platelets
• Lactate dehydrogenase (LDH) enzyme increased
• Increase in the number of lymphocytes and lymphoblasts when there are leukemic manifestations.

The diagnostic imaging, Essentially by means of computerized axial tomography (CT), nuclear magnetic resonance (NMR) or scintigraphy, it will allow to assess the involvement of lymph node regions that are not accessible by palpation.

The lymph node and bone marrow biopsy It will make it possible to study the cells that make up lymphoma and determine their cell type, allowing the chemotherapy treatment to be adapted.

Non-Hodgkin Lymphoma Treatment

Treatment is based on chemotherapy, whose guidelines will be different depending on the level of aggressiveness of the non-Hodgkin lymphoma that you want to treat.

• In low aggressive tumors you can opt for the bone marrow autotransplantation as a first option
• In the most aggressive tumors, it is advisable to reserve the transplant for cases in which chemotherapy is not effective.
• In Burkitt-type lymphomas, surgery to reduce the tumor mass that exists, a fact that allows a better response to chemotherapy. When applying chemotherapy, a lot of uric acid is released into the blood, which is why it is advisable to administer allopurinol before chemotherapy and to ensure good hydration.

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