Lymphomas are cancers of the immune system. They are among the most diverse and most curable of all cancers. There are two major groups of lymphomas: Hodgkin lymphomas and non-Hodgkin lymphomas.
Hodgkin lymphoma is diagnosed in approximately 9,000 Americans annually. Hodgkin lymphoma of any stage is curable in the majority of affected patients. Non-Hodgkin lymphoma (NHL) is diagnosed in approximately 72,000 Americans annually and comprises a group of diseases that vary widely with respect to clinical presentation, therapy, and prognosis. Diagnosis and classification of these lymphomas are facilitated by specialized testing called immunophenotyping, flow cytometry, and molecular genetic studies. Slow growing NHLs, called indolent, include follicular lymphomas, marginal zone lymphomas, lymphoplasmacytic lymphomas, and small lymphocytic lymphomas.
Combination chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine is the most commonly used chemotherapy regimen for Hodgkin lymphoma. The number of courses varies with the stage of disease. Low-dose radiation therapy is commonly administered following a short course of chemotherapy for the management of early-stage classical Hodgkin lymphoma.
For non-Hodgkin lymphoma treatment varies, thus establishment of a correct diagnosis at the time of initial presentation is critical to optimize management decisions, and almost always requires an adequately sized biopsy. Asymptomatic patients with indolent NHLs do not need to be treated at the time of diagnosis if they have small tumor burdens. Aggressive NHLs grow rapidly and typically require initiation of therapy soon after diagnosis. Combination chemotherapy is nearly always used in the management of aggressive NHLs. The addition of the anti-CD20 monoclonal antibody rituximab has been an essential component to the management of B-cell NHLs.