What are the causes and treatment options for Lymphoma

Lymphoma can be divided into Hodgkin and non-Hodgkin lymphoma. The categorization is based on the histological presentation of the cells after a biopsy from the tumour. The hallmark of Hodgkin lymphoma is the Reed-Stenberg cells found in the tumour which are not seen in non-Hodgkin lymphoma, they are also differed by the common body sites of involvement. For Hodgkin lymphoma, the origin of the tumour cells is usually from B-cell whereas B-cell (70%) and T-cell (30%) brings about the occurrence of non-Hodgkin lymphoma.

Non-Hodgkin lymphoma is more prevalent that Hodgkin lymphoma globally and the causes are still unknown. There are several hypotheses suggesting the causes of lymphoma but none of it has proven to be directly linked to this disease. First of all, multiple genetic expressions are found to be associated with lymphoma such as the change in Bcl-2 gene, but there are no direct causes found to generate the changes in the genes. It is also found to be familial in nature where risks are higher if immediate family members are diagnosed with any sort of lymphoid cancer.

Likewise, the immune system of an individual is also responsible for the occurrence of lymphoma. It is said that lymphoma tends to develop when one’s immune system is compromised, evidently shown in AIDS patient where the lymphoma is frequently a late manifestation of advanced HIV infection. Besides that, Epstein-Barr virus, Human Herpesvirus 8, Human T-cell lymphotropic virus and Helicobacter pylori bacteria also found to be associated with specific non-Hodgkin lymphomas such as post-transplant lymphoma, primary effusion lymphoma, adult T-cell leukaemia lymphoma and gastric lymphoma respectively. In the case of Hodgkin lymphoma, it usually happens in individuals with the age group of 20 to 35 years old or 50-70 years old while non-Hodgkin lymphoma only happens in an older age group of 65 to 70 years old.

Treatment modality for both types of lymphoma is determined by the staging of the disease. Ann-Arbour classification is used clinically to stage a Hodgkin lymphoma depending on the parameters of number and sites of involvement together with the presence of systemic symptoms. For early-stage disease, ABVD regimen (doxorubicin, vinblastine, bleomycin and dacarbazine) of chemotherapy and adjunctive radiotherapy is used on the lymph nodes involved which will yield approximately 90% of remission. Patients with the advanced-stage disease are commonly managed by longer duration of ABVD chemotherapy regimen without adjunctive radiotherapy. It is found that 50 to 70% of advanced-stage Hodgkin lymphoma can be cured. Lastly, there is also autologous haematopoietic stem cell transplant as the last resort because this modality is not always readily available.

As for non-Hodgkin lymphoma, it is classified into low-grade and high-grade depending on the production rate of the affected cells. Oral chemotherapy with chlorambucil is used in most of the low-grade non-Hodgkin lymphoma patient but this option is not curative. Hence, a more intensive R-CVP regimen is used by incorporating biological agent which is Rituximab with cyclophosphamide, vincristine and prednisolone as the first-line therapy shown to improve quality of life for affected individuals. In the case of high-grade non-Hodgkin lymphoma, R-CHOP chemotherapy regimen (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) with adjunctive radiotherapy is recommended to improve the chance of survival for the patients. Autologous haematopoietic stem cell transplant can also be the last modality for suitable patients as a cure.

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