Lymphoma

Lymphomas represent a diverse group of haematological malignancies, primarily classified into classic Hodgkin lymphomas (cHL) and non-Hodgkin lymphomas (NHL).^1,2 cHL is characterised by the presence of Reed–Sternberg cells, and is a distinct entity with unique epidemiological, pathological and clinical features, compared with the heterogeneous group of NHL.¹

Epidemiologically, cHL typically manifests in two age peaks: young adulthood (20–40 years) and later in life (over 55 years), whereas NHL is more commonly diagnosed in adults over the age of 65–70 years, with a median age of 67 years.^1,2 Both lymphomas can present with similar symptoms, such as painless lymphadenopathy, fever, night sweats and weight loss.¹ However, cHL often exhibits unique symptoms, such as pain in lymph nodes following alcohol consumption and severe pruritus.¹ Pathologically, cHL is derived from B cells but is marked by the presence of Reed–Sternberg cells, which are necessary for diagnosis.¹

In contrast with cHL, NHL can originate from B cells, T cells or natural killer cells, and lacks Reed–Sternberg cells.^2,3 Certain types of NHL contain Reed–Sternberg-like cells, potentially leading to misdiagnosis.³ NHL encompasses several different subtypes, each with its own pattern of behaviour and prognosis.²

The treatment approach for cHL is typically determined by the stage of the disease, with localised stages often treated with a combination of chemotherapy and radiation, while advanced stages may require more aggressive treatment.⁴ NHL treatment strategies are more varied due to the heterogeneity of the subtypes. Some forms of NHL are indolent (mature B-cell lymphoma) and may not require immediate treatment, while others are aggressive and necessitate intensive therapy.²

Mature B-cell lymphomas typically have a favourable outlook, with many patients experiencing a life expectancy similar to their peers. However, younger patients and/or those whose lymphoma quickly progresses or transforms into an aggressive form after initial treatment have a less favourable prognosis.⁵

Curing these types of NHL in their advanced stages can be difficult.⁶ For indolent NHL that is detected early, specifically in stages 1 and 2, radiation therapy alone can be a successful treatment method; however, chemotherapy and monoclonal antibodies are also commonly used. Aggressive NHL typically progresses more rapidly, yet many patients achieve remission through intensive combination chemotherapy treatments.⁶

Prognostically, advances in the diagnosis and treatment of cHL have significantly improved outcomes, with many patients achieving complete remission.¹ NHL outcomes vary widely depending on the subtype, with some being highly curable and others having a more guarded prognosis.²

In conclusion, while cHL and NHL share some clinical similarities, they are distinct diseases with different pathological features, treatment strategies and prognoses. Understanding these differences is crucial for accurate diagnosis and appropriate disease management. The ongoing research and development of targeted therapies hold promise for further improving outcomes for people with both cHL and NHL.

References

1. Kaseb and Babiker, 2024. Hodgkin Lymphoma. https://www.ncbi.nlm.nih.gov/pubmed/29763144
2. Sapkota and Shaikh, 2024. Non-Hodgkin Lymphoma. https://www.ncbi.nlm.nih.gov/books/NBK559328/
3. Hartmann, 2019. CD30 expression in neoplastic T cells of follicular T cell lymphoma is a helpful diagnostic tool in the differential diagnosis of Hodgkin lymphoma. https://www.doi.org/10.1038/s41379-018-0108-5
4. Kallam and Vose, 2019. Hope After Salvage Therapy Fails: Novel Agents for Relapsed/Refractory Hodgkin Lymphoma. https://pubmed.ncbi.nlm.nih.gov/31095720/
5. Lumish, 2021. How we treat mature B-cell neoplasms (indolent B-cell lymphomas). https://www.doi.org/10.1186/s13045-020-01018-6
6. PDQ Adult Treatment Editorial Board, 2023. Non-Hodgkin Lymphoma Treatment (PDQ^®): Health Professional Version. https://www.ncbi.nlm.nih.gov/books/NBK66057/