Bay Biosciences provides high-quality, fresh frozen biopsy tissue samples. Formalin fixed paraffin embedded (FFPE) tissue blocks with matched fresh frozen sera (serum), plasma, and peripheral blood mononuclear cells (PBMC) bio-fluids, from patients diagnosed with Non-Hodgkin’s lymphoma.
The sera (serum), plasma and PBMC biofluid specimens are processed from patient’s peripheral whole-blood using customized collection and processing protocols from non-Hodgkin’s lymphoma patients.
Fresh frozen tissue and matched biofluid samples are collected from unique patients diagnosed with non-Hodgkin’s lymphoma.
Bio-samples are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Non-Hodgkin’s Lymphoma Overview
Hodgkin’s and Non-Hodgkin are the two main types of lymphoma’s.
Non-Hodgkin’s lymphoma (NHL) is a group of blood cancers that start in certain types of white blood cells. NHL begins in the lymphatic system, which is part of the body’s germ-fighting immune system.
In non-Hodgkin’s lymphoma, white blood cells called lymphocytes grow abnormally and can form growths (tumors) throughout the body.
There are many subtypes that fall in the category of non-Hodgkin’s lymphoma. Diffuse Large B-Cell Lymphoma DLBCL and follicular lymphoma are among the most common subtypes. The other general category of lymphoma is Hodgkin’s lymphoma.
According to the ACS non-Hodgkin lymphoma is among the most common forms of cancers in the United States, making up around 4% of all cancer cases in the country.
It can develop at any age and is common in children and young adults. The risk, however, increases as a person ages, and more than half of those with the disease are 65 or older when they receive the diagnosis.
Non-Hodgkin lymphoma is more common in males, about 1 in 42 develop it, while the disease occurs in about 1 in 54 females.
Lymphomas are cancers that begin in white blood cells called lymphocytes. These cells are a part of the lymphatic system, which is part of the immune system.
As well as contributing to the fight against infections and diseases, the lymphatic system helps fluids, including blood, move around the body.
Lymphoma can develop in any area of the body that contains lymph tissue, including the following:
- Lymph nodes, which exist throughout the body, in the chest, abdomen, and pelvis.
- Spleen, which creates lymphocytes and other immune cells
- Bone marrow, where new blood cells form
- Thymus , a gland in the upper chest that plays a role in developing lymphocytes
- Adenoids and tonsils, which fight against infection in the back of the throat
- Digestive tract, as some areas contain lymph tissues
Without treatment, non-Hodgkin’s lymphoma can spread throughout the body. The blood can transport cancerous white blood cells to distant areas.
Types of Non-Hodgkin’s Lymphoma
There are several types of non-Hodgkin’s lymphoma. They fall into two main groups, based on whether the affected white blood cells are B cells or T cells. Also less common type is NK-cell lymphoma. Less than 1% of patients with lymphoma have NK-cell lymphoma.
Researchers also classify lymphoma based on how fast they grow. Any type can be slow-growing (indolent) or fast-growing (aggressive).
B-Cell Types
According to the Cancer Support Community, around 85% of non-Hodgkin’s lymphoma cases in the U.S. start in B cells. Below are the two most common types.
Less common types of B cell non-Hodgkin’s lymphoma include:
- Mucosa-associated lymphatic tissue lymphoma
- Small cell lymphocytic lymphoma, or chronic lymphocytic leukemia
- Intravascular large B cell lymphoma
- Mantle cell lymphoma
- Burkitt’s lymphoma
- Hairy cell leukemia
- Primary central nervous system lymphoma
- Mediastinal (thymic) large B cell lymphoma
- Lymphoplasmacytic lymphoma, or Waldenstrom macroglobulinemia
- Nodal marginal zone B cell lymphoma
- Splenic marginal zone lymphoma
- Extranodal marginal zone B cell lymphoma
- Primary effusion lymphoma
Sub-Types of B-Cell lymphoma
Following are the most common subtypes of B-cell lymphoma:
Diffuse large B-cell lymphoma
Around 1 in 3 cases of non-Hodgkin’s lymphoma are this type. It usually starts as a lump in a lymph node.
Sometimes, diffuse large B cell lymphoma starts in the intestine, bone, brain, or spinal cord. It grows quickly but usually responds well to treatment.
Follicular Lymphoma
Almost 20% of lymphomas in the U.S. are this type, which starts in the lymph nodes and bone marrow.
Follicular lymphoma usually grows slowly and responds to treatment, but it is difficult to cure and may come back.
Mantle Cell Lymphoma
About 5% to 7% of patients with NHL have mantle cell lymphoma. It most often appears in patients older than 60 and is much more common in men than in women. It usually involves the bone marrow, lymph nodes, spleen, and gastrointestinal system, which includes the esophagus, stomach, and intestines.
Small Lymphocytic Lymphoma
This type of lymphoma is the same disease as B-cell chronic lymphocytic leukemia (CLL) but without a significant amount of disease circulating in the blood. About 5% of people with NHL have this subtype, which is considered an indolent lymphoma.
Double Hit/Triple Hit Lymphoma
This is a highly aggressive subtype of Diffuse Large B-Cell Lymphoma (DLBCL), accounting for about 5% of these cases. Rarely, low-grade follicular lymphoma may also transform into double hit lymphoma. Double hit lymphomas have changes in the MYC gene and in either the BCL2 or BCL6 gene.
Primary Mediastinal Large B-cell Lymphoma
This is an aggressive form of Diffuse Large B-Cell Lymphoma (DLBCL), it appears as a large mass in the central chest. The mass may cause breathing problems or superior vena cava (SVC) syndrome, a collection of symptoms caused by the partial blockage or compression of the superior vena cava.
The superior vena cava is the major vein that carries blood to the heart from the head, neck, upper chest, and arms. Mediastinal large B-cell lymphoma is most common in women between 30 and 40 years old. About 2.5% of patients with NHL have this subtype.
Splenic Marginal Zone B-cell Lymphoma
This type of lymphoma begins in the spleen and usually involves the bone marrow and the blood. It is usually slow growing.
Extranodal Marginal Zone B-cell Lymphoma of MALT
This type of lymphoma is usually localized at diagnosis. It most commonly occurs in the stomach. However, it may also occur in the lung, skin, thyroid, salivary gland, or in the orbit, adjacent to the eye, or in the bowel.
Patients with this type of lymphoma sometimes have a history of autoimmune disease, such as lupus, rheumatoid arthritis, or Sjögren’s Syndrome. When MALT occurs in the stomach, it is sometimes caused by a bacteria called Helicobacter pylori.
Nodal Marginal Zone B-cell Lymphoma
This rare type of indolent lymphoma involves the lymph nodes. About 1% of patients with lymphoma have this subtype.
Lymphoplasmacytic Lymphoma
This is an indolent form of lymphoma, and 1% of patients with NHL have this subtype. This form of lymphoma often involves the bone marrow, sometimes lymph nodes, and spleen. In most patients, this type of lymphoma produces an immunoglobulin (IgM antibody) protein, called an “M protein,” that is found in the blood.
Lymphoplasmacytic lymphoma is also known as Waldenstrom’s macroglobulinemia (WM). Patients with WM sometimes have elevated serum viscosity, or “thickened” blood, which may cause symptoms such as headache, blurry vision, dizziness, and shortness of breath.
Changes in the MYD88 gene are detected in more than 90% of cases of lymphoplasmacytic lymphoma and WM.
Burkitt lymphoma/Burkitt cell leukemia
This is a very rare and aggressive form of lymphoma. There are three types of Burkitt lymphoma:
- Endemic
- Sporadic
- Immunodeficiency-related lymphoma
In the United States, Burkitt lymphoma sometimes appears with a mass in the abdomen, but it can affect many other parts of the body.
Because this type of lymphoma spreads quickly, it needs immediate treatment. This subtype is characterized by genetic changes on chromosome 8 involving the MYC gene, which contributes to rapid cancer growth.
T-Cell Types
The Cancer Support Community report that T cell types account for fewer than 15% of all non-Hodgkin’s lymphoma cases in the United States subtypes include:
- Peripheral T cell lymphoma: Also known as generic T cell lymphoma, this is the most common type of T cell lymphomas, and there is a range of further subtypes.
- Cutaneous T cell lymphoma: This type includes T cell lymphomas that primarily affect the skin, but they can also affect the blood, lymph nodes, and internal organs.
Other types of lymphoma that affect the T cells include:
Sub Types of T-Cell and NK-Cell Lymphoma
Following are the most common subtypes of T-cell and NK-cell lymphoma:
Anaplastic Large Cell Lymphoma, Primary Cutaneous Type
This subtype of lymphoma only involves the skin. It is often indolent, although aggressive subtypes of the disease are possible.
Anaplastic Large Cell Lymphoma, Systemic Type
This aggressive form of lymphoma makes up about 2% of all lymphomas and about 10% of all childhood lymphomas. Some patients with this subtype have genetic changes on chromosome 2, involving the ALK gene.
Patients with cancer cells that have changes in ALK, called ALK-positive, often have a a better prognosis than those without this change, called ALK-negative.
Breast Implant-associated Anaplastic Large Cell Lymphoma
This is a relatively recently recognized subtype that arises in tissue near breast implants. It is usually less aggressive than the systemic type of anaplastic large cell lymphoma.
Peripheral T-cell Lymphoma, Not Otherwise Specified (NOS)
This is an aggressive form of lymphoma that is often advanced when doctors find it. It is most common in patients older than 60 and makes up about 6% of all lymphomas in the United States and Europe.
The cells of this lymphoma vary in size, and they have certain types of proteins, called CD4 or CD8, on their surface. Researchers are studying several new drugs in clinical trials to treat this subtype of lymphoma.
Angioimmunoblastic T-cell Lymphoma
This is an aggressive form of lymphoma with specific symptoms:
- Enlarged lymph nodes
- Fever
- Rash
- High levels of immunoglobulins in the blood
- Unexplained Weight Loss
Patients with angioimmunoblastic lymphoma have a lowered immune system function, so infections are also common.
Adult T-cell Lymphoma/Leukemia (human T-cell Lymphotropic Virus Type-I Positive)
This type of lymphoma is caused by a virus called the human T-cell lymphotropic virus type I. It is an aggressive disease that often involves the bone and skin. Often, lymphoma cells are found in the blood, which is why this condition is sometimes also called leukemia.
Extranodal NK/T-Cell Lymphoma, Nasal Type
This is an aggressive type of lymphoma that is very rare in the United States and Europe in general, but more common in Asian and Hispanic communities.
It can occur in children or adults, most often involving the nasal area and sinuses. It can also involve the gastrointestinal tract, skin, the testicles, or other areas in the body.
Enteropathy-Associated T-Cell Lymphoma
This type of lymphoma is rare in the United States but is more common in Europe. It is an aggressive form of T-cell lymphoma that involves the intestines. Some people with this subtype have celiac disease or a history of gluten intolerance.
Hepatosplenic T-cell Lymphoma
This is an aggressive form of peripheral T-cell lymphoma that involves the liver and spleen. It is more common in males and occurs more frequently in teenagers and young adults, with a median age at diagnosis of 35 years.
Subcutaneous panniculitis-like T-cell Lymphoma
This is a form of peripheral T-cell lymphoma that is similar to hepatosplenic T-cell lymphoma. The disease involves the tissue under the skin and is often first diagnosed as panniculitis, which is inflammation of fatty tissues.
Mycosis Fungoides
This rare T-cell lymphoma primarily involves the skin, either in patches or with diffuse redness of the skin. It often has a very long and indolent course but may become more aggressive and spread to lymph nodes or internal organs.
Signs and Symptoms of Non-Hodgkin’s Lymphoma
The symptoms of non-Hodgkin’s lymphoma often depend on the specific type and where it is in the body.
Some people experience no symptoms before the cancer has become advanced.
Following are the common symptoms of non-Hodgkin’s lymphoma:
- A swollen belly
- Bruising easily
- Chills
- Cough
- Enlarged lymph nodes
- Excessive sweating specially at night
- Fatigue
- Feeling full after eating very little
- Frequent infections
- Loss of appetite
- Painless swelling of lymph nodes
- Enlarged spleen or liver
- Shortness of breath
- Unexplained Weight Loss
A patient with a B-cell type may also have a fever that comes and goes and severe night sweats.
The symptoms of cutaneous T cell lymphoma tend to include enlarged lymph nodes, dry skin, itching, and a red rash.
Examples of symptoms related to a specific tumor location:
- A tumor in the abdomen can cause a stretched belly or pain in the back or abdomen.
- An enlarged spleen may cause back pain and a feeling that the stomach is full.
- Tumor in the groin may cause swelling in the legs.
- A tumor in the underarms may cause swelling in the arms.
- If the lymphoma spreads to the brain, there may be symptoms similar to those of a stroke.
- A tumor in the center of the chest may press on the trachea and cause coughing, chest pain, shortness of breath (difficulty breathing), and other respiratory problems.
Causes of Non-Hodgkin’s Lymphoma
Most lymphomas are not associated with any known risk factors. Some factors that can increase your risk of non-Hodgkin’s lymphoma include:
- Age, most non-Hodgkin’s lymphoma cases occur in adults over the age of 60.
- Certain infections such as Human T-lymphoma virus-1, Epstein-Barr virus infection and human herpesvirus-8.
- Immune system deficiency where the immune system is weakened in patients with HIV or taking immunosuppressants or autoimmune diseases.
In the vast majority of individual cases, however, no specific cause can be identified. Non-Hodgkin’s lymphoma is not infectious to partners or anyone else, and does not run in families.
Diagnosis of Non-Hodgkin’s Lymphoma
A biopsy is the only way to diagnose non-Hodgkin’s lymphoma. This involves taking a sample of cells using a small needle.
A pathologist will then examine this sample under a microscope to check for signs of the condition.
Staging
After making a diagnosis of non-Hodgkin’s lymphoma, the doctor will perform a number of tests to see how far the cancer has progressed. This is known as staging.
Staging may involve imaging tests, such as X-rays or MRI scans.
The healthcare team may also perform blood tests, bone marrow biopsies, or heart and lung function tests.
There are four stages of non-Hodgkin’s lymphoma. Stage-1 is the least advanced, while stage 4 is the most advanced.
Further Tests
If the results of your biopsy indicate that you have non-Hodgkin’s lymphoma, you may have further tests to see how far the cancer has spread. Additional tests can include:
- Blood tests to check you liver and kidney function (there is no direct blood test for lymphoma)
- Bone marrow biopsy
- Imaging tests such as CT scan, PET and MRI scans and ultrasound
- Lumbar puncture also known as spinal tap
The two important questions when a diagnosis of non-Hodgkin’s lymphoma is made are:
- What exact subtype is it (as treatment varies)
- How far has it spread in the body (stage)
Treatment of Non-Hodgkin’s Lymphoma
Following are the four main types of treatment for non-Hodgkin’s lymphoma:
- Chemotherapy
- Immunotherapy
- Radiation therapy
- Targeted cell therapies
Doctors often recommend combining treatments, and the best combination will depend on a number of factors, including the following:
- The type and stage of the lymphoma
- The patient’s overall health and fitness levels
Risk Factors of Non-Hodgkin’s Lymphoma
Researchers have found several factors that can affect a person’s chance of getting non-Hodgkin’s lymphoma (NHL). There are many types of lymphoma, and some of these factors have been linked only to certain types.
The risk factors for non-Hodgkin’s lymphoma include the following:
- Autoimmune diseases
- Age: being older, as most patients who receive the diagnosis are 60s or older.
- Body weight: Being over weight and having an unhealthy diet
- Breast implants
- Certain infections
- Family History:
- Exposure to certain chemicals and drugs
- Gender: The risk of non-Hodgkin’s lymphoma (NHL) is higher in men than in women , but there are certain types of non-Hodgkin’s lymphoma (NHL) that are more common in women. The reasons for this are unknown.
- Having weakened immune system
- Race
- Radiation exposure
- Ethnicity
- Geography.
In addition following conditions can increase the risk of developing non-Hodgkin’s lymphoma (NHL):
- Bacterial infections, such as with Helicobacter pylori
- Viral infections, such as with the Epstein-Barr virus
- Having an autoimmune disorder, such as rheumatoid arthritis
- Individuals who have received an organ transplant
- Patients who had cancer treatment
- Having an immunodeficiency disorder, such as AIDS
Outlook of Non-Hodgkin’s Lymphoma
The term “5-year survival rate” refers to the percentage of people who live for at least 5 years after receiving a diagnosis.
The overall 5-year survival rate for non-Hodgkin’s lymphoma is 70%. However, it is important to remember that this figure is based on averages.
A person’s outlook depends on the type and stage of the cancer, among other factors. A doctor can provide more detailed information based on factors specific to each patient.
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