Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) are both types of cancers that affect the lymphocytes (white blood cells). Abnormally large lymph nodes, weight loss, and fever are the general signs of these lymphomas. Out of these two categories of lymphomas, there are more than 67 subclasses.
These two categories of lymphomas differ in development, spread, and management. Both the Hodgkin and Non-Hodgkin lymphomas are similar in various aspects, but distinctions are made after examining the cancerous material either from a biopsy or aspiration of the cancerous mass of cells (Stoppler, 2007).
There are different subtypes of NHL, which are mainly B-cell lymphoma, NK-cell lymphoma, and T-cell lymphoma. In addition, NHL is defined based on the rate of tumor growth; indolent or aggressive (American Society of Clinical Oncology, 2013). Both types of NHL are apparent in adults, but aggressive NHLs mainly occur in children.
Huang, Xu & Zhou (2013) indicate that 85% of B-cell NHL present in adults, with large diffuse B-cell (also an aggressive NHL) being the predominant type. Follicular and marginal zone lymphomas are some of the types of indolent NHL. Aggressive lymphomas are more fatal but also curable. The four-stage Ann Arbor system is used in the staging of the lymphomas.
The first stage is marked by the presence of cancer in a specific region of the lymph nodes while at stage 2 cancer attacks two or more regions of the lymph nodes, but on the same side of the diaphragm. Stage 3 lymphoma is present on both sides of the diaphragm, while stage 4 is characterized by the extensive spread of cancer beyond the lymph nodes (American Society of Clinical Oncology, 2013).
The Hodgkin disease is marked by giant neoplastic cells referred to as Reed-Steinberg, but the types of lymphoid cells that they originate from are not yet known due to the variable nature of Hodgkin and Reed-Sternberg cells (Schmitz, Stanelle, Hansmann & Kuppers, 2009).
A member of the tumor necrosis factor receptor: marker CD30, is often used in the diagnosis of classical HL. It mainly manifests in areas around the neck, between the lungs and around the breastbone. Hodgkin lymphomas have two incidence age peaks: in children and adults. This is in contrast to NHL whose incidence increases with age, and whose diagnoses are mainly made at the age of 60 (Stoppler, 2007).
Non-Hodgkin lymphoma is more common than Hodgkin lymphoma, and its incidence rates have tremendously increased in the recent past. More than 50% of individuals diagnosed with lymphoma have Non-Hodgkin lymphoma. The major classes of Hodgkin lymphoma based on classification by the American Joint Committee on Cancer are classical Hodgkin lymphoma, which is characterized by the Reed-Sternberg cells, and nodular lymphocyte-predominant Hodgkin lymphoma that is apparent in lymph nodes of the neck/groin.
These two classes of HL differ in immunophenotype and morphology of the cancer cells. Classical Hodgkin lymphoma is the more common of the two types of Hodgkin lymphomas. The subtypes of classical HL are “mixed cellularity, lymphocyte-rich subtypes, nodular sclerosis, and lymphocyte depletion” (Schmitz, Stanelle, Hansmann, & Kuppers, 2009).
A study by Oerlemans, Mols, Nijziel, Lybbert & van de Poll-Franse (2011) indicated the symptoms of NHL as constipation, dyspnea, appetite loss, and fatigue. Dyspnea and insomnia were the reported symptoms for HL.
There is no definite known cause of NHL, but an impaired immune system and exposure to “environmental carcinogens, chemicals, and microorganisms are some of the causative factors” (Lymphoma Research Foundation, 2012). Individuals who are genetically inclined to NHL, those with an autoimmune disease, and those with Epstein-Barr, HIV, human T-lymphotropic virus type 1 and hepatitis C virus and H-pylori bacterium are at a higher risk of NHL. There are also no known causative factors of HL.
Kadin & Rathore (2010) are of the opinion that prognostic factors in HL determine health outcomes of patients and type of therapy to be given. These prognostic factors include a tumor with a diameter of more than 10cm, increased levels of ESR, age, detection of multiple sites of Hodgkin lymphoma, and extranodal disease.
Kadin & Rathore (2010) indicated that patients who received chemotherapy compared with those that did not receive this mode of treatment had a worse overall health functioning and social well-being (Oerlemans, Mols, Nijziel, Lybbert & van de Poll-Franse, 2011, p. 1001).
The international prognostic index gives the prognostic scores of the NHL and HL. Reference to this index, the prognostic factors for HL include an age ≥ 45years, sex (male), serum albumin <4g/dl, advanced stage of the disease, lymphocytopenia, hemoglobin <10.5g/dl, & WBC ≥15, 000/mm3. The prognostic factors for NHL include an age >60, advanced disease, ECOG performance status ≥ 2, and LDH > specified range.
The prognosis of NHL and HL varies since HL is associated with better prognosis. Hodgkin lymphoma rarely metastasizes and is very responsive to treatment, unlike Non-Hodgkin lymphoma. It was the first kind of cancer to be cured without surgery, and currently, 90% of individuals diagnosed with early Hodgkin lymphoma, and 70% of those with advanced Hodgkin lymphoma are cured (Kadin & Rathore, 2010).
Huang, Xu & Zhou (2013) indicated that combined treatment, chemoradiotherapy, was associated with higher event-free survival and reduced toxicities, but no overall survival benefit. According to Schmitz, Stanelle, Hansmann, & Kuppers (2009), the overall survival rate reduces as age increases. Regardless, there is no one mode of treatment that can be deemed more advantageous over another.
Treatment is usually determined by the type of lymphoma, stage of lymphoma at diagnosis, symptoms, and one’s age, and overall health (Chen, 2013). There are some differences in the management of NHL between adults and children.
For example, whereas the international prognostic index is used in adults, it is not used in children. However, it is apparent that there is no standard treatment approach for NHL, and this has piqued the interest of scientists, clinicians, and the general public. There have not been consistencies in research with regard to the management of NHL.
Modern therapy for NHL has developed from the foundation stage and histology of multi-agent chemotherapy. The main modes of treatment used for NHL are radiotherapy, chemotherapy, biologic therapy (Lymphoma Research Foundation, 2012). Alternatively, a combination of either two or more of these treatments can be used. Stem cell or bone marrow transportation is also used on some occasions, and surgery is used mainly for diagnostic purposes.
Chemotherapy comprising cyclophosphamide, vincristine, doxorubicin & prednisone (CHOP) treatment is effective on diffuse large B-cell lymphoma, and this treatment is also associated with a >40%, 5-year overall survival rate, according to Sehn et al. & Bendandi cited in Huang, Xu & Zhou (2013). Radiotherapy is effective in treating early-stage follicular lymphoma.
However, no study endorses a particular mode of treatment. Radiotherapy alone has long been used as the only mode of treatment for early-stage favorable Hodgkin lymphoma, but now, either the limited duration of chemotherapy or combined treatment is used (Kadin & Rathore, 2010, p. 2904).
References
American Society of Clinical Oncology. (2013). Lymphoma-Non-Hodgkin. Cancer. Web.
Chen, Y. (2013). Non-Hodgkin lymphoma. Medline Plus.
Huang, Z., Xu, Z., & Zhou, Y. (2013). Chemotherapy alone versus chemotherapy followed by consolidative radiotherapy for limited-stage aggressive non- Hodgkin lymphoma: A meta-analysis of randomized controlled trials. Cancer, 17, 736-743.
Kadin, M., & Rathore, B. (2010). Hodgkin’s Lymphoma Therapy: Past, Present, and Future. Expert Opin Pharmacother.,11(17), 2891-2906.
Lymphoma Research Foundation. (2012). Non-Hodgkin Lymphoma.
Oerlemans, S., Mols, F., Nijziel, M. R., Lybeert, M., & van de Poll-Franse, L. V. (2011). The impact of treatment, socio-demographic and clinic characteristics on health-related quality of life among Hogkin’s and non-Hodgkin’s lymphoma survivors: a systematic review. Ann Hermatol, 90, 993-1004.
Schmitz, R., Stanelle, J., Hansmann, M., & Kuppers, R. (2009). Pathogenesis of classical and lymphocyte-predominant Hodgkin Lymphoma. Annual Review of Pathology. Mechanisms of Disease, 4, 151-174.
Stoppler, M. C. (2007). Hodgkin’s and Non-Hodgkin’s Lymphoma: Differences and Similarities. Medicine Net.