How long do people live with non-Hodgkin's lymphoma? Causes, treatment and survival prognosis for diffuse non-Hodgkin lymphoma Non-Hodgkin lymphoma in cellular treatment

is a type of cancer that affects the lymphatic system. The lymphatic system consists of lymph nodes, which are connected by small vessels. Experts divide this type of cancer into Hodgkin lymphoma and non-Hodgkin lymphoma (another name is Non-Hodgkin lymphoma). They differ in the structure of their cells. Non-Hodgkin's lymphoma is less treatable than Hodgkin's lymphoma, and the response to drug intervention is unpredictable.

This name for a group of diseases has come into use since 1971 by the scientist Billroth.

Non-Hodgkin's lymphoma: what is it?

Non-Hodgkin's lymphoma (NHL) is the general name for cancer, which consists of more than 30 varieties, where the cell structure is fundamentally different from the structure of Hodgkin's lymphoma cells. With this type of disease, malignant cells form in organs with lymphatic tissue (spleen, thymus, tonsils, etc.) and in the lymph nodes themselves.

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According to statistics, the life prognosis is such that only 25% of patients are cured of this disease.

But there are several factors that influence the outcome of the disease. These factors are timely access to a medical institution, correct diagnosis, qualified treatment, age and even gender of the patient. Thus, according to research, women suffer from non-Hodgkin lymphoma much less often than men. It also occurs more often in the elderly and adults than in children. But if the disease is detected in children (usually over 5 years old) or adolescents, then NHL can provoke new diseases in the organ system and often this leads to death.

Causes of NHL

In recent years, this type of cancer has tended to increase. This disease is especially common in people over 40 years of age and ranks sixth in mortality among malignant diseases. In this situation, naturally, scientists are making attempts to study the true cause of the disease. But to date, the exact reason has not been fully established. Based on observations and studies of patients' medical histories, doctors have identified some of the causes of non-Hodgkin's lymphoma. Let's look at them:

• Heredity. As is often observed in many cancers, if someone in your family has had cancer, then the risk of the disease in the next generation is high. The same is true for non-Hodgkin's lymphoma. There are no exact laboratory studies to prove this. But there are statistical observations confirming this factor.
• Old age and obesity. The disease often occurs after 60 years of age. This may be due to different etiologies acquired due to the patient’s age.
• Ecology. It has been established that in areas where a man-made disaster occurred, people are often exposed to cancer, including lymphoma.
• Viral infections. It has been proven that HIV, Epstein-Barr virus, and severe forms of hepatitis can trigger the occurrence of lymphoma due to the fact that they suppress human immunity
• Radiation. If a patient has had cancer while being treated with radiation therapy, the risk of lymphoma increases. This is due to the fact that during radiation therapy, healthy blood cells are deformed. This can trigger the appearance of one of the types of lymphoma.

This list is not final. Scientists are also studying the effect of bad habits, such as smoking, alcohol, certain medications, and various types of carcinogens on human hematopoiesis.

Signs of illness

The clinical picture of neo-Dgkin's lymphoma is very clear. Lymphoid tissue is affected first. This group of lymphomas manifests itself in three stages:

These symptoms are not reliable and require additional diagnostics.

Classification of the disease

NHL has 4 degrees of development and 3 types of disease progression. The choice of treatment method and prognosis depend on the degree and type of disease. Let's look at them:

1. The first stage is the easiest, since the disease does not yet manifest itself in any way. Only some changes in the blood test are possible. Single enlargements of lymph nodes are possible.
2. The second stage is characterized by primary changes in internal organs, tumors in peripheral lymph nodes are possible.
3. The third stage shows clear signs of the disease. Distributes to both sides of the diaphragm and the abdominal cavity.
4. The fourth stage is characterized by damage to the central nervous system, bone marrow, and skeleton. This stage of non-Hodgkin lymphoma is the most difficult for both the patient and specialists when choosing treatment methods.

Non-Hodgkin's lymphoma is divided into three types. They are called aggressive, indolent and highly aggressive. It is when the clinical picture is bright, with the simultaneous manifestation of all four, that this indicates an aggressive type of non-Hodgkin lymphoma. The indolent type proceeds sluggishly and does not manifest itself for a long time. But the prognosis for survival with an aggressive form is much better than with a sluggish course. It is extremely rare that indolent non-Hodgkin's lymphoma can be cured. A highly aggressive type is characterized by a rapid, uncontrolled course of the oncological process.

Non-Hodgkin's lymphomas are divided into B-cell and T-cell. Depending on what type of illness the patient has, predictions can be made.

B cells include:

T-cell lymphomas include:

• Lymphoma or leukemia from progenitor cells- is rare (2%). Leukemia or lymphoma differs in the number of blast cells in the bone marrow.
• Peripheral lymphomas- These include cutaneous lymphomas, panniculitis-like, extranodal, angioimmunoblastic and lymphomas with enteropathy.

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The prognosis for life with T-cell lymphoma is poor, since this type of lymphoma is super-aggressive and more often than not, patients are in the terminal stage of the disease.

Diagnostics

Non-Hodgkin's lymphoma is an extremely severe type of cancer; therefore, the choice of diagnostic method and subsequent choice of therapy rests with oncohematologists. The main stage of diagnosis is a biopsy of lymph node tissue and bone marrow puncture. But to clarify the prognosis of life, the condition of internal organs, and carry out a number of medical procedures, diagnostic methods are also carried out, such as blood tests, X-rays, MRI, ultrasound, lymphoscintigraphy, bone scintigraphy. After a thorough diagnosis and determination of the type and stage of non-Hodgkin lymphoma, if one is detected, specialists select the type of therapy.

NHL: Treatment

When a diagnosis of NHL is confirmed, doctors choose a treatment regimen based on what specific form of non-Hodgkin's lymphoma the patient suffers from, how widespread the disease is within the body, and what stage the lymphoma is at.

The main treatment methods are:

1. Chemotherapy
2. Radiation therapy
3. Surgery
4. Transplantation

The success of treatment depends on how much the disease has progressed and what stage it is at. If the disease is localized and has no tendency to develop, it is possible to achieve complete destruction of lymphoma, cure or at least prolong a person’s life. When malignant tumors are widespread, treatment is quite complex and is aimed at increasing life expectancy and improving the patient’s quality of life. With over-aggressive and some indalent types of NHL, when the disease cannot be treated, the patient is not left to the mercy of fate. Provides spiritual and psychological assistance.

If the prognosis for aggressive NHL is favorable, there is standard therapy according to the ASOR (CHOP) regimen, which involves the administration of drugs: Doxorubicin, Oncovin, Cyclophosphamide, as well as taking Prednisolone. Treatment is carried out in courses.

With partial regression of non-Hodgkin lymphoma, drug therapy is carried out in combination with radiation therapy in the affected areas.

If large tumor sizes are observed after treatment, the so-called large cell diffuse NHL, then the risk of relapse is high. The dose of medication is increased. Experts call this therapy “despair therapy.” Remission can be achieved in 25% of cases. But this achievement is short-lived. Then the patient is prescribed high-dose chemotherapy. This treatment method is appropriate for the first relapses observed in aggressive lymphoma.

With the indolet type of lymphoma, malignant neoplasms are difficult to treat. Doctors use it, which gives short-term remission. But after some time, relapses often occur.

Surgery is justified if the tumor does not spread and is isolated, which is extremely rare.

Nutrition for NHL:

• It should be frequent and fractional, not allowing you to gain excess weight; adequate in energy consumption to prevent weight gain;
• Food should be healthy, containing both proteins, fats, carbohydrates in moderation, and containing vitamins and minerals necessary for recovery;
• The amount of salt should be limited; therefore, it is necessary to limit the consumption of pickles and smoked meats.

Lymphomas are a broad group of tumors of lymphatic tissue. These tumors have different origins, symptoms, manifestations and progression. The entire group can be divided into two subgroups: one is Hodgkin lymphoma, the other is non-Hodgkin lymphoma.

General description, causes

Non-Hodgkin's lymphomas are neoplasms of altered lymphocytes, initially have a malignant form and an unpredictable response to drug treatment. These tumors, depending on the variety, have different development periods, ranging from slowly developing (indolent) to very aggressive forms that quickly affect almost the entire patient’s body.

First of all, with the development of diseases of this type, the lymph nodes and lymphatic tissues contained in the structure of the organs are affected. The organs of the gastrointestinal tract, spleen, and various secretory glands are at risk. Less commonly, other organs are affected.

Lymphoma has no age restrictions; adults, children, and the elderly are susceptible to it. As you age, your risk of getting lymphoma increases. In Russia, up to 25 thousand patients with such requests are officially registered every year, which is about 4% of the total number of cancer diseases.

The causes of pathologies of this type are not fully understood. Possible risk factors include the following:

• genetic mutations;
• the impact of intensive chemotherapy and radiation therapy in the treatment of cancer;
• state of immunodeficiency due to various reasons;
• reaction to toxins (carcinogens - benzenes, insecticides, herbicides);
• viral diseases.

But exposure to these factors does not necessarily lead to the development of lymphoma.

Classification of the disease and clinical signs

Lymphomas are classified according to different criteria.

Depending on the location there are:

• nodal lymphomas;
• extranodal lymphomas.

Nodal are formations that develop in the lymph nodes. Extranodal tumors affect not only the lymph nodes, but also the tissues of other organs.

Non-Hodgkin's lymphomas are formed from modified lymphocytes. All lymphocytes are divided into three types:

According to this division, lymphomas of the corresponding types are distinguished.

B-cell lymphomas, in turn, are divided into the following subtypes:

• large cell lymphoma;
• small cell lymphoma;
• plasma cell myeloma;
• extraosseous plasmacytoma;
• lymphoplasmacytic lymphoma;
• follicular lymphoma;
• mantle cell lymphoma;
• from mature B cells;
• from B cell precursors;
• unspecified (not included in the classification) and others.

Tumors of T- and NK-types also have their own varieties:

• smallpox-like lymphoma;
• hepatosplenic;
• lymphoblastic;
• from T cell precursors;
• subcutaneous panniculitis-like;
• mycosis fungoides, etc.

All types of non-Hodgkin lymphomas have a diffuse type of spread, that is, when they form in the lymph nodes, they disrupt their structure and grow into the tissues of other organs.

Features of diffuse type lymphoma

Diffuse non-Hodgkin's lymphoma of the b-cell type is one of the most common among lymphatic tumors, occurring in a third of all registered cases. It can form both in the cells of the lymph nodes and in the tissues of other organs - the spleen, thyroid gland, bone marrow, etc. Large cell diffuse B-cell lymphoma most often develops in people aged 40 to 60 years.

The peculiarity of this type of lymphoma is that it develops in the mediastinal area. Mediastinal diffuse large cell lymphoma is one of the most aggressive B-cell tumors. First of all, it affects the lymph nodes in the area behind the sternum, rapidly spreading to other groups and organs.

All non-Hodgkin lymph tumors are characterized by staged development:

• At stage 1, a destructive change in one lymph structure occurs.
• On the 2nd – nodal change in more than two lymph structures on one side of the diaphragm (above or below relative to it).
• On the 3rd – nodal changes in lymph structures in combination with extranodal damage to other organs.
• On the 4th – multifocal changes in one or more organs in combination with changes in distant lymph nodes.

The symptoms of non-Hodgkin's lymphomas are varied. More often they appear with aggressive development of tumors. There is a group of clinical signs, the so-called B-symptoms, which are characteristic of most types of diffuse large B-cell lymphoma:

• increased body temperature;
• rapid weight loss;
• increased sweating at night (hyperhidrosis).

In addition, the patient may notice signs such as:

• enlargement of lymph nodes and other organs;
• skin rash;
• pain in the area of ​​internal organs;
• weakness and fatigue;
• bleeding gums.

Indolent large cell lymphoma does not manifest itself for a long time; therefore, the patient notices changes in the body too late, often irreversible.

Types of disease diagnosis

Patients with diffuse large B-cell lymphoma are treated by an oncologist or hematologist. Diagnostic tests include:

• study of anamnesis;
• palpation of all groups of peripheral lymph nodes, liver and spleen and their ultrasound examination;
• computed tomography of the areas where groups of lymph nodes are located;
• general and biochemical blood test, blood test for HIV infection, hepatitis B- and C-type;
• bone marrow biopsy and myelogram.

In some cases, additional diagnostic procedures specific to each individual patient are required:

• if one testicle is affected, ultrasound of the second testicle and lumbar puncture;
• in case of primary damage to one of the sections of the gastrointestinal tract, all its sections are examined;
• in case of damage to the membranes of the brain and spinal cord - computer or magnetic resonance imaging of the affected area, examination by a neurologist, lumbar puncture;
• if the patient has complaints, an x-ray examination of the bones;
• if indicated, osteoscintigraphy;
• in the presence of malignant lymphomas - scintigraphy.

If the patient has complaints of discomfort in an organ or organs that have not been examined, then they also need to be examined.

The diagnosis is made based on a study of the structure of the tumor tissue. The earliest affected lymph node is suitable for examination. Moreover, during the operation it must be completely removed without damaging it. Inguinal lymph nodes are not taken for histological examination if there are affected nodes of other groups.

Data from a single biopsy are not enough to establish an accurate diagnosis, but for patients who require urgent treatment, cytological data can be used at the first stage.

The main methods of treating the disease

Non-Hodgkin's lymphoma is treated using the following methods:

• radiation therapy (using X-rays);
• chemotherapy;
• surgical intervention (mostly carried out to take samples of material for histological examination).

The intensity of each type of therapy depends on the stage of development of the disease, the degree of its aggressiveness and the response to this type of treatment.

According to statistical data, chemotherapy has the greatest therapeutic effect. X-ray irradiation is used in cases where chemotherapy is contraindicated. Surgical removal of the affected area is possible when it is local in nature. Sometimes a combination of these methods is most effective. Additionally, drug treatment may be required.

After treatment for diffuse large B-cell lymphoma is completed, the patient must attend a follow-up examination for the first two years, which is repeated every three months. Then a control inspection is carried out every six months for three years and then once a year. After 6, 12 and 24 months, computed tomography of the primary lesions is performed.

To assess the prognosis of b-cell lymphoma, the International Prognostic Index scale is used. It includes 5 divisions (from 0 to 5). In order to determine the index on this scale, each of the following indicators, if available, is taken as 1 point:

• 3-4 stages of tumor development;
• ECOG scale score – from 2 to 4 points (assessment of the patient’s motor activity and his ability to self-care, where 4 points is complete disability);
• the patient's age exceeds 60 years;
• the level of lactate dehydrogenase (an enzyme involved in the formation of lactic acid, which is broken down and does not accumulate in a healthy body) is higher than normal;
• extranodal damage to several organs.

The points received are summed up and the final indicator is analyzed:

• 0 – 1 point – low level;
• 2 – low intermediate;
• 3 – high intermediate;
• 4-5 – high.

The prognosis of the disease in a particular case depends on many factors:

• age;
• the state of the patient's immune system;
• degree of development of the disease;
• type of lymphoma;
• level of extent of damage;
• nature of response to therapy, etc.

On average, the number of patients with complete remission reaches 85%; 70% of patients pass the five-year survival threshold without relapse.

Diffuse lymphoma is a serious disease, but modern medicine is doing everything possible to increase the effectiveness of treatment and the survival rate of patients.

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Malignant diseases of the lymphatic system or lymphoma: Hodgkin's and non-Hodgkin's are manifested by enlarged lymph nodes.

Non-Hodgkin's lymphomas comprise a group of cancers that differ in the structure of their cells. Multiple non-Hodgkin's lymphomas can be distinguished by patterns of affected lymphoid tissue. The disease forms in the lymph nodes and in organs with lymphatic tissue. For example, in the thymus gland (thymus), spleen, tonsils, lymphatic plaques of the small intestine.

Malignant cells

People get lymphoma at any age, but more often in the elderly. Non-Hodgkin's, most often occurs after 5 years of age. They tend to leave the site of primary development and invade other organs and tissues, for example, the central nervous system, liver, bone marrow.

In children and adolescents, high-grade tumors are called “highly malignant NHLs” because they cause new, severe disease in organs and can be fatal. Non-Hodgkin's lymphoma, which is low-grade and slow-growing, is more common in adults.

Causes of Non-Hodgkin's Lymphomas

The causes of lymphomas are still being studied by doctors. It is known that Non-Hodgkin lymphoma begins from the moment of mutation (malignant change) of lymphocytes. At the same time, the genetics of the cell changes, but the reason for its change is not clear. It is known that not all children with such changes get sick.

It is believed that the cause of the development of Non-Hodgkin lymphoma in children is a combination of several risk factors:

• congenital disease of the immune system (Wiskott-Aldrich or Louis-Bar syndrome);
• acquired immunodeficiency (for example, HIV infection);
• suppression of one's own immunity during organ transplantation;
• viral disease;
• radiation;
• certain chemicals and medications.

Symptoms and signs of Non-Hodgkin's lymphoma

Symptoms of non-Hodgkin lymphoma of an aggressive course and high malignancy due to the growth rate are manifested by a noticeable tumor or enlarged lymph nodes. They do not hurt, but they swell on the head, in the area or. It is possible that the disease begins in the peritoneum or chest, where it is impossible to see or palpate the nodes. From here it spreads to non-lymphoid organs: meninges, bone marrow, spleen or liver.

Non-Hodgkin lymphoma manifests itself:

• high temperature;
• weight loss;
• increased sweating at night;
• weakness and fatigue;
• high temperature;
• lack of appetite;
• feeling sick.

Non-Hodgkin lymphoma exhibits symptoms of a specific type.

The patient may suffer from:

• Abdominal pain, indigestion (diarrhea or constipation), vomiting and loss of appetite. Symptoms appear when lymph nodes or abdominal organs (spleen or liver) are affected.
• Chronic cough, shortness of breath due to damage to the lymph nodes in the cavity of the sternum, thymus and/or lungs, respiratory tract.
• Joint pain due to bone damage.
• Headaches, blurred vision, vomiting on a lean stomach, cranial nerve palsy due to damage to the central nervous system.
• Frequent infections when the level of healthy white blood cells decreases (anemia).
• Pinpoint skin hemorrhages (petechiae) due to low platelet levels.

Attention! Increasing symptoms of Non-Hodgkin lymphomas occur over a period of two to three weeks or more. They manifest themselves differently in each patient. If one or 2-3 symptoms are noticed, these may be infectious and diseases not related to lymphoma. To clarify the diagnosis, you need to contact specialists.

Lymphoma stages

A classification (St. Jude Classification) has been proposed for lymphoblastic lymphoma.

It provides the following categories:

1. Stage I – with a single lesion: extranodal or nodal to one anatomical area. The mediastinum and abdominal cavity are excluded.
2. Stage II – with a single extranodal lesion and involvement of regional lymph nodes, primary damage to the gastrointestinal tract (ileocical region ± mesenteric lymph nodes).
3. Stage III - with damage to nodal or lymphoid structures on both sides of the diaphragm and primary mediastinal (including the thymus) or pleural lesions (III-1). Stage III-2, regardless of other lesions, refers to any extensive primary intra-abdominal unresectable lesions, all primary paraspinal or epidural tumors.
4. Stage IV – with all primary lesions of the central nervous system and bone marrow.

A separate classification has been proposed for mycosis fungoides.

It provides:

1. Stage I, indicating changes only in the skin;
2. II - A stage indicating skin lesions and reactively enlarged lymph nodes;
3. Stage III with lymph nodes having an increased volume and verified lesions;
4. Stage IV with visceral lesions.

Forms of Non-Hodgkin's lymphomas

The form of NHL depends on the type of cancer cells under a microscope and on the molecular genetic features.

The WHO international classification distinguishes three large groups of NHL:

1. Lymphomas are lymphoblastic B-cell and T-cell (T-LBL, pB-LBL), growing from immature precursor cells of B-lymphocytes and T-lymphocytes (lymphoblasts). The group is 30-35%.
2. Mature B-cell NHL and mature cell B-form-ALL (B-ALL), growing from mature B lymphocytes. These NHLs are the most common form of cancer - almost 50%.
3. Anaplastic large cell lymphomas (ALCL), accounting for 10-15% of all NHLs.

Each main form of NHL has subspecies, but other forms of NHL are also less common.

Classification of Non-Hodgkin's lymphomas (WHO, 2008)

Non-Hodgkin's includes:

B cell lymphomas:

• B-cell precursor lymphomas;
• B-lymphoblastic lymphoma/leukemia;
• Lymphomas of mature B cells;
• Chronic lymphocytic leukemia/small cell lymphocytic lymphoma;
• B-cell prolymphocytic leukemia;
• Lymphoma from marginal zone cells of the spleen;
• Hairy cell leukemia;
• Lymphoplasmacytic lymphoma/Waldenström macroglobulinemia;
• Heavy chain diseases;
• Plasma cell myeloma;
• Solitary plasmacytoma of bone;
• Extraosseous plasmacytoma;
• Extranodal lymphoma from marginal zone cells of mucosal associated lymphoid tissues (MALT lymphoma);
• Nodal marginal zone cell lymphoma;
• Follicular Non-Hodgkin's lymphoma;
• Primary cutaneous centrofollicular lymphoma;
• Mantle cell lymphoma;
• , nonspecific;
• Large B cell non-Hodgkin lymphoma with a large number of T cells/histiocytes;
• Lymphomatoid granulomatosis;
• Non-Hodgkin's lymphoma diffuse large B-cell lymphoma associated with chronic inflammation;
• Primary cutaneous large B-cell lymphoma;
• Intravascular large B cell lymphoma
• ALK-positive large B-cell lymphoma;
• Plasmablastic lymphoma
• Large B cell lymphoma derived from HHV8-associated multicentric Castleman disease
• EBV positive large B cell lymphoma of the elderly
• Primary mediastinal lymphoma (thymic) large B-cell;
• Primary exudative lymphoma
• B-cell lymphoma with morphology intermediate between diffuse large B-cell lymphoma and classical lymphoma;
• Hodgkin B-cell with morphology intermediate between Burkitt's lymphoma and diffuse large B-cell lymphoma.

T-cell and NK-cell lymphomas:

• T-cell precursor lymphomas;
• T-lymphoblastic lymphoma/leukemia;
• Lymphomas from mature T and NK cells;
• Smallpox-like lymphoma;
• Adult non-Hodgkin T-cell lymphoma;
• Extranodal NK/T-cell lymphoma, nasal type;
• T-cell Hodgkin's lymphoma associated with enteropathy;
• Hepatosplenic T-cell lymphoma;
• Subcutaneous pannicula-like T-cell lymphoma;
• Mycosis fungoides/Sézary syndrome;
• Primary cutaneous anaplastic large cell lymphoma;
• Primary cutaneous gamma-delta T-cell lymphoma;
• Primary cutaneous CD4 positive small and medium cell T-cell lymphoma;
• Primary cutaneous aggressive epidermotropic CD8 positive cytotoxic T-cell lymphoma;
• Peripheral T-cell lymphoma, nonspecific;
• Angioimmunoblastic T-cell lymphoma;
• Anaplastic large cell lymphoma ALK-positive;
• Anaplastic large cell lymphoma ALK-negative.

Diagnosis and treatment of the disease

It is carried out in clinics specializing in cancer and blood diseases. To determine the right type of non-Hodgkin's lymphoma, many tests must be done, including blood tests, ultrasound, x-rays and an excisional biopsy of the earliest lymph node. It is completely removed. When removing it, it must not be damaged mechanically. It is not recommended to remove lymph nodes in the groin for histological research if there are other groups of lymph nodes involved in the process.

Examination of tumor tissue

If preliminary tests suspect non-Hodgkin lymphoma, diagnosis and treatment in the future will depend on the results of comprehensive additional diagnostics:

• The affected organ tissue is surgically removed or the lymph nodes are removed.
• When fluid accumulates in cavities, for example, in the abdominal cavity, the fluid is examined. It is taken using a puncture.
• A bone marrow tap is performed to examine the bone marrow.

Based on the results of cytological, immunological and genetic analyses, immunophenotyping, the pathology is confirmed or not confirmed, and its form is determined. Immunophenotyping is performed by flow cytometry or immunohistochemical methods.

If a comprehensive diagnosis of lymphoma confirms NHL, then specialists determine its prevalence throughout the body to draw up a treatment regimen. For this purpose, ultrasound and X-ray images, MRI and CT scans are examined. Additional information is obtained from PET - positron emission tomography. The presence of tumor cells in the central nervous system is determined by a sample of cerebrospinal fluid (CSF) using a lumbar puncture. For the same purpose, children undergo a bone marrow puncture.

Pre-treatment studies

Children and adults have their heart function checked using an ECG - electrocardiogram and EchoCG - echocardiogram. They find out whether NHL has affected the function of any organ, metabolism, or whether infections are present.

Initial test results are very important if there are any changes in NHL treatment. Treatment of lymphoma is not complete without blood transfusions. Therefore, the patient’s blood type is immediately determined.

Drawing up treatment regimens

After confirming the diagnosis, doctors draw up an individual treatment regimen for each patient, taking into account certain prognostic and risk factors that affect the patient’s survival prognosis.

Important prognostic factors and criteria influencing the course of treatment are:

• the specific form of NHL, depending on which the treatment protocol is drawn up;
• scale of spread of the disease throughout the body, stages. The intensity of treatment and duration depend on this.

Surgical treatment of non-Hodgkin lymphoma

Surgeries for NHL are not performed often, only in case of removal of part of the tumor and for the purpose of removing tissue samples to clarify the diagnosis. If there is isolated damage to an organ, for example, the stomach or liver, then surgery is used. But more often preference is given to irradiation.

Treatment of Non-Hodgkin's lymphomas by risk groups

For non-Hodgkin lymphomas, treatment is complex.

To develop the basic principles of treatment of Non-Hodgkin's lymphomas, each individual clinical situation is repeatedly assessed and accumulated experience in the treatment of indolent and aggressive NHL is added. This became the basis of approaches to therapy. Treatment of lymphoma should take into account intoxication of the body (A or B), extranodal lesions (E) and lesions of the spleen (S), and the volume of tumor foci. Important differences in the prognosis of the results of aggressive chemotherapy and radiation therapy (RT) at stages III and IV compared with the observed results in Hodgkin lymphoma.

To prescribe treatment, stage III tumors began to be divided into:

• III - 1 - taking into account lesions on both sides of the diaphragm, limited to the involvement of the spleen, hilar, celiac and portal lymph nodes;
• III - 2 - taking into account paraortic, iliac or mesenteric lymph nodes.

Is there a cure for lymphoma? It is known that patients over 60 years of age in the first stage of the proliferative disease proceed relatively well, but in the fourth stage they have a high level of lactate dehydrogenase (LDH) in the blood and a poor survival prognosis. To choose a principle and increase the aggressiveness of treatment, they began to consider the largest volume of tumor masses: peripheral, nodal lesions - 10 cm or more in diameter, and the ratio of the diameter of enlarged mediasteal lymph nodes to the transverse dimensions of the chest is more than 0.33. In special cases, the largest tumor size – 5 cm in diameter – is considered an unfavorable prognostic sign that influences the choice of therapy for nodal lesions.

The principle of choice of therapy is influenced by 5 more unfavorable risk factors, which were combined by the International Prognostic Index (IPI):

• age 60 years or more;
• increased level of LDH in the blood (2 times more than normal);
• performance status >1 (2–4) on the ECOG scale;
• stages III and IV;
• number of extranodal lesions >1.

1. Group 1 – low level (presence of 0-1 signs);
2. Group 2 – low intermediate level (presence of 2 signs);
3. Group 3 – high intermediate level (presence of 3 signs);
4. Group 4 – high level (presence of 4-5 signs).

For patients under 60 years of age with aggressive NHL, a different MPI model is used and another 4 risk categories are defined based on 3 unfavorable factors:

• stages III and IV;
• increased serum LDH concentration;
• overall ECOG status >1 (2–4).

1. category 1 – low risk in the absence of (0) factors;
2. category 2 – low intermediate risk with one risk factor;
3. category 3 – high intermediate risk with two factors;
4. Category 4 – high risk with three factors.

The 5-year survival rates according to the categories will be 83%, 69%, 46% and 32%.

Scientists oncologists, explaining what it is and how it is treated, believe that risk indicators for MPI influence the choice of treatment not only for aggressive NHL in general, but also for any form of NHL and in any clinical situation.

The original treatment algorithm for indolent NHL is that it targets B-cell lymphomas. More often for follicular tumors of I and II degrees. But in 20-30% of cases they transform into diffuse large B-cells. And this requires a different treatment, corresponding to the fundamental treatment of aggressive forms, which include follicular NHL of the III degree.

The main method of treating Non-Hodgkin lymphomas is using combinations of cytostatic drugs. Treatment is often carried out in short courses, intervals between them are 2-3 weeks. To determine the sensitivity of a tumor to each specific type of chemotherapy, at least 2 cycles of treatment are carried out. If there is no effect, then the lymphoma is treated with another chemotherapy regimen.

The chemotherapy regimen is changed if, after a significant reduction in the size of the lymph nodes, they increase in the interval between cycles. This indicates tumor resistance to the combination of cytostatics used.

If the long-awaited effect of the standard chemotherapy regimen does not occur, high-dose chemotherapy is performed and hematopoietic stem cells are transplanted. With high-dose chemotherapy, high doses of cytostatics are prescribed, which kill even the most resistant and persistent lymphoma cells. However, this treatment can destroy hematopoiesis in the bone marrow. Therefore, stem cells are transferred into the hematopoietic system to restore the destroyed bone marrow, i.e. allogeneic stem cell transplantation is performed.

It is important to know! In an allogeneic transplant, stem cells or bone marrow are taken from another person (a compatible donor). It is less toxic and is performed more often. In autologous transplantation, stem cells are taken from the patient himself before high-dose chemotherapy is performed.

Cytostatics are administered by transfusion (infusion) or injections intravenously. As a result of systemic chemotherapy, the medicine is carried throughout the body through blood vessels and fights lymphoma cells. If damage to the central nervous system is suspected or test results indicate this, then in addition to systemic chemistry, the medicine is injected directly into the brain fluid, i.e. intrathecal chemistry is performed.

Brain fluid is found in the space around the spinal cord and brain. The blood-brain barrier that protects the brain does not allow cytostatics to pass through the blood vessels to the brain tissue. Therefore, intratectal chemistry is important for patients.

To increase the effectiveness of treatment, it is additionally used. NHL is a systemic disease that can affect the entire body. Therefore, it is impossible to cure with one surgical intervention. The operation is used for diagnostic purposes only. If a small tumor is detected, it is removed promptly and a less intensive course of chemotherapy is prescribed. Cytostatic drugs are completely abandoned only if there are tumor cells on the skin.

Biological treatment

Biological drugs: serums, vaccines, proteins replace natural substances produced by the body. Protein drugs that stimulate the production and growth of blood stem cells include, for example, Filgrastrim. They are used after chemotherapy to restore hematopoiesis and reduce the risk of developing infections.

Cytokines such as Interferon-alpha are used to treat skin T-cell lymphomas and hairy cell leukemia. Special white cells - monoclonal antibodies bind to antigens that are located on the surface of the tumor cell. Due to this, the cell dies. Therapeutic antibodies bind to antigens dissolved in the blood and are not bound to cells.

These antigens promote tumor growth. Then a monoclonal antibody is used for therapy. Biological treatment increases the effect of standard chemotherapy and prolongs remission. Monoclonal therapy is classified as immune therapy. Its various types activate the immune system so much that it itself begins to destroy cancer cells.

Tumor vaccines are capable of inducing an active immune response against proteins specific to tumor cells. A new type of CC T-cells carrying a load of chimeric antigen receptors that will act against a given target is being actively explored.

Radioimmunotherapy works with monoclonal therapeutic antibodies combined with a radioactive substance (radioisotope). When monoclonal antibodies bind to tumor cells, they die under the influence of a radioisotope.

Informative video

Nutrition for Non-Hodgkin's Lymphomas

Nutrition for non-Hodgkin lymphoma should be as follows:

• adequate in energy consumption to prevent weight gain;
• as varied as possible: with vegetables and fruits, animal meat, poultry, fish and products derived from it, seafood and herbs.
• with minimal consumption of pickles and fermented foods, table (sea or table) salt, and smoked meats.

Meals should be tasty, frequent and in small doses. Each patient should be approached individually so as not to exclude hypernatremia (excess sodium salts). This retains fluid in the body and forms swelling. In this case, salt and smoked foods should be excluded so as not to increase salt K in the blood. If the patient cannot eat fresh food, his appetite spoils, then you can add a minimum amount of caviar, olives and other pickles to the menu, but in combination with drugs that remove sodium. It should be borne in mind that after chemotherapy for diarrhea and vomiting, sodium salts, on the contrary, are very necessary for the body.

Traditional treatment

Includes: tinctures, infusions and decoctions of mushrooms and medicinal herbs. Infusions of wormwood, cocklebur, hemlock, Djungarian aconite, and black henbane are effective.

The following mushrooms have medicinal anti-oncological properties: birch chaga, reishi, cordyceps, meitake and shiitake, and Brazilian agaric. They prevent metastases, normalize hormonal levels, and reduce the side effects of chemotherapy: hair loss, pain and nausea.

To remove tumor toxins, crushed chaga (birch mushroom) is mixed with chopped knotweed root (3 tablespoons each) and poured with vodka (strong moonshine) - 0.5 liters. Let it brew for 3 weeks in the dark and take 30-40 drops 3-6 times a day.

The active substance Leuthinan, amino acids and polysaccharides of the reishi mushroom in combination with substances of the shiitake mushroom activates specific immunity and restores the blood formula.

Birch tar (100 g) should be washed 9 times in water, then ground with ammonia powder (10 g) and flour, calcined in a frying pan. Form the dough into balls measuring 0.5 cm in diameter. You can store them in a cardboard box, after sprinkling them with flour. For the first three days, take 1 ball 4 times 60 minutes before meals. Take 100 ml of herbal decoction.

Decoction: mix crushed agrimony herb with plantain (leaves), calendula (flowers) - all 50 grams. Cook (10 min) in 600 ml water 3 tbsp. l. collection Let it cool a little, then drink with lemon and honey.

Survival prognosis for non-Hodgkin lymphoma

Many patients and their relatives are interested in the question, how long do patients with one or another type of Non-Hodgkin lymphoma live? The prognosis depends on the subtype of the disease, stage and degree of its spread throughout the body. The classification of this disease includes 50 types of lymphomas.

According to research, the table shows the life expectancy for Non-Hodgkin's lymphoma after treatment for 5 years.

If a patient is diagnosed with non-Hodgkin's lymphoma, the lymphatic tissue is damaged by cancer cells. Today, cancer remains one of the most serious diseases. Lymphomas belong to a group of oncologies that directly affect the lymphatic system.

The patient’s chances for a successful recovery, first of all, depend on timely diagnosis, therefore, in order to promptly identify signs of the disease, you should carefully read the general information and symptoms of the pathology.

What is non-Hodgkin's lymphoma

In oncology, non-Hodgkin lymphoma is a malignant disease, during the development of which the lymphatic systems, as well as somatic organs, are damaged. This oncology is included in the neoplastic heterogeneous group. A favorable outcome for patients with this diagnosis is observed in only 25% of cases.

Pathology occurs in people of any age category, but more often it can be found in older people who are 60 years or more. Statistical studies prove that tumor lesions occur more often in men.

Causes

The specific reasons why non-Hodgkin's lymphoma occurs are unknown. Most of these cancers are formed from B cells; in other cases, the raw material is T cells. Today, the following risk factors are identified that occur in the development of this disease:

• viral infections such as hepatitis, Epstein-Barr, HIV, etc.;
• excess weight and age of the patient;
• organ transplantation or treatment with radiation and chemical therapy;
• exposure to carcinogens.

It is not yet possible to identify the exact cause of the appearance of malignant non-Hodgkin lymphomas in adults and children, but a number of the risk factors described above can greatly contribute to the development of the pathology.

Symptoms

When non-Hodgkin lymphoma occurs, symptoms may vary, depending on the location of the tumor, the extent of the pathological process and the degree of malignancy of the disease. All signs of lymphoma can be divided into three syndromes:

1. Lymphadenopathy;
2. Fever and intoxication;
3. Extranodal lesion.

The first sign is an increase in lymphatic tissue, which is accompanied by pain. This is usually observed in the cervical, inguinal and axillary lymph nodes.

Lymphosarcoma may also have other symptoms:

• rapid decrease in body weight;
• constant fatigue;
• increased sweating;
• itching;
• fever;
• anemia.

The above symptoms indicate generalization of the disease.

Stages of the disease

When making a diagnosis, the stage of development and level of malignancy of the tumor must be determined. Non-Hodgkin's lymphomas have 4 stages of development. Treatment methods and further prognosis depend on the stage.

1. The initial stage, which usually does not have characteristic symptoms. There is a single lesion of lymph nodes or internal organs.
2. In patients, simultaneous damage occurs in several lymph nodes, or extranodal organ damage, with the lesions localized on one side in relation to the diaphragm. Symptoms are partially absent.
3. At stage 3, lymphomas form on both sides of the diaphragm - in the chest cavity and abdominal region.
4. Terminal - stage 4 non-Hodgkin's lymphoma is characterized by a serious condition of the patient. In this case, where the first focus was localized no longer matters, since the cancer cells that are carried by blood and lymph have already affected the entire body, so the prognosis for a successful cure is disappointing. Damage to bone tissue and bone marrow also occurs.

Classification of the disease

Primary lymphosarcoma developing in the lymph nodes is called nodal, and when they form in other organs (brain, thyroid gland, spleen and intestine) they are called extranodal lymphoma. The structure of neoplasms of non-Hodgkin lymphomas can be follicular and diffuse.

In the case of non-Hodgkin lymphoma, the classification has the following main types:

1. Indolent;
2. Non-Hodgkin's lymphomas;
3. Highly aggressive.

Indolent lymphoma is characterized by slow progression and has a favorable prognosis. In the absence of qualified treatment, patients with indolent lymphomas can live up to 10 years. Aggressive lymphomas are caused by rapid development with vivid manifestations of symptoms. Tumors with rapid generalization of the oncological process are called highly aggressive.

• diffuse non-Hodgkin's lymphoma - the most common form of the histological type of disease is large cell non-Hodgkin's lymphoma. The disease is aggressive in nature, but in most cases patients are predicted to recover. Large cell diffuse lymphoma can occur in any area of ​​the body, but is most often localized in the cervical, axillary and groin areas.
• - occurs in approximately 22% of cases. The development of the tumor is indolent, but in case of late diagnosis or lack of treatment, it can transform into diffuse lymphoma with an aggressive nature. 5-year survival is observed in 60-70% of cases.
• Small cell lymphoma and chronic lymphocytic leukemia are similar types of non-Hodgkin lymphoma, occurring in approximately 7% of all cases. They develop slowly, but the prognosis is disappointing, since the disease cannot be treated. In the best case, a patient can live with a tumor for up to 10 years, subject to slow development, but transformation into a fast-growing oncology is also possible.
• Mantle cell lymphoma is a complex form of the disease with a 5-year survival rate of no more than 20% of patients. Occurs in 6% of cases.
• Lymphomas from marginal zone cells can be extranodal, nodal and splenic. Pathological cells of this form of the disease develop slowly and, with timely diagnosis in the early stages, respond well to therapy.
• Mediastinal lymphoma is a rare form of the disease, observed in only 2% of cases. The risk group includes women aged 30 to 40 years. It is characterized by rapid development, which can cause compression of the mediastinal organs. Cure is possible only in 50% of cases.
• Lymphoplasmacytic lymphoma is a rare disease, occurring in 1% of cases of non-Hodgkin's lymphoma. There may be an increase in blood viscosity, capillary ruptures, and the formation of vascular blood clots. Survival can vary from 2 to 20 years, depending on how quickly the tumor develops.
• Hairy cell leukemia - seen in older people. Progression is slow, so treatment is not always required.
• - occurs in 2% of cases, with men under 30 years of age falling into the high-risk group. The development of oncology is aggressive. Curing patients is only possible with intensive chemotherapy. Life expectancy can be 2-3 years.
• Lymphoma of the central nervous system - initial development can affect the spinal cord and brain. Often occurs in conjunction with HIV infection. Prediction of survival in this case is no more than 5 years, and only in 30% of cases.
• Lymphocytic plasmacytoma is a rare disease, but when a tumor-like neoplasm occurs, the pathology can spread throughout the body. A tumor is formed from bone marrow cells and lymph nodes.

Types of T-cell lymphomas:

• Lymphoma or leukemia from progenitor cells is observed in only 2% of cases. Leukemia or lymphoma differ in the number of blast cells in the bone marrow. In 25% it forms as leukemia, in other cases - lymphoma.
• Peripheral lymphomas - this list includes cutaneous lymphomas, as well as panniculitis-like, extranodal, angiomunoblastic and lymphoma with enteropathy. For the most part, the progression of T-cell non-Hodgkin's lymphomas is short-lived and the chances of cure are poor.

If non-Hodgkin's lymphoma is diagnosed, the prognosis for life depends on a number of factors, such as the form of the disease, stage and pattern of progression. For each form of the disease, the process of development and treatment may take place differently.

Diagnostics

When non-Hodgkin's lymphoma occurs, diagnosis is carried out by oncohematologists. During an external examination, the occurrence of lymphoma may be indicated by an increase in certain lymphatic groups, as well as intoxication and extranodal lesions. When diagnosing, to confirm a probable diagnosis, a biopsy should be performed, removing tissue that will be examined. Also, during the diagnostic process, the patient may be referred for the following procedures:

• radiography;
• computed tomography (CT);
• lymphoscintigraphy;
• bone scintigraphy;
• magnetic resonance imaging (MRI).

Also, during the examination, the doctor must differentiate non-Hodgkin's lymphoma from lymphogranulosis, metastatic cancer, tuberculosis, syphilis or some other disease. Only after an accurate diagnosis can optimal therapy be prescribed, based on the nature of the disease, stage of development and location.

Treatment

Once non-Hodgkin's lymphoma is diagnosed, treatment can be done with a variety of therapies. During treatment, radiation therapy, chemotherapy and surgery may be prescribed. Depending on the form of the disease, localization of the tumor, prevalence, general physical condition of the patient and his age, the doctor prescribes the optimal course of treatment.

In some cases, if the patient is elderly and the tumor is progressing slowly, it may not be rational to treat it. Then monitoring of the dynamics of tumor development is prescribed. Also, treatment may be ineffective if the cancer has already spread to the entire body, so when the first signs of the disease appear, you should definitely undergo an examination. In case of isolated damage to any organ, surgical intervention is more often prescribed. Non-Hodgkin's lymphoma is not curable using traditional medicine.

Radiation therapy

Treatment of non-Hodgkin's lymphoma with radiation can be effective only when the pathology has a low level of malignancy and is localized in a specific area. In some cases, radiation therapy may be prescribed if chemotherapy is not possible, for example, if the patient has contraindications.

Chemotherapy

Chemical drugs are most often prescribed to treat non-Hodgkin's lymphoma. When diagnosing the disease at an early stage of development, monochemotherapy is used. If a severe stage is detected, when lymphoma manifests itself aggressively, polychemotherapy is necessary. In some cases, complex treatment is possible, when chemotherapy is combined with radiation therapy.

Nutrition for lymphoma

The diet for lymphoma should be frequent, small portions and as varied as possible. Food should contain vegetables, fruits, seafood and meat of different types of animals. It is important to minimize the consumption of fermented foods and salts. If the patient cannot eat bland food, some pickles, such as olives or caviar, can be added to the food.

Forecast

Damage to the lymphatic system can develop into breast cancer, brain cancer, liver cancer and other organs. When treating non-Hodgkin's lymphoma, the prognosis for the patient's life is individual, depending on the stage, malignancy, age of the patient and other factors, so the prognosis cannot be general for everyone. Some patients manage to be completely cured of cancer, in other cases tumor relapses are observed, and sometimes medicine may be powerless, for example, if small cell lymphoma occurs.

It is impossible to determine exactly how long patients with this form of cancer live; in some cases, this period can reach 10 years; in others, rapid progression may begin at a certain stage. In case of timely diagnosis of non-Hodgkin lymphomas in the initial stages of development, with an optimal course of treatment, the patient’s chances of recovery can reach 70%.