B-cell lymphoma natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
B-cell lymphomas include both Hodgkin's lymphomas and most Non-Hodgkin lymphomas. 30% of patients with Hodgkin's lymphoma may progress to develop B symptoms. The natural history of Non-Hodgkin lymphomas significantly varies depending on the subtype and its prognosis. Complications of B cell lymphomas are usually due to side effects of chemotherapy and/or radiotherapy. Depending on the stage of the Hodgkin's lymphoma at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent. The prognosis of non-Hodgkin's lymphoma (NHL) varies with the histopathology, the extent of involvement, and patient factors. Low-grade lymphomas have the most favorable prognosis.
Natural History, Complications, and Prognosis
B-cell lymphomas include both Hodgkin's lymphomas and most Non-Hodgkin lymphomas.
Natural History
- 30% of patients with Hodgkin's lymphoma may progress to develop B symptoms (unintentional weight loss, fever, drenching night sweats)[1].
- The natural history of Non-Hodgkin lymphomas significantly varies depending on the subtype and its prognosis. If left untreated, aggresive lymphomas present with B symptoms, and patients' condition significantly deteriorates within days or weeks. On the other hand, indolent lymphomas usually present with waxing and waning lymphadenopathy for years[2].
Complications
- Complications of B cell lymphomas are usually due to side effects of chemotherapy and/or radiotherapy.
- Complications in patients with Hodgkin's lymphoma include:
- Common complications of chemotherapy and/or radiotherapy in patients with Hodgkin's lymphoma include:[3][4]
- Nausea and vomiting
- Xerostomia
- Sore throat
- Dysgeusia
- Diarrhea
- Fatigue
- Skin reactions
- Late and long-term complications of chemotherapy and/or radiotherapy in patients with Hodgkin's lymphoma include:[3][4]
- Second malignancies (e.g., breast cancer, lung cancer, colon cancer, leukemias, non-Hodgkin lymphomas, etc.)[5][6][7]
- Infertility
- Infections
- Hypothyroidism
- Dyspnea
- Growth delay in children
- Cardiovascular complications (e.g., congestive heart failure, cardiomyopathies, myocardial infarction, pericarditis, arryhtmias, etc.)[8][9][10]
- Common complications of chemotherapy and/or radiotherapy in patients with Hodgkin's lymphoma include:[3][4]
- Complications in patients with non-Hodgkin's lymphoma include:
- Common complications of chemotherapy and/or radiotherapy in patients with non-Hodgkin lymphoma include:[2]
- Nausea and vomiting
- Fatigue
- Myelosuppression
- Febrile neutropenia
- Immunosuppression
- Late and long-term complications of chemotherapy and/or radiotherapy in patients with non-Hodgkin lymphoma include:[2][8]
- Second malignancies (e.g., myelodysplastic syndrome, acute myeloid leukemia, bladder cancer, lung cancer, gastrointestinal tract cancer, breast cancer, skin cancer, squamous cell carcinoma of the head and neck)
- Cardiovascular complications (e.g., cardiomyopathies, congestive heart failure, myocardial infarction)
- Infertility
- Hypothyroidism
- Growth hormone deficiency
- Insulin resistance
- Hypogonadism
- Dyslipidemia
- Post-traumatic stress disorder
- Progressive multifocal leukoencephalopathy (in patients treated with an anti-CD20 monoclonal antibody)
- Common complications of chemotherapy and/or radiotherapy in patients with non-Hodgkin lymphoma include:[2]
- Complications in patients with Hodgkin's lymphoma include:
Prognosis
- Depending on the stage of the Hodgkin's lymphoma at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent.[1]
- In patients with stage 1 or 2a Hodgkin's lymphoma, the 5-year overall survival is approximately 90%.
- In patients with stage 4 Hodgkin's lymphoma, the 5-year overall survival is approximately 60%.
- The prognosis of non-Hodgkin's lymphoma (NHL) varies with the histopathology, the extent of involvement, and patient factors. Low-grade lymphomas have the most favorable prognosis.[2][11]
- International Prognostic Index (IPI) is the main prognostic tool for NHL to determine the risk, which consists of five factors, including age >60 years, an increased serum LDH level, more than one extranodal involvement, Eastern Cooperative oncology group (ECOG) performance status 2 or greater than 2, and clinical stage III or IV.
- Patients with aggressive NK or T cell lymphomas generally have the worst prognosis. In addition, patients with immunodeficiency states have a poor response to treatment.
References
- ↑ 1.0 1.1 Kaseb H, Babiker HM. PMID 29763144. Missing or empty
|title=(help) - ↑ 2.0 2.1 2.2 2.3 Sapkota S, Shaikh H. PMID 32644754 Check
|pmid=value (help). Missing or empty|title=(help) - ↑ 3.0 3.1 Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/treatment/?region=ab Accessed on September 10, 2015
- ↑ 4.0 4.1 "Radiation Therapy for Hodgkin Lymphoma | Radiation for Hodgkin Disease".
- ↑ Schaapveld M, Aleman BM, van Eggermond AM, Janus CP, Krol AD, van der Maazen RW, Roesink J, Raemaekers JM, de Boer JP, Zijlstra JM, van Imhoff GW, Petersen EJ, Poortmans PM, Beijert M, Lybeert ML, Mulder I, Visser O, Louwman MW, Krul IM, Lugtenburg PJ, van Leeuwen FE (December 2015). "Second Cancer Risk Up to 40 Years after Treatment for Hodgkin's Lymphoma". N Engl J Med. 373 (26): 2499–511. doi:10.1056/NEJMoa1505949. PMID 26699166.
- ↑ Borchmann P, Behringer K, Josting A, Rueffer JU, Schnell R, Diehl V, Engert A, Kvasnicka HM, Thiele J (February 2006). "[Secondary malignancies after successful primary treatment of malignant Hodgkin's lymphoma]". Pathologe (in German). 27 (1): 47–52. doi:10.1007/s00292-005-0811-0. PMID 16369761.
- ↑ van Leeuwen FE, Klokman WJ, Veer MB, Hagenbeek A, Krol AD, Vetter UA, Schaapveld M, van Heerde P, Burgers JM, Somers R, Aleman BM (February 2000). "Long-term risk of second malignancy in survivors of Hodgkin's disease treated during adolescence or young adulthood". J Clin Oncol. 18 (3): 487–97. doi:10.1200/JCO.2000.18.3.487. PMID 10653864.
- ↑ 8.0 8.1 Ng AK, LaCasce A, Travis LB (May 2011). "Long-term complications of lymphoma and its treatment". J Clin Oncol. 29 (14): 1885–92. doi:10.1200/JCO.2010.32.8427. PMID 21483015.
- ↑ Galper SL, Yu JB, Mauch PM, Strasser JF, Silver B, Lacasce A, Marcus KJ, Stevenson MA, Chen MH, Ng AK (January 2011). "Clinically significant cardiac disease in patients with Hodgkin lymphoma treated with mediastinal irradiation". Blood. 117 (2): 412–8. doi:10.1182/blood-2010-06-291328. PMID 20858859.
- ↑ Zinzani PL, Federico M, Oliva S, Pinto A, Rigacci L, Specchia G, Tucci A, Vitolo U (January 2015). "The more patients you treat, the more you cure: managing cardiotoxicity in the treatment of aggressive non-Hodgkin lymphoma". Leuk Lymphoma. 56 (1): 12–25. doi:10.3109/10428194.2014.894187. PMID 24559287.
- ↑ "Survival Rates and Factors That Affect Prognosis (Outlook) for Non-Hodgkin Lymphoma".