Non-Hodgkin’s lymphoma, from which actress Jane Fonda suffers, for example, is a cancer of the lymphatic system. What symptom should alert? What treatments when he is aggressive? What prognosis? Answers with Dr Julien Lenglet, hematologist at the Private Hospital of Antony.
[Mis à jour le 7 septembre 2022 à 12h49] Non-Hodgkin’s lymphoma is cancer of the lymphocytes, white blood cells involved in the body’s defense reactions. The actress Jane Fonda, 84, has published a post September 4, 2022 on her Instagram account in which she announces that she has non-Hodgkin’s lymphoma and has started treatment by chemotherapy. In France, non-Hodgkin’s lymphoma is located 6th most common cancerand has about 11,600 new cases per year. They affect men a little more often (54%) and are observed at any age, with however an increased frequency after 60-65 years. Thanks to therapeutic progress, many cures are now possible. What difference between Hodgkin’s and non-Hodgkin’s lymphoma ? What are the symptoms ? What life expectancy or what prognosis with Hodgkin lymphoma? Know everything.
Definition: what is non-Hodgkin’s lymphoma?
Non-Hodgkin’s lymphoma is a cancer which develops from lymphatic system cells, lymphocytes. It is a type of white blood cells involved in the body’s defense reactions. Non-Hodgkin’s lymphoma appears on more often in one group of lymph nodes (nodal lymphoma) or, more rarely, in another organ such as the stomach, intestine, skin or brain (extra-nodal lymphoma). It can spread, through the lymphatic system or the blood system, to any tissue or organ (stomach, intestine, skin, part of the Oto-Rhino-Laryngological system, testicles, brain, etc.), with or without associated lymph node involvement . It causes a overall drop in immunity.
What is the difference with Hodgkin lymphoma?
The difference between Hodgkin’s lymphoma (Hodgkin’s disease) and NHL is the presence of Reed-Sternberg cells. A Reed-Sternberg cell is a cell derived from a B lymphocyte and which is present only in the case of Hodgkin’s lymphoma.
► If Reed-Sternberg cells are present when the tumor is seen under a microscope, the diagnosis is Hodgkin’s lymphoma.
► If there is no Reed-Sternberg cell in the lymphatic tumour, the diagnosis will likely be NHL. The NHL is more common than Hodgkin’s lymphomain a ratio of 6 to 1. Of all lymphoma diagnoses, 85% are NHL. “Distinguishing between Hodgkin’s lymphoma and NHL is important because they have different ways of spreading and they require different treatments,” insists the doctor.
What are the symptoms of non-Hodgkin’s lymphoma?
The lymph nodes are neither painful nor inflammatory and grow more or less quickly depending on the aggressiveness of the disease. Enlarged lymph nodes in the neck, armpits or groin is due to the abnormal proliferation of diseased lymphocytes that compose them. Depending on the location of the affected lymph nodes, other manifestations may appear:
- Persistent fatigue and intense;
- Fever and chills apart from common winter infections;
- Persistent night sweats ;
- Unexplained weight loss ;
- Repeated chest pain or difficulty breathing;
- Itching without skin lesions.
What is aggressive non-Hodgkin’s lymphoma?
Adult non-Hodgkin’s lymphomas include aggressive or high-grade forms of malignancy characterized by rapid progression. These forms, which would represent about half, evolve in a few weeks or even a few months only. “Given this rapid development, these situations require the establishment of rapid therapeutic management, from the diagnosis. Namely chemotherapy, most often associated with immunotherapy. We speak of immunochemotherapy” explains Dr. Julien Lenglet, hematologist at the Private Hospital of Antony.
What is Burkitt’s lymphoma?
What causes non-Hodgkin’s lymphoma?
The exact causes of non-Hodgkin’s lymphoma are not known. However, the occurrence of the disease could be favored by the combination of several factors:
- Chronic viral infection (hepatitis C, HIV, Epstein Barr virus) or bacterial infection (in particular prolonged presence in the stomach of the Helicobacter pylori germ, responsible in particular for peptic ulcer disease);
- Prolonged immune deficiency (autoimmune disease: lupus, immunosuppressive treatment given for example in the event of a transplant);
- Celiac disease not treated by a gluten-free diet;
- History of chemotherapy with drugs containing elements called “alkylating agents”;
- Exposure to toxic products: pesticides, solvents, fertilizers. Non-Hodgkin’s lymphoma linked to exposure to pesticides is included in the table of occupational diseases for farmers.
Of all lymphoma diagnoses, 85% are non-Hodgkin’s.
What are the different stages of non-Hodgkin’s lymphoma?
Depending on the extent and locations, as for Hodgkin’s disease, 4 stages will be defined:
- Stage I : involvement of a single lymph node group;
- Stage II: involvement of several lymph node groups but only on one side of the diaphragm (muscle separating the thorax and abdomen);
- Stage III: lymph node involvement on either side of the diaphragm;
- Stage IV: damage affecting one or more viscera.
The histological aspect will also make it possible to characterize the type of non-Hodgkin’s lymphoma (diffuse, follicular, with small or large cells, etc.) and to define its grade of malignancy and scalability (low to high).
Diagnosis of non-Hodgkin’s lymphoma includes a clinical examination and blood tests. It is established by pathological examination of a lymph node taken from the patientt. A PET scanner is performed to determine the number and size of affected lymph nodes. A bone marrow examination is often necessary. Complementary examinations may be prescribed in certain cases (cerebrospinal fluid examination, other imaging testsetc.).
What is the treatment for non-Hodgkin’s lymphoma?
“Given the heterogeneity of the non-Hodgkin’s lymphoma family, there is not one treatment but treatments adapted to the type of non-Hodgkin’s lymphoma, its level of extension, age and general condition. of the patient”, continues the specialist. The various methods will often be associated or combined, and their indications vary according to the situation. The constant progress recorded in recent years for the treatment of non-Hodgkin’s lymphomas is very encouraging and many therapeutic protocols currently being evaluated offer hope for further improving the prognosis of these conditions.
► The Chemotherapy is however the keystone. More aggressive non-Hodgkin’s lymphomas will be treated with intravenous polychemotherapy courses with greater toxicity, therefore more side effects.
► In recent years, other methods have proven themselves, in particular certain types ofmonoclonal antibodies (rituximab) to “block” the growth of the tumor cell (immunotherapy), which can be used alone or in combination with chemotherapy.
► Overall, the most indolent forms of non-Hodgkin’s lymphoma, especially in the elderly, do not require any treatment, easy monitoring. They are only treated if the lymph nodes have a very increased size or if they compress another organ, or if they are responsible for anemia (lower hemoglobin level).
► Intensive treatments (autologous stem cell transplantss) are sometimes indicated, either in first line, or in case of relapse.
► Radiation therapy retains only a few more and more limited indications.
It usually recurs in the form in which it originated.
What is the risk of relapse?
Recurrence of NHL means that the lymphoma comes back after treatment. If it reappears where it first originated, it is called a local recurrence. But it can reappear in another part of the body. When NHL recurs, it usually does so in the form in which it started. This means that low-grade (indolent) NHL usually recurs as low-grade lymphoma. But sometimes a type of low-grade NHL will recur as high-grade (aggressive) NHL.
The relative survival is 85% at 5 years in men and 92% in women
What is the life expectancy with non-Hodgkin’s lymphoma?
However, the prognosis depends on several factors: the type of lymphoma, the age of the patient and the associated diseases, the stage of advancement of the disease as well as other biological prognostic factors. Small cell lymphomas, known as indolent lymphomas, generally progress very slowly, but the response of the disease to chemotherapy is incomplete and relapses are not uncommon. Conversely, large cell lymphomas, known as aggressive lymphomas, evolve very quickly without treatment. “But thanks to the effectiveness of current treatments, recovery is frequent (90%) in localized forms, and more and more often obtained in the extended forms”, concludes Dr. Lenglet. The relative survival is 85% at 5 years in men and 92% in womenaccording to the France Lymphoma Hope Association.
Thank you to Dr Julien Lenglet, hematologist at the Private Hospital of Antony.