Non-Hodgkin Lymphoma Diagnosis and Treatment

Clinical Presentation and Diagnosis

The American College of Hematology recommends that non-Hodgkin lymphoma diagnosis should be based on an excisional lymph node biopsy providing adequate tissue for histopathology and immunohistochemistry, as fine needle aspiration or core biopsy is inadequate except in rare emergency situations 1, 3
The European Society for Medical Oncology states that diffuse large B-cell lymphoma represents 30-58% of NHL cases, with incidence increasing dramatically with age from 0.3/100,000 at ages 35-39 to 26.6/100,000 at ages 80-84 2

The National Comprehensive Cancer Network recommends that complete staging requires CT scan of chest, abdomen, and pelvis, bone marrow aspirate and biopsy, complete blood count, LDH, uric acid, and screening for HIV, hepatitis B, and hepatitis C 1
The American Society of Clinical Oncology suggests that the Ann Arbor staging system with notation of bulky disease (>10 cm) should be used, and the International Prognostic Index (IPI) must be calculated for large cell lymphomas 1, 2

The American College of Hematology recommends that six to eight cycles of R-CHOP given every 21 days is the standard treatment for CD20-positive large B-cell NHL of all stages 1, 2, 3
The European Society for Medical Oncology states that treatment should be stratified by IPI score and patient factors, with standard R-CHOP for young low-risk patients (IPI 0-1), and consideration of high-dose chemotherapy with stem cell transplant for young high-risk patients (IPI ≥2) 1, 2, 3

The National Comprehensive Cancer Network recommends that radiological assessment should be performed after 2-4 cycles, after completion of treatment, and whenever response is questioned, with PET-CT preferred for response assessment in FDG-avid lymphomas 1, 3, 4
The American Society of Clinical Oncology suggests that patients with incomplete or inadequate response should be immediately evaluated for salvage regimens 1

The American College of Hematology recommends that for chemosensitive relapsed disease, high-dose chemotherapy with autologous stem cell transplantation is standard, with salvage regimens used before transplant 3
The European Society for Medical Oncology states that history, physical examination, blood count, and LDH should be performed at 3, 6, 12, and 24 months, then only as clinically indicated for patients suitable for further therapy 2, 4