Lymphoma: Hodgkin & Non-Hodgkin

Hodgkin Lymphoma is defined by the presence of distinctive Reed-Sternberg cells on biopsy and tends to spread in a predictable pattern through adjacent lymph node groups. It is highly curable with standard therapy in many patients. Non-Hodgkin Lymphoma is a much broader category encompassing over 60 subtypes of B-cell, T-cell, and NK-cell lymphomas with widely varying behavior, from very slow-growing (indolent) to rapidly progressive (aggressive).

The most common early sign is painless swelling of one or more lymph nodes, usually in the neck, armpit, or groin. Some patients also notice persistent fatigue, unexplained weight loss, drenching night sweats, or unexplained fevers. These systemic symptoms (called B-symptoms) are particularly important to report to a doctor promptly. Not all lymph node swelling indicates lymphoma — infections are a far more common cause — but swelling that persists beyond a few weeks without a clear cause warrants medical evaluation.

Many lymphoma subtypes are potentially curable, particularly Hodgkin Lymphoma and certain aggressive B-cell NHLs like DLBCL when caught and treated appropriately. Indolent NHLs such as Follicular Lymphoma are generally not curable with standard therapy but are manageable as a chronic condition over many years. The advent of CAR-T cell therapy and bispecific antibodies has further improved outcomes in relapsed and refractory settings that were previously associated with poor prognosis.

CAR-T (Chimeric Antigen Receptor T-cell) therapy involves collecting a patient's own T-cells, engineering them in a laboratory to recognize and attack lymphoma cells (typically targeting CD19), and infusing them back into the patient. It is currently approved for relapsed/refractory large B-cell lymphoma after two or more prior lines of therapy, and in some settings as second-line therapy for early relapse. Eligibility depends on performance status, organ function, prior therapy, and disease characteristics. Several approved CAR-T products exist, with differences in manufacturing and toxicity profiles.

PET-CT (positron emission tomography combined with CT) is now the standard imaging modality for most lymphoma subtypes. It is used at diagnosis to determine the extent of disease (staging), after several cycles of therapy to assess interim response (which can guide de-escalation or escalation decisions), and at the end of treatment to confirm remission. PET-CT is more sensitive than CT alone for detecting active lymphoma and plays a central role in response-adapted treatment strategies.

Double-hit lymphoma refers to aggressive B-cell lymphoma (usually DLBCL) that carries rearrangements of both the MYC gene and either BCL2 or BCL6. These concurrent rearrangements drive unusually aggressive tumor biology. Outcomes with standard R-CHOP are inferior compared to other DLBCL subtypes, and more intensive induction regimens, early consideration of CNS prophylaxis, and consolidation transplant or CAR-T in eligible patients are often employed. Expert management at a specialized lymphoma center is strongly recommended.

Relapsed or refractory lymphoma requires a reassessment of diagnosis (sometimes with a repeat biopsy to rule out transformation) and selection of salvage therapy. For eligible patients with chemosensitive disease, autologous stem cell transplant remains a standard option. CAR-T cell therapy and bispecific antibodies (epcoritamab, glofitamab) have changed the outlook in relapsed DLBCL. Allogeneic transplant may be considered in patients with T-cell lymphomas or those relapsing after autologous SCT. Clinical trial enrollment at this stage is strongly encouraged.

Most lymphoma cases are not directly inherited. However, certain hereditary immune conditions (e.g., Autoimmune Lymphoproliferative Syndrome, X-linked Lymphoproliferative Disease) significantly increase lymphoma risk. First-degree relatives of lymphoma patients have a modestly elevated risk compared to the general population, but this does not typically warrant routine screening. Genetic counseling may be appropriate in families with multiple affected members or associated immune deficiency diagnoses.

Yes. CancerFax works with lymphoma patients and families to facilitate medical report review by expert hematologists and hematopathologists, arrange second opinions for unusual or high-risk presentations, and coordinate access to advanced therapies including CAR-T cell therapy, bispecific antibodies, and clinical trials at specialist centers in India, China, the United States, and Europe. We can also assist with cross-border care coordination for patients seeking internationally available treatments not yet approved in their home country. Contact CancerFax to share your medical reports and begin the process.