Non-Hodgkin Lymphoma

Overview

Non-Hodgkin lymphoma (NHL) is the sixth most commonly diagnosed cancer in both men and women in the United States. In 2015, it is estimated that there will be 71,850 new cases of NHL (39,850 men and 32,000 women) and 19,790 deaths from NHL. The disease represents approximately 4.3% of all cancer diagnoses (4.7% in males and 4% in females). Notably, incidence rates of NHL almost doubled between 1970 and 1990 but have stabilized since the late 1990s among general populations. Some of this increase may be artifactual, resulting from improved diagnostic techniques and access to medical care, or directly related to the development of NHL in 25- to 54-year-old men with human immunodeficiency virus (HIV) infection. However, additional factors must be responsible for this unexpected increase in frequency of NHL that has been observed throughout the United States.

The increases have been more pronounced in whites, males, the elderly, and those with NHL diagnosed at extranodal sites. Similar findings have been reported in other developed countries. In the United States, incidence rates increased significantly during 2002-2011 for marginal zone lymphoma (average 1.7% per year), mantle cell lymphoma (MCL) (1.7% per year), adult T-cell leukemia/lymphoma (6.6% per year), and natural killer (NK)/T-cell lymphoma (3.5% per year) but decreased for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (−1.4% per year).

Sidebar: Analysis of pre-diagnosis blood specimens for evidence of t(14;18) in patients with follicular lymphoma revealed that progression to follicular lymphoma may occur up to 20 years later in apparently healthy individuals carrying this marker. Investigators estimated that for individuals with a high frequency of peripheral blood t(14;18), the risk of developing follicular lymphoma may be as high as 23-fold that of controls. This marker of risk was present many years before diagnosis in patients. (Roulland S et al: J Clin Oncol 32:1347-1355, 2014).

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