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Lymphoma: Hodgkin's & Non-Hodgkin's

Lymphoma is a form of cancer that originates from a type of white blood cell called lymphocytes. 


Normal lymphocytes are an important part of the immune system that help our body to fight infection. They are present in the blood stream and lymphatic system.


The lymphatic system is a network of vessels that transports fluid and nutrients around the body and is a part of the immune system.



When some of these cells in the lymphatic system multiply uncontrollably and abnormally, they become cancerous. This is called Lymphoma.


Types of Lymphoma


1. Hodgkin’s Lymphoma (HL)

    (Hodgkin’s Disease)


2. Non-Hodgkin's Lymphoma (NHL)



What is Lymphoma?  click her for a short video



Diagnosis & Tests for Lymphoma

A diagnosis of lymphoma must be obtained with biopsy.  A representative sample of the swelling is removed, sent to a pathologist for analysis. 
The pathologist can then determine if this is lymphoma, its type (Hodgkin’s or Non-Hodgkin’s Lymphoma), its subtype and its behaviour (aggressive or indolent).          

Staging for Lymphoma

Once a diagnosis of lymphoma is confirmed, your doctor will carry out tests to stage the tumour and to determine the spread and extent of the tumour.
These follow-on tests include :
• Blood tests
• Radiological Imaging
   X-Ray / C T Scan / PET-CT Scan / MRI

   PET-CT Scan


Treatment Options

1. Watch & Wait


‘Watch & wait’ approach is sometimes adopted for lymphomas which are slow-growing, still in early stage and those that do not cause too much discomfort or side effect to the patient.


It is not the same as doing nothing; 

Close monitoring with your doctor is needed.  

You will require periodic blood tests and scans.


2. Radiation Therapy

 This involves the use of high energy X-ray to kill cancer cells directly.  This is useful in certain types of Lymphoma and 

when the disease if confined to one or two areas of the body.​​


Further Information on Lymphoma / Maklumat Tentant Limfoma

What's new ?

Previously untreated:

R-CHOP Regimen > Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone plus anti-CD20 Monoclonal Antibody (mAb) Rituximab

click > Coiffer et al. Blood 2010

POLARIX > Polatuzumab Vedotin+Rituximab, Cyclophosphamide,Doxorubicin and Prednisolone

 click>  Tilly et al. NEJM 2022

DLBCL Relapsed/Refractory

to consider CAR-T cell Therapy

click > ASTCT Guidelines


Symptoms of Lymphoma

The most common symptom of Lymphoma is painless swelling in the neck, armpit or groin area.  


Lymphoma  may also affect other parts of the body 

such as the lungs and the bowels. 


Apart from swellings, the common symptoms of lymphoma are recurrent or persistent fever, night sweats, weight loss, loss of appetite,tiredness, persistent itching of the body, breathlessness or cough.

Painless Swelling of the Armpit


Indolent vs Aggressive Lymphoma

'Indolent’ NHLs grow slowly. 


They typically cause no symptoms initially,

and so remained undetected for some time. 


The most common symptom of indolent NHL

is an enlarged lymph node, noticed as a lump.


Aggressive’ NHLs grow quickly.


Patients are likely to notice symptoms and go to their doctor earlier. 


Treatment is usually required shortly after diagnosis. 

Although the name ‘aggressive’ sounds frightening,

these lymphomas often respond very well to treatment.



Treatment Options

3. Chemotherapy


Chemotherapy drugs are drugs that are used to kill cancer cells.  Different combinations of chemotherapy drugs are used to treat different types of Lymphoma. 


The common combinations or regimens are ‘CHOP’ for Non-Hodgkin’s Lymphoma and ‘ABVD’ for Hodgkin’s Lymphoma.


Chemotherapy is also often given in combination with other types of treatment e.g. monoclonal antibodies


Watch a Youtube Video on Rituximab

Drugs used in Lymphoma


The Lymphatic System



Fluid in the Left Lung


Follicular Lymphoma: usually indolent


Diffuse Large Cell Lymphoma : usually aggressive



Treatment Options


4. Monoclonal Antibody


This is a type of targeted therapy or ‘smart bullet’’.  

Once administered into the body, it will bind to the cancerous lymphoma cells and destroy them.  

Its effect is enhanced if it is used in combination with chemotherapy.


One combination is Rituximab (a type of monoclonal antibody) with CHOP chemotherapy, commonly used for the treatment of Non-Hodgkin’s Lymphoma.

Monoclonal Antibody : Rituximab / Mabthera

Rituximab = R is an antibody against CD20.


CD20 is a protein found

(1) on the surface of white blood cells called B-lymphocytes (B-cells);

(2) in most of the cancerous B-cells that occur in many types of Lymphoma.


Rituximab  ‘locks on’ to a protein called CD20, which is found on the surface these lymphoma cells. 



Site of Action of Rituximab



CAR T Cell Therapy