Non-Hodgkin’s lymphoma: diagnosis and management

Context

Non‑Hodgkin's lymphoma is the sixth most common cancer in the UK. There are many different subtypes of the disease, with markedly different clinical courses and requirements for therapy. Diagnosing non‑Hodgkin's lymphoma and identifying the precise subtype is challenging, and optimising the diagnostic process is central to improved management. Significant improvements in our understanding of the biology of non‑Hodgkin's lymphoma have contributed to improved diagnosis and also allowed for more targeted therapies.

The treatment of non‑Hodgkin's lymphoma has been a beacon for the development of specific treatment strategies (now applied to many other forms of cancer), but paradoxically there is a paucity of large randomised clinical trials to define best practice in treating the various subtypes. As a consequence there are considerable differences between centres and countries in the ways in which some subtypes of the disease are diagnosed and managed.

There have been some improvements in outcome for people with non‑Hodgkin's lymphoma in the last decade, but these have been relatively modest and there is still a need for improvement. This is a rapidly developing field, with a number of new therapies proving to be exciting in initial studies. It is too soon, however, to judge their long‑term impact, and ongoing assessment of these new agents compared with standard therapy will be needed.

This guideline covers adults and young people (16 years and older) who are referred to secondary care with suspected non‑Hodgkin's lymphoma, or who have newly diagnosed or relapsed non‑Hodgkin's lymphoma. It addresses a number of areas where there is uncertainty or variation in clinical practice, in relation to diagnosing non‑Hodgkin's lymphoma and management of the subtypes at different times in the course of the disease. It is not intended as a comprehensive guide to diagnosing and treating lymphomas. Topics include the best type of biopsy for diagnosis, genetic testing, the role of FDG‑PET‑CT imaging in staging, patient information needs and survivorship. Management of the more common subtypes is covered: that is, follicular lymphoma, MALT lymphoma, mantle cell lymphoma, diffuse large B‑cell lymphoma, Burkitt lymphoma and peripheral T‑cell lymphoma.

This guideline aims to facilitate standardisation of practice in treating non‑Hodgkin's lymphoma. But because of the rapid development of new therapies as a result of improved understanding of the biology of the disease, continual re‑evaluation will be essential.