Anthropometric Measurements as Predictors of Low Birth Weight Among Tanzanian Neonates: A Hospital-Based Study
November 7, 2025
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Background
NHL (Non-Hodgkin Lymphoma) is a cancer that originates from the T cell precursors, B cell precursors, mature T cells and mature B cells. This condition can be divided into two groups namely aggressive and indolent depending on the prognosis of the disease. Common neoplasms due to mature B cells include Burkitt lymphoma, Mantle cell lymphoma, Follicular lymphoma, primary CNS lymphoma, and marginal zone lymphoma. The treatment varies based on the stages of tumor, grade, type of lymphoma and clinical history of patients. The nature of NHL tumors varies characteristically. Indolent lymphomas may have waning and waxing lymphadenopathy manifested over many years whereas aggressive lymphomas are usually accompanied by B symptoms and could lead to death if left untreated. 66% of these patients show signs such as those typical for the peripheral lymphatic system. Other features include extra-nodal involvement, of which 10- 35% cases show primary extranodal lymphoma during diagnosis. Symptoms related to visceral obstruction, weight loss, early satiety, nausea, vomiting, and fullness of the abdomen manifest primary lymphoma of gastrointestinal tract.
Epidemiology
Non-Hodgkin lymphoma is common among people between 65 to 74 years of age who have a median age of 67. While Burkitt lymphoma is endemic in Africa, it has a higher prevalence in USA as well as Western Europe especially among children aged between 4 to 7 years old. Mantle Cell Lymphoma constitutes 7% of Adult Non-Hodgkin Lymphomas in The United States and Europe with annual incidences ranging from 4-8 cases per million people. It is very rare for infants to get lymphoma, though about 4% of childhood cancers affect babies. 25% adolescent boys aged 10-19 are diagnosed with high level Lymphomas while at least a quarter are girls the same age group.
Anatomy
Pathophysiology
Non-Hodgkin lymphoma, which generally arises from a chromosome translocation or mutation/deletion in B, T, or natural killer cells (chromosomal), is especially prevalent in follicular lymphoma, mantle cell lymphoma, Burkitt lymphoma, diffuse large B-cell lymphoma and primary CNS lymphoma, often associated with HIV/AIDS. The most prevalent chromosomal abnormality is translocation at t (14;18).
Etiology
Different factors can lead to non-Hodgkin Lymphomas (NHL) such as infections, environmental factors, immunodeficiency states and chronic inflammation while some kinds of NHL are brought about by human T-cell leukemia virus type 1, Epstein-Barr virus, Hepatitis C virus, human herpesvirus 8 and Helicobacter pylori infection. Furthermore, other infectious agents include drugs like phenytoin, digoxin and TNF antagonist, as well as organic chemicals, pesticides and radiation exposure. The human has a variety of intrinsic factors like Wiskott Aldrich syndrome, SCID or extrinsic factors like immunosuppressant drugs, this includes Sjögren’s disease, rheumatoid arthritis and Hashimoto’s thyroiditis among others. Apart from Hashimoto’s thyroiditis and Celiac disease that can cause it, there are other autoimmune conditions also associated with NHL risk. In general, NHL is a multifactorial disorder demanding for comprehensive management practices.
Genetics
Prognostic Factors
The prognosis of Non-Hodgkin lymphoma is influenced by histopathology, involvement, and patient factors. Standard-of-care treatment is assessed in terms of overall survival using the International Prognostic Index (IPI). Factors assessed by the index include age, serum LDH levels, ECOG performance status, clinical stage, and extranodal involvement. Categorized into low, intermediate, and poor risk are the IPI scores. Acquired or congenital immunodeficiency states increase the risk of lymphoma and poor therapy response. IPI has been modified for various NHL types for better prognosis assessment. Aggressive T or NK cell lymphomas have a worse prognosis, while low-grade lymphomas offer increased survival of 6-10 years.
Clinical History
Age: NHL is less common in children and adolescents, with common subtypes including Burkitt lymphoma and lymphoblastic lymphoma. Young adults may present with painless lymph node enlargement, fatigue, fever, night sweats, and unexplained weight loss. In middle-aged and older adults, NHL is more common, with aggressive features and increased incidence, including diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma.
Physical Examination
Examination of lymph node: Enlarged, non-tender, and firm lymph nodes may indicate lymphoma. Location and size of palpable lymph nodes should be assessing carefully.
Skin examination: Changes in skin, including lesions, rashes or nodules should be diagnosed.
Abdominal examination: Abdominal palpation should be done to check for enlargement of liver or spleen.
Respiratory examination: Respiratory symptoms like shortness of breath, chest pain or cough should be identified.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
NHL subtypes can present indolently with slow-growing lymph node enlargement, with a prolonged disease course. Aggressive NHLs, like DLBCL or Burkitt lymphoma, have rapidly growing tumors, pronounced B symptoms, and widespread involvement of lymph nodes and organs. These subtypes often require more intensive treatment. Asymptomatic NHLs may be discovered during routine medical exams or imaging studies, indicating a need for more targeted treatment.
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
There are different steps that are followed in the treatment of NHL. These include its staging, risk assessment as well as active surveillance. Staging refers to evaluating how far the disease has spread within the body which may include lymph node involvement or organ involvement. Such factors may include age, performance status, presence of constitutional symptoms or lymphoma characteristics when considering risk assessment for this disease. With this approach, then patients with minimal or even absent symptoms could benefit from it.
Chemotherapy is common and often combines rituximab with chemotherapy. Immunotherapy uses monoclonal antibodies that target specific proteins on lymphoma cells for improving the immune response to cancer by destroying targeted lymphoma cells more effectively. There are cases where radiation therapy is used alone or together with chemotherapy for attacking localized sites of the disease process. Supportive care measures, such as medications, supportive transfusions, and growth factors, are often integrated into the overall treatment plan to address side effects.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
modification-of-the-environment
Recognition of cancer including NHL can be difficult emotionally, and people with the disease and their family members may require psycho-social support usually provided by ounselling or psychotherapy. Through support groups, individuals with the illness are given an avenue where they can share common experiences and learn. Both during and after treatment, there is a need for good feeding and as such dieticians should offer advice on how best to have adequate nourishment and control the side impacts felt after receiving medication.
Overall, physical activity and rehabilitation help cancer patients feel better with targeted training exercises being helpful. Concerning such targets as functional limitations, mobility and quality of life, rehabilitation services may be considered. Anger or anxiety management, sleep promotion or elevation of moods through stress control are among the issues that mind-body techniques such as mindfulness meditation or breathing exercises can help handle. Complementary therapies including acupuncture, massage as well as reflexology can help to reduce pain. Palliative care as well as hospice services focus on improving life quality among severe illnesses such as NHL; at the same time educating them through patient’s education empowers them to actively participate in their medical treatment as well as make informed choices.
Administration of pharmaceutical agents with drugs
Chlorambucil: This drug inhibits the replication of DNA and transcription of RNA and cross-links and alkylates DNA strands. It is primarily used in treating indolent lymphomas especially CLL (chronic lymphocytic leukemia) and Waldenstrom macroglobulinemia.
Cyclophosphamide: This is related chemically to nitrogen mustards. It acts as an alkylating agent and may cause DNA cross- linking. This can be used as a monotherapy agent or in combination with other regimens.
Doxorubicin: It is an anthracycline antibiotic. It cannot cross the blood-brain barrier and excreted mainly in the bile. It is used in combination with vincristine, prednisone, cyclophosphamide and hydroxydaunomycin.
Vincristine: The mode of action of vincristine is unknown. It can cause a reduction in function of reticuloendothelial cells or an increased production of platelets. It is indicated in non-hematologic and hematologic malignancies.
Fludarabine: This is an analogue of purine which interferes with the synthesis of DNA via inhibition of ribonucleotide reductase. It is introduced into RNA leading to the inhibition of synthesis of RNA and proteins.
Pralaxate: It is an inhibitor of folate and indicated in treating refractory or relapsed peripheral T-cell lymphoma.
Etoposide: This is a derivative of podophyllotoxin. It exerts the cytotoxic activity by the stabilization of covalent intermediates that are produced between topoisomerase II and DNA substrate, causing breakage of double and single stranded DNAs.
Cyatarabine:  The active compound of cyatarabine namely cytarabine-5’-triphosphate is an inhibitor of DNA polymerase. It is specific to act in the S phase of cell cycle and blocks the process of cell division from G1 to S phase.
Bendamustine: This is an alkylating agent used in treating non-Hodgkin lymphoma of B-cell that increased in six months of treatment with rituximab.
Carboplatin: This is cisplatin analogue. Being a heavy metal complex, it exerts its actions via platination of DNA causing interstrand and intrastrand cross-links of DNA and inhibiting replication of DNA.
Bleomycin: This is a group of glycopeptides that are isolated from Streptomyces.
Use of antineoplastic agents/ histone deacetylase inhibitors
Vorinostat: It is an inhibitor of histone deacetylase. It is used in treating persistent, recurrent, or progressive cutaneous T-cell lymphoma.
Romidepsin: This causes alterations in the structure of chromatin and activation of transcription factor that in turn causes cell death. It is indicated in CTCL patients who received atleast one prior therapy.
Use of antineoplastic agents/ PI3K inhibitors
Copanlisib: This drug is a class-I inhibitor of PI3K (phosphatidylinositol-3-kinase) with predominant inhibition against alpha and delta forms of PI3K. It may inhibit proliferation of B cells that are premalignant and induce apoptosis that ultimately causes death of tumor cells.
Idelalisib: It induces apoptosis and causes proliferation in cell lines obtained from primary tumor cells and malignant B cells.
Duvelisib: It is a small oral molecule and selective inhibitor of delta and gamma forms of PI3K. It is generally indicated in adults with refractory/relapsed follicular cell lymphoma.
Use of monoclonal antibodies
Rituximab: It is engineered genetically as chimeric murine/human monoclonal antibody and directed towards the CD20 antigen that is found on the surface and malignant and normal B lymphocytes.
Rituximab/ hyaluronidase: This SC product is used in combination with human hyaluronidase that enhances the permeability via subcutaneous tissue. It is used in untreated diffuse large B-cell lymphoma in combination with vincristine, cyclophosphamide, prednisone or doxorubicin.
Ofatumumab: It is an anti-CD20 monoclonal antibody which inhibits the activation of B-cell in early stages. It is employed in treating chronic lymphocytic leukemia that is reftractory to alemtuzumab and fludarabine.
Use of antineoplastic agents/ proteasome inhibitors
Bortezomib: It is the first drug that is approved as anticancer agents. It is an inhibitor of proteasome.
Use of antineoplastic agents/ mTOR kinase inhibitors
Temsirolimus: It is a water-soluble ester. With high affinity, it binds to immunophilin FKBP and this complex works by inhibiting mTOR (mammalian target or rapamycin) kinase which is a key protein regulating gene translation for regulation of cell cycle.
Use of antineoplastic agents/ angiogenesis inhibitors
Lenadolimide: It is an analog of thalidomide and inhibits the production of TNF-α. It also stimulates T cells, decreases the serum levels of cytokine VEGF (vascular endothelial growth factor), bFGF (basic fibroblast growth factor) and inhibits the process of angiogenesis.
Use of PD-L1/PD-1 inhibitors
Pembrolizumab: It is employed in treatment of refractory PMBCL (primary mediastinal large B-cell lymphoma) in pediatric and adult patients.
Use of CAR T-cell therapy
CAR (chimeric antigen receptor) T-cell therapy, a type of adoptive therapy is genetically engineered to express CAR.
Axicabtagene ciloleucel: It is a kind of CD19-direceted genetically modified form of T-cell immunotherapy. It is approved for treating refractory or relapsed large B-cell lymphoma.
Tisagenlecleucel: This involves reprogramming a patient’s own T cell through transgene encoding of CAR receptor thereby identifying and eliminating CD-19 expressing malignant cells.
Lisocabtagene maraleucel: This is indicated in treating refractory/relapsed B-cell lymphoma, grade 3B follicular lymphoma, primary mediastinal large B-cell in adults.
Use of antineoplastic agents/ Anti-CD19 monoclonal antibodies
Loncastuximab tesirine: It is indicated for treating R/R large B-cell lymphoma and disuse large B-cell lymphoma in adults.
Tafasitamab: It is a humanized and Fc-modified cytolytic monoclonal antibody that targets CD19 and indicated in treatment of DLBCL in adults along with lenalidomide.
Use of colony-stimulating factor growth factors
Epoetin alfa: This is a purified glycoprotein which is produced from the mammalian cells. The aminoacid sequence of this product mimics endogenous EPO.
Darbepoetin alfa: This protein stimulates erythropoietin and related closely to EPO. It is also a primary growth factor that is synthesized in the kidney and stimulates erythoid progenitor cells development.
Filgarstim: It is a recombinant r-metHuG-CSF (methionyl human granulocyte colony-stimulating factor) that contains a protein with 175 aminoacids weighing 18,800 daltons. It is synthesized by E. coli into which the human gene G-CSF is inserted.
Use of immunomodulators
Interferon alfa-2a or 2b: These medications are responsible for regulating the crucial phases in immune reactions.
Use of corticosteroids
Dexamethasone: Â It is an immunosuppressant glucocorticoid that exerts its action by stimulation of the synthesis of enzymes required for reducing the response to inflammation. It is a component of methotrexate, doxorubicin, Oncovin, bleomycin, cyclophosphamide, and dexamethasone regimen (m-BACOD).
Prednisolone: It is a component of various regimens like CHOP. It is also a glucocorticoid immunosuppressant which acts via stimulation of enzymes responsible for reducing inflammatory response.
use-of-intervention-with-a-procedure-in-treating-non-hodgkin-lymphoma
Diagnosis of NHL involves biopsy, imaging tests, bone marrow biopsy, and induction therapy. Chemotherapy is the main treatment for many subtypes of  NHL, aiming to destroy or delay cancer cell development for remission. Monoclonal antibodies, like rituximab, can be used in combination with chemotherapy or as standalone treatments. Targeted therapies may be employed to address specific pathways involved in lymphoma growth. Additional treatment may be recommended to consolidate initial response, such as more cycles of chemotherapy or targeted agents. Stem cell transplantation may be used to restore injured bone marrow tissue in resistant or relapsed NHL patients. Maintenance therapy may be recommended to prolong remission and delay disease progression. Patients are regularly monitored to assess response, detect relapse, and manage late effects. Palliative care is integrated early in treatment to monitor symptoms, manage side effects, and improve quality of life. Clinical trials may be considered at various stages of NHL management.
Medication
120 mg/m² Intravenous infusion on day 1 and 2 of a 21-day cycle, repeated up to 8 times.
Dosage modifications
Non-hematologic toxicity
Above Grade 3: Decrease dosage to 90 mg/m2 on Day 1 and 2 of every cycle.
If toxicity above grade 3 develops again, lower the dosage to 60 mg/m2 on Day 1 and 2 of every cycle.
Hematologic toxicity
Grade 4: Decrease dosage to 90 mg/m2 on Day 1 and 2 of every cycle.
When grade 4 toxicity occurs again, lower the dosage to 60 mg/m2 on Day 1 and 2 of every cycle.
Dose Adjustments
Dosage Modifications
Hepatic impairment
Mild: caution advised
Moderate (bilirubin 1.5-3 xULN and AST/ALT 2.5-10 xULN): Avoid use.
Severe impairment (bilirubin above 3 times ULN): Usage is not advised
Renal impairment
CrCl below 30 mL/min: Not advised
Mild-to-moderate: caution is recommended
Lymphoma of Mantle Cell (Off-label)
90 mg/m2 Intravenous on days 2 and 3 of a 28-day cycle with rituximab for a maximum of 4 cycles
Day 1
Following the last dose of first-line chemotherapy, begin the ibritumomab therapeutic regimen for at least 6 weeks, but no more than 12 weeks, unless platelet counts have recovered to 150,000/mm3
Premedicate with acetaminophen 650 mg orally and diphenhydramine 50 mg orally prior to rituximab infusion
Infuse 250 mg/m2 intravenous rituximab at a rate of 50 mg/hr initially; can increase the rate by 50 mg per hour every 30 minutes with a maximum of 400 mg/hr; discontinue if a severe reaction occurs
Within 4 hours of rituximab infusion, administer 5 mCi of In-111 ibritumomab tiuxetan over 10 minutes
Imaging 48-72 hours after therapy can be used to assess biodistribution
Day 7, 8, or 9
Verify to see if the expected biodistribution is present
Prior to rituximab infusion, premedicate with acetaminophen 650 mg orally and diphenhydramine 50 mg orally
Administer 250 mg/m2 rituximab at a rate of 100 mg/hr initially, then increase to 100 mg/hr every 30 minutes; should not exceed more than 400 mg/hr
Platelet counts greater than 150,000 cells/mm3: Within 4 hours following rituximab infusion, administer 0.4 mCi/kg of Y-90 ibritumomab tiuxetan as a 10-minute IVP; do not exceed 32 mCi Y-90 ibritumomab tiuxetan regardless of patient weight
Platelet count ranges from 100,000 to 149,000 cells/mm3: Over 10 minutes, administer 0.3 mCi/kg ibritumomab tiuxetan; do not exceed 32 mCi Y-90 ibritumomab tiuxetan regardless of patient weight
Platelet count less than 100,000 cells/mmÂł: Do not use it
Monitor
CBC and platelet count every week until levels return to normal
Future Trends
NHL (Non-Hodgkin Lymphoma) is a cancer that originates from the T cell precursors, B cell precursors, mature T cells and mature B cells. This condition can be divided into two groups namely aggressive and indolent depending on the prognosis of the disease. Common neoplasms due to mature B cells include Burkitt lymphoma, Mantle cell lymphoma, Follicular lymphoma, primary CNS lymphoma, and marginal zone lymphoma. The treatment varies based on the stages of tumor, grade, type of lymphoma and clinical history of patients. The nature of NHL tumors varies characteristically. Indolent lymphomas may have waning and waxing lymphadenopathy manifested over many years whereas aggressive lymphomas are usually accompanied by B symptoms and could lead to death if left untreated. 66% of these patients show signs such as those typical for the peripheral lymphatic system. Other features include extra-nodal involvement, of which 10- 35% cases show primary extranodal lymphoma during diagnosis. Symptoms related to visceral obstruction, weight loss, early satiety, nausea, vomiting, and fullness of the abdomen manifest primary lymphoma of gastrointestinal tract.
Non-Hodgkin lymphoma is common among people between 65 to 74 years of age who have a median age of 67. While Burkitt lymphoma is endemic in Africa, it has a higher prevalence in USA as well as Western Europe especially among children aged between 4 to 7 years old. Mantle Cell Lymphoma constitutes 7% of Adult Non-Hodgkin Lymphomas in The United States and Europe with annual incidences ranging from 4-8 cases per million people. It is very rare for infants to get lymphoma, though about 4% of childhood cancers affect babies. 25% adolescent boys aged 10-19 are diagnosed with high level Lymphomas while at least a quarter are girls the same age group.
Non-Hodgkin lymphoma, which generally arises from a chromosome translocation or mutation/deletion in B, T, or natural killer cells (chromosomal), is especially prevalent in follicular lymphoma, mantle cell lymphoma, Burkitt lymphoma, diffuse large B-cell lymphoma and primary CNS lymphoma, often associated with HIV/AIDS. The most prevalent chromosomal abnormality is translocation at t (14;18).
Different factors can lead to non-Hodgkin Lymphomas (NHL) such as infections, environmental factors, immunodeficiency states and chronic inflammation while some kinds of NHL are brought about by human T-cell leukemia virus type 1, Epstein-Barr virus, Hepatitis C virus, human herpesvirus 8 and Helicobacter pylori infection. Furthermore, other infectious agents include drugs like phenytoin, digoxin and TNF antagonist, as well as organic chemicals, pesticides and radiation exposure. The human has a variety of intrinsic factors like Wiskott Aldrich syndrome, SCID or extrinsic factors like immunosuppressant drugs, this includes Sjögren’s disease, rheumatoid arthritis and Hashimoto’s thyroiditis among others. Apart from Hashimoto’s thyroiditis and Celiac disease that can cause it, there are other autoimmune conditions also associated with NHL risk. In general, NHL is a multifactorial disorder demanding for comprehensive management practices.
The prognosis of Non-Hodgkin lymphoma is influenced by histopathology, involvement, and patient factors. Standard-of-care treatment is assessed in terms of overall survival using the International Prognostic Index (IPI). Factors assessed by the index include age, serum LDH levels, ECOG performance status, clinical stage, and extranodal involvement. Categorized into low, intermediate, and poor risk are the IPI scores. Acquired or congenital immunodeficiency states increase the risk of lymphoma and poor therapy response. IPI has been modified for various NHL types for better prognosis assessment. Aggressive T or NK cell lymphomas have a worse prognosis, while low-grade lymphomas offer increased survival of 6-10 years.
Age: NHL is less common in children and adolescents, with common subtypes including Burkitt lymphoma and lymphoblastic lymphoma. Young adults may present with painless lymph node enlargement, fatigue, fever, night sweats, and unexplained weight loss. In middle-aged and older adults, NHL is more common, with aggressive features and increased incidence, including diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma.
Examination of lymph node: Enlarged, non-tender, and firm lymph nodes may indicate lymphoma. Location and size of palpable lymph nodes should be assessing carefully.
Skin examination: Changes in skin, including lesions, rashes or nodules should be diagnosed.
Abdominal examination: Abdominal palpation should be done to check for enlargement of liver or spleen.
Respiratory examination: Respiratory symptoms like shortness of breath, chest pain or cough should be identified.
NHL subtypes can present indolently with slow-growing lymph node enlargement, with a prolonged disease course. Aggressive NHLs, like DLBCL or Burkitt lymphoma, have rapidly growing tumors, pronounced B symptoms, and widespread involvement of lymph nodes and organs. These subtypes often require more intensive treatment. Asymptomatic NHLs may be discovered during routine medical exams or imaging studies, indicating a need for more targeted treatment.
There are different steps that are followed in the treatment of NHL. These include its staging, risk assessment as well as active surveillance. Staging refers to evaluating how far the disease has spread within the body which may include lymph node involvement or organ involvement. Such factors may include age, performance status, presence of constitutional symptoms or lymphoma characteristics when considering risk assessment for this disease. With this approach, then patients with minimal or even absent symptoms could benefit from it.
Chemotherapy is common and often combines rituximab with chemotherapy. Immunotherapy uses monoclonal antibodies that target specific proteins on lymphoma cells for improving the immune response to cancer by destroying targeted lymphoma cells more effectively. There are cases where radiation therapy is used alone or together with chemotherapy for attacking localized sites of the disease process. Supportive care measures, such as medications, supportive transfusions, and growth factors, are often integrated into the overall treatment plan to address side effects.
Hematology
Physical Medicine and Rehabilitation
Recognition of cancer including NHL can be difficult emotionally, and people with the disease and their family members may require psycho-social support usually provided by ounselling or psychotherapy. Through support groups, individuals with the illness are given an avenue where they can share common experiences and learn. Both during and after treatment, there is a need for good feeding and as such dieticians should offer advice on how best to have adequate nourishment and control the side impacts felt after receiving medication.
Overall, physical activity and rehabilitation help cancer patients feel better with targeted training exercises being helpful. Concerning such targets as functional limitations, mobility and quality of life, rehabilitation services may be considered. Anger or anxiety management, sleep promotion or elevation of moods through stress control are among the issues that mind-body techniques such as mindfulness meditation or breathing exercises can help handle. Complementary therapies including acupuncture, massage as well as reflexology can help to reduce pain. Palliative care as well as hospice services focus on improving life quality among severe illnesses such as NHL; at the same time educating them through patient’s education empowers them to actively participate in their medical treatment as well as make informed choices.
Hematology
Oncology, Other
Chlorambucil: This drug inhibits the replication of DNA and transcription of RNA and cross-links and alkylates DNA strands. It is primarily used in treating indolent lymphomas especially CLL (chronic lymphocytic leukemia) and Waldenstrom macroglobulinemia.
Cyclophosphamide: This is related chemically to nitrogen mustards. It acts as an alkylating agent and may cause DNA cross- linking. This can be used as a monotherapy agent or in combination with other regimens.
Doxorubicin: It is an anthracycline antibiotic. It cannot cross the blood-brain barrier and excreted mainly in the bile. It is used in combination with vincristine, prednisone, cyclophosphamide and hydroxydaunomycin.
Vincristine: The mode of action of vincristine is unknown. It can cause a reduction in function of reticuloendothelial cells or an increased production of platelets. It is indicated in non-hematologic and hematologic malignancies.
Fludarabine: This is an analogue of purine which interferes with the synthesis of DNA via inhibition of ribonucleotide reductase. It is introduced into RNA leading to the inhibition of synthesis of RNA and proteins.
Pralaxate: It is an inhibitor of folate and indicated in treating refractory or relapsed peripheral T-cell lymphoma.
Etoposide: This is a derivative of podophyllotoxin. It exerts the cytotoxic activity by the stabilization of covalent intermediates that are produced between topoisomerase II and DNA substrate, causing breakage of double and single stranded DNAs.
Cyatarabine:  The active compound of cyatarabine namely cytarabine-5’-triphosphate is an inhibitor of DNA polymerase. It is specific to act in the S phase of cell cycle and blocks the process of cell division from G1 to S phase.
Bendamustine: This is an alkylating agent used in treating non-Hodgkin lymphoma of B-cell that increased in six months of treatment with rituximab.
Carboplatin: This is cisplatin analogue. Being a heavy metal complex, it exerts its actions via platination of DNA causing interstrand and intrastrand cross-links of DNA and inhibiting replication of DNA.
Bleomycin: This is a group of glycopeptides that are isolated from Streptomyces.
Hematology
Vorinostat: It is an inhibitor of histone deacetylase. It is used in treating persistent, recurrent, or progressive cutaneous T-cell lymphoma.
Romidepsin: This causes alterations in the structure of chromatin and activation of transcription factor that in turn causes cell death. It is indicated in CTCL patients who received atleast one prior therapy.
Hematology
Copanlisib: This drug is a class-I inhibitor of PI3K (phosphatidylinositol-3-kinase) with predominant inhibition against alpha and delta forms of PI3K. It may inhibit proliferation of B cells that are premalignant and induce apoptosis that ultimately causes death of tumor cells.
Idelalisib: It induces apoptosis and causes proliferation in cell lines obtained from primary tumor cells and malignant B cells.
Duvelisib: It is a small oral molecule and selective inhibitor of delta and gamma forms of PI3K. It is generally indicated in adults with refractory/relapsed follicular cell lymphoma.
Hematology
Rituximab: It is engineered genetically as chimeric murine/human monoclonal antibody and directed towards the CD20 antigen that is found on the surface and malignant and normal B lymphocytes.
Rituximab/ hyaluronidase: This SC product is used in combination with human hyaluronidase that enhances the permeability via subcutaneous tissue. It is used in untreated diffuse large B-cell lymphoma in combination with vincristine, cyclophosphamide, prednisone or doxorubicin.
Ofatumumab: It is an anti-CD20 monoclonal antibody which inhibits the activation of B-cell in early stages. It is employed in treating chronic lymphocytic leukemia that is reftractory to alemtuzumab and fludarabine.
Hematology
Bortezomib: It is the first drug that is approved as anticancer agents. It is an inhibitor of proteasome.
Hematology
Temsirolimus: It is a water-soluble ester. With high affinity, it binds to immunophilin FKBP and this complex works by inhibiting mTOR (mammalian target or rapamycin) kinase which is a key protein regulating gene translation for regulation of cell cycle.
Hematology
Lenadolimide: It is an analog of thalidomide and inhibits the production of TNF-α. It also stimulates T cells, decreases the serum levels of cytokine VEGF (vascular endothelial growth factor), bFGF (basic fibroblast growth factor) and inhibits the process of angiogenesis.
Hematology
Pembrolizumab: It is employed in treatment of refractory PMBCL (primary mediastinal large B-cell lymphoma) in pediatric and adult patients.
Hematology
CAR (chimeric antigen receptor) T-cell therapy, a type of adoptive therapy is genetically engineered to express CAR.
Axicabtagene ciloleucel: It is a kind of CD19-direceted genetically modified form of T-cell immunotherapy. It is approved for treating refractory or relapsed large B-cell lymphoma.
Tisagenlecleucel: This involves reprogramming a patient’s own T cell through transgene encoding of CAR receptor thereby identifying and eliminating CD-19 expressing malignant cells.
Lisocabtagene maraleucel: This is indicated in treating refractory/relapsed B-cell lymphoma, grade 3B follicular lymphoma, primary mediastinal large B-cell in adults.
Loncastuximab tesirine: It is indicated for treating R/R large B-cell lymphoma and disuse large B-cell lymphoma in adults.
Tafasitamab: It is a humanized and Fc-modified cytolytic monoclonal antibody that targets CD19 and indicated in treatment of DLBCL in adults along with lenalidomide.
Hematology
Epoetin alfa: This is a purified glycoprotein which is produced from the mammalian cells. The aminoacid sequence of this product mimics endogenous EPO.
Darbepoetin alfa: This protein stimulates erythropoietin and related closely to EPO. It is also a primary growth factor that is synthesized in the kidney and stimulates erythoid progenitor cells development.
Filgarstim: It is a recombinant r-metHuG-CSF (methionyl human granulocyte colony-stimulating factor) that contains a protein with 175 aminoacids weighing 18,800 daltons. It is synthesized by E. coli into which the human gene G-CSF is inserted.
Hematology
Interferon alfa-2a or 2b: These medications are responsible for regulating the crucial phases in immune reactions.
Hematology
Dexamethasone: Â It is an immunosuppressant glucocorticoid that exerts its action by stimulation of the synthesis of enzymes required for reducing the response to inflammation. It is a component of methotrexate, doxorubicin, Oncovin, bleomycin, cyclophosphamide, and dexamethasone regimen (m-BACOD).
Prednisolone: It is a component of various regimens like CHOP. It is also a glucocorticoid immunosuppressant which acts via stimulation of enzymes responsible for reducing inflammatory response.
Hematology
Physical Medicine and Rehabilitation
NHL (Non-Hodgkin Lymphoma) is a cancer that originates from the T cell precursors, B cell precursors, mature T cells and mature B cells. This condition can be divided into two groups namely aggressive and indolent depending on the prognosis of the disease. Common neoplasms due to mature B cells include Burkitt lymphoma, Mantle cell lymphoma, Follicular lymphoma, primary CNS lymphoma, and marginal zone lymphoma. The treatment varies based on the stages of tumor, grade, type of lymphoma and clinical history of patients. The nature of NHL tumors varies characteristically. Indolent lymphomas may have waning and waxing lymphadenopathy manifested over many years whereas aggressive lymphomas are usually accompanied by B symptoms and could lead to death if left untreated. 66% of these patients show signs such as those typical for the peripheral lymphatic system. Other features include extra-nodal involvement, of which 10- 35% cases show primary extranodal lymphoma during diagnosis. Symptoms related to visceral obstruction, weight loss, early satiety, nausea, vomiting, and fullness of the abdomen manifest primary lymphoma of gastrointestinal tract.
Non-Hodgkin lymphoma is common among people between 65 to 74 years of age who have a median age of 67. While Burkitt lymphoma is endemic in Africa, it has a higher prevalence in USA as well as Western Europe especially among children aged between 4 to 7 years old. Mantle Cell Lymphoma constitutes 7% of Adult Non-Hodgkin Lymphomas in The United States and Europe with annual incidences ranging from 4-8 cases per million people. It is very rare for infants to get lymphoma, though about 4% of childhood cancers affect babies. 25% adolescent boys aged 10-19 are diagnosed with high level Lymphomas while at least a quarter are girls the same age group.
Non-Hodgkin lymphoma, which generally arises from a chromosome translocation or mutation/deletion in B, T, or natural killer cells (chromosomal), is especially prevalent in follicular lymphoma, mantle cell lymphoma, Burkitt lymphoma, diffuse large B-cell lymphoma and primary CNS lymphoma, often associated with HIV/AIDS. The most prevalent chromosomal abnormality is translocation at t (14;18).
Different factors can lead to non-Hodgkin Lymphomas (NHL) such as infections, environmental factors, immunodeficiency states and chronic inflammation while some kinds of NHL are brought about by human T-cell leukemia virus type 1, Epstein-Barr virus, Hepatitis C virus, human herpesvirus 8 and Helicobacter pylori infection. Furthermore, other infectious agents include drugs like phenytoin, digoxin and TNF antagonist, as well as organic chemicals, pesticides and radiation exposure. The human has a variety of intrinsic factors like Wiskott Aldrich syndrome, SCID or extrinsic factors like immunosuppressant drugs, this includes Sjögren’s disease, rheumatoid arthritis and Hashimoto’s thyroiditis among others. Apart from Hashimoto’s thyroiditis and Celiac disease that can cause it, there are other autoimmune conditions also associated with NHL risk. In general, NHL is a multifactorial disorder demanding for comprehensive management practices.
The prognosis of Non-Hodgkin lymphoma is influenced by histopathology, involvement, and patient factors. Standard-of-care treatment is assessed in terms of overall survival using the International Prognostic Index (IPI). Factors assessed by the index include age, serum LDH levels, ECOG performance status, clinical stage, and extranodal involvement. Categorized into low, intermediate, and poor risk are the IPI scores. Acquired or congenital immunodeficiency states increase the risk of lymphoma and poor therapy response. IPI has been modified for various NHL types for better prognosis assessment. Aggressive T or NK cell lymphomas have a worse prognosis, while low-grade lymphomas offer increased survival of 6-10 years.
Age: NHL is less common in children and adolescents, with common subtypes including Burkitt lymphoma and lymphoblastic lymphoma. Young adults may present with painless lymph node enlargement, fatigue, fever, night sweats, and unexplained weight loss. In middle-aged and older adults, NHL is more common, with aggressive features and increased incidence, including diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma.
Examination of lymph node: Enlarged, non-tender, and firm lymph nodes may indicate lymphoma. Location and size of palpable lymph nodes should be assessing carefully.
Skin examination: Changes in skin, including lesions, rashes or nodules should be diagnosed.
Abdominal examination: Abdominal palpation should be done to check for enlargement of liver or spleen.
Respiratory examination: Respiratory symptoms like shortness of breath, chest pain or cough should be identified.
NHL subtypes can present indolently with slow-growing lymph node enlargement, with a prolonged disease course. Aggressive NHLs, like DLBCL or Burkitt lymphoma, have rapidly growing tumors, pronounced B symptoms, and widespread involvement of lymph nodes and organs. These subtypes often require more intensive treatment. Asymptomatic NHLs may be discovered during routine medical exams or imaging studies, indicating a need for more targeted treatment.
There are different steps that are followed in the treatment of NHL. These include its staging, risk assessment as well as active surveillance. Staging refers to evaluating how far the disease has spread within the body which may include lymph node involvement or organ involvement. Such factors may include age, performance status, presence of constitutional symptoms or lymphoma characteristics when considering risk assessment for this disease. With this approach, then patients with minimal or even absent symptoms could benefit from it.
Chemotherapy is common and often combines rituximab with chemotherapy. Immunotherapy uses monoclonal antibodies that target specific proteins on lymphoma cells for improving the immune response to cancer by destroying targeted lymphoma cells more effectively. There are cases where radiation therapy is used alone or together with chemotherapy for attacking localized sites of the disease process. Supportive care measures, such as medications, supportive transfusions, and growth factors, are often integrated into the overall treatment plan to address side effects.
Hematology
Physical Medicine and Rehabilitation
Recognition of cancer including NHL can be difficult emotionally, and people with the disease and their family members may require psycho-social support usually provided by ounselling or psychotherapy. Through support groups, individuals with the illness are given an avenue where they can share common experiences and learn. Both during and after treatment, there is a need for good feeding and as such dieticians should offer advice on how best to have adequate nourishment and control the side impacts felt after receiving medication.
Overall, physical activity and rehabilitation help cancer patients feel better with targeted training exercises being helpful. Concerning such targets as functional limitations, mobility and quality of life, rehabilitation services may be considered. Anger or anxiety management, sleep promotion or elevation of moods through stress control are among the issues that mind-body techniques such as mindfulness meditation or breathing exercises can help handle. Complementary therapies including acupuncture, massage as well as reflexology can help to reduce pain. Palliative care as well as hospice services focus on improving life quality among severe illnesses such as NHL; at the same time educating them through patient’s education empowers them to actively participate in their medical treatment as well as make informed choices.
Hematology
Oncology, Other
Chlorambucil: This drug inhibits the replication of DNA and transcription of RNA and cross-links and alkylates DNA strands. It is primarily used in treating indolent lymphomas especially CLL (chronic lymphocytic leukemia) and Waldenstrom macroglobulinemia.
Cyclophosphamide: This is related chemically to nitrogen mustards. It acts as an alkylating agent and may cause DNA cross- linking. This can be used as a monotherapy agent or in combination with other regimens.
Doxorubicin: It is an anthracycline antibiotic. It cannot cross the blood-brain barrier and excreted mainly in the bile. It is used in combination with vincristine, prednisone, cyclophosphamide and hydroxydaunomycin.
Vincristine: The mode of action of vincristine is unknown. It can cause a reduction in function of reticuloendothelial cells or an increased production of platelets. It is indicated in non-hematologic and hematologic malignancies.
Fludarabine: This is an analogue of purine which interferes with the synthesis of DNA via inhibition of ribonucleotide reductase. It is introduced into RNA leading to the inhibition of synthesis of RNA and proteins.
Pralaxate: It is an inhibitor of folate and indicated in treating refractory or relapsed peripheral T-cell lymphoma.
Etoposide: This is a derivative of podophyllotoxin. It exerts the cytotoxic activity by the stabilization of covalent intermediates that are produced between topoisomerase II and DNA substrate, causing breakage of double and single stranded DNAs.
Cyatarabine:  The active compound of cyatarabine namely cytarabine-5’-triphosphate is an inhibitor of DNA polymerase. It is specific to act in the S phase of cell cycle and blocks the process of cell division from G1 to S phase.
Bendamustine: This is an alkylating agent used in treating non-Hodgkin lymphoma of B-cell that increased in six months of treatment with rituximab.
Carboplatin: This is cisplatin analogue. Being a heavy metal complex, it exerts its actions via platination of DNA causing interstrand and intrastrand cross-links of DNA and inhibiting replication of DNA.
Bleomycin: This is a group of glycopeptides that are isolated from Streptomyces.
Hematology
Vorinostat: It is an inhibitor of histone deacetylase. It is used in treating persistent, recurrent, or progressive cutaneous T-cell lymphoma.
Romidepsin: This causes alterations in the structure of chromatin and activation of transcription factor that in turn causes cell death. It is indicated in CTCL patients who received atleast one prior therapy.
Hematology
Copanlisib: This drug is a class-I inhibitor of PI3K (phosphatidylinositol-3-kinase) with predominant inhibition against alpha and delta forms of PI3K. It may inhibit proliferation of B cells that are premalignant and induce apoptosis that ultimately causes death of tumor cells.
Idelalisib: It induces apoptosis and causes proliferation in cell lines obtained from primary tumor cells and malignant B cells.
Duvelisib: It is a small oral molecule and selective inhibitor of delta and gamma forms of PI3K. It is generally indicated in adults with refractory/relapsed follicular cell lymphoma.
Hematology
Rituximab: It is engineered genetically as chimeric murine/human monoclonal antibody and directed towards the CD20 antigen that is found on the surface and malignant and normal B lymphocytes.
Rituximab/ hyaluronidase: This SC product is used in combination with human hyaluronidase that enhances the permeability via subcutaneous tissue. It is used in untreated diffuse large B-cell lymphoma in combination with vincristine, cyclophosphamide, prednisone or doxorubicin.
Ofatumumab: It is an anti-CD20 monoclonal antibody which inhibits the activation of B-cell in early stages. It is employed in treating chronic lymphocytic leukemia that is reftractory to alemtuzumab and fludarabine.
Hematology
Bortezomib: It is the first drug that is approved as anticancer agents. It is an inhibitor of proteasome.
Hematology
Temsirolimus: It is a water-soluble ester. With high affinity, it binds to immunophilin FKBP and this complex works by inhibiting mTOR (mammalian target or rapamycin) kinase which is a key protein regulating gene translation for regulation of cell cycle.
Hematology
Lenadolimide: It is an analog of thalidomide and inhibits the production of TNF-α. It also stimulates T cells, decreases the serum levels of cytokine VEGF (vascular endothelial growth factor), bFGF (basic fibroblast growth factor) and inhibits the process of angiogenesis.
Hematology
Pembrolizumab: It is employed in treatment of refractory PMBCL (primary mediastinal large B-cell lymphoma) in pediatric and adult patients.
Hematology
CAR (chimeric antigen receptor) T-cell therapy, a type of adoptive therapy is genetically engineered to express CAR.
Axicabtagene ciloleucel: It is a kind of CD19-direceted genetically modified form of T-cell immunotherapy. It is approved for treating refractory or relapsed large B-cell lymphoma.
Tisagenlecleucel: This involves reprogramming a patient’s own T cell through transgene encoding of CAR receptor thereby identifying and eliminating CD-19 expressing malignant cells.
Lisocabtagene maraleucel: This is indicated in treating refractory/relapsed B-cell lymphoma, grade 3B follicular lymphoma, primary mediastinal large B-cell in adults.
Loncastuximab tesirine: It is indicated for treating R/R large B-cell lymphoma and disuse large B-cell lymphoma in adults.
Tafasitamab: It is a humanized and Fc-modified cytolytic monoclonal antibody that targets CD19 and indicated in treatment of DLBCL in adults along with lenalidomide.
Hematology
Epoetin alfa: This is a purified glycoprotein which is produced from the mammalian cells. The aminoacid sequence of this product mimics endogenous EPO.
Darbepoetin alfa: This protein stimulates erythropoietin and related closely to EPO. It is also a primary growth factor that is synthesized in the kidney and stimulates erythoid progenitor cells development.
Filgarstim: It is a recombinant r-metHuG-CSF (methionyl human granulocyte colony-stimulating factor) that contains a protein with 175 aminoacids weighing 18,800 daltons. It is synthesized by E. coli into which the human gene G-CSF is inserted.
Hematology
Interferon alfa-2a or 2b: These medications are responsible for regulating the crucial phases in immune reactions.
Hematology
Dexamethasone: Â It is an immunosuppressant glucocorticoid that exerts its action by stimulation of the synthesis of enzymes required for reducing the response to inflammation. It is a component of methotrexate, doxorubicin, Oncovin, bleomycin, cyclophosphamide, and dexamethasone regimen (m-BACOD).
Prednisolone: It is a component of various regimens like CHOP. It is also a glucocorticoid immunosuppressant which acts via stimulation of enzymes responsible for reducing inflammatory response.
Hematology
Physical Medicine and Rehabilitation
Hematology
Oncology, Other
Pathology
Radiology
Diagnosis of NHL involves biopsy, imaging tests, bone marrow biopsy, and induction therapy. Chemotherapy is the main treatment for many subtypes of  NHL, aiming to destroy or delay cancer cell development for remission. Monoclonal antibodies, like rituximab, can be used in combination with chemotherapy or as standalone treatments. Targeted therapies may be employed to address specific pathways involved in lymphoma growth. Additional treatment may be recommended to consolidate initial response, such as more cycles of chemotherapy or targeted agents. Stem cell transplantation may be used to restore injured bone marrow tissue in resistant or relapsed NHL patients. Maintenance therapy may be recommended to prolong remission and delay disease progression. Patients are regularly monitored to assess response, detect relapse, and manage late effects. Palliative care is integrated early in treatment to monitor symptoms, manage side effects, and improve quality of life. Clinical trials may be considered at various stages of NHL management.
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