Lymphoma

Overview

Lymphoma is a malignant tumor originating from lymphoid tissue, including two major types: Hodgkin's lymphoma (HL) and non Hodgkin's lymphoma (NHL). Lymphoma can invade any part of the body and has diverse clinical manifestations, typically characterized by lymph node enlargement, fever, weight loss, and night sweats. Although the exact cause of lymphoma is unknown, it is generally believed to be related to infection, immunity, environmental factors, and genetics. The number of new cases of lymphoma worldwide is increasing, with data showing that there were many new cases of lymphoma worldwide in 2018.

Figure 1. Lymphoma.

Symptoms of Lymphoma

The early symptoms of lymphoma include painless lymph node enlargement and unexplained fever. Lymph node enlargement may occur in the neck, clavicle, axilla, groin, and other areas. If adjacent organs are compressed, it can also cause corresponding symptoms. The systemic symptoms of lymphoma include fever, night sweats, weight loss, and possible skin itching, fatigue, and other symptoms.

Etiology

The etiology and pathogenesis of lymphoma are not fully understood, and are generally believed to be related to factors such as infection, immunity, physicochemical factors, and genetics.

Etiology	Details
Epstein Barr (EB) virus infection	EB virus infection is associated with the onset of Hodgkin's lymphoma (HL). In China, the detection rate of EB virus in Hodgkin lymphoma patients can reach 48% to 57%. EB virus infection is also an important cause of Burkitt lymphoma.
Retrovirus	Research suggests that retroviruses are associated with adult T-cell leukemia/lymphoma and fungal lymphoma.
Measles virus	Some studies suggest that the onset of HL is related to the measles virus. Helicobacter pylori (Hp) infection Hp antigen plays a crucial role in the pathogenesis of gastric mucosal lymphoma.
Human herpesvirus	The positivity rate and antibody titer of human herpesvirus 6 (HHV-6) in HL patients are higher than those in non HL patients, and the HHV-6 antibody titer gradually increases with disease progression. Human herpesvirus 8 is a lymphophilic DNA virus associated with characteristic coelomic lymphoma/primary exudative lymphoma.
Immunocompromised	Patients with hereditary or acquired immunodeficiency (AIDS) have a higher risk of developing lymphoma compared to normal individuals. The risk of AIDS patients developing NHL is 60 to 100 times higher than that of the general population. Lymphoma accounts for one-third of malignant tumors induced by long-term use of immunosuppressants after organ transplantation.
Genetic factors	Individuals with a family history of HL have a higher risk of developing the disease than others, and certain specific alleles can increase susceptibility to Hodgkin lymphoma.
Occupational and environmental factors	Insecticides, organic solvents, hair dyes, smoking, and other factors are related to the incidence of non Hodgkin lymphoma. People who smoke heavily have an increased risk of developing follicular lymphoma. Celiac disease is associated with the development of intestinal T-cell lymphoma.

Diagnosis

If the patient experiences progressive and painless lymph node enlargement, the doctor may suspect lymphoma and further pathological examination of the lymph nodes is required. If skin lymphoma is suspected in this case, skin biopsy and printing can be performed; If abnormal blood cell count, elevated serum alkaline phosphatase, or skeletal lesions are found in routine laboratory tests, bone marrow biopsy can be performed to clarify the extent of bone marrow involvement. In conclusion, based on the pathological examination results, a diagnosis and classification of lymphoma can be made.

Staged Diagnosis

In addition to diagnosis and classification, doctors also need to perform staging diagnosis of lymphoma to guide treatment. Generally, lymphoma is staged according to the clinical staging scheme proposed by Ann Arbor in 1971.

Staging based on the extent of lymph node lesions:

Stage I: Stage I refers to the involvement of a single lymph node region, while stage IE refers to the occurrence of focal single extranodal organ involvement;
Stage II: Two or more groups of lymph nodes on the same side of the diaphragm are affected, while focal single extranodal organ and regional lymph node involvement, with or without involvement of other lymph node areas on the same side of the diaphragm, is stage IIE;
Stage III: If both the upper and lower lymph node regions of the diaphragm are affected, it is stage III; if there is focal involvement of extranodal organs, it is stage III E; if there is involvement of the spleen, it is stage III S; if both are present, it is stage III E+S;
Stage IV: Diffuse involvement of single or multiple extranodal organs, with or without associated lymph node enlargement, or isolated involvement of extranodal organs with distant lymph node enlargement, is stage IV, such as liver or bone marrow involvement, even if the lesion is localized.

Treatment Options

The treatment of lymphoma mainly relies on chemotherapy and radiotherapy, and the specific plan depends on the type, stage, and prognostic factors of lymphoma. Among them, Hodgkin's lymphoma is mainly treated with a combination of chemotherapy and radiotherapy, while the focus of treatment for non Hodgkin's lymphoma is chemotherapy. For cases of recurrence and difficult treatment, DHAP or DICE regimens can be used for rescue treatment, followed by high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation.

Prevention of Lymphoma

The prevention of lymphoma mainly involves avoiding infection and enhancing immunity, while also paying attention to genetic and environmental factors. In population census and early diagnosis, laboratory tests such as neurological examination, blood routine examination, serum lactate dehydrogenase, β 2-microglobulin measurement, and imaging examination are helpful for the diagnosis and treatment of lymphoma. Adequate examination and timely diagnosis can improve the cure rate of lymphoma and enhance the quality of life.

Transfer

The metastatic characteristics of non Hodgkin lymphoma are jumping dissemination, and it often involves extranodal organs such as bones, pulmonary hilum, mediastinum, gastrointestinal tract, liver, etc., causing corresponding clinical symptoms.

Involved chest: The hilum and mediastinum are most affected, which can lead to lymph node infiltration and pleural effusion in the lungs, as well as invasion of the pericardium and heart.
Involving the gastrointestinal tract: The small intestine is most affected, and symptoms such as abdominal pain, diarrhea, and abdominal masses similar to digestive ulcers, intestinal tuberculosis, or fat diarrhea may occur.
Involving the liver: there may be liver enlargement, liver pain, and jaundice.
Involved bones: The most common are the thoracic and lumbar vertebrae, which can manifest as bone pain, spinal cord compression, etc.
Skin involvement: can manifest as skin masses, subcutaneous nodules, infiltrative plaques, and ulcers.

Reagent Solutions

Antibodies

Cat. No.	Product Name	Host	Isotype	Application
CABT-L0796YC	Magic™ Mouse Anti-Human TCL1A Monoclonal antibody, clone 1H21	Mouse	IgG1	ELISA(Cap)	Inquiry
CABT-L0797YD	Magic™ Mouse Anti-Human TCL1A Monoclonal antibody, clone 6B9	Mouse	IgG1	ELISA(Det)	Inquiry
DCABH-1490	Anti-BCL11A monoclonal antibody, clone 4E0	Mouse	IgG2a	WB, ELISA, IHC-P	Inquiry
DCABH-1499	Anti-PTPN1 monoclonal antibody, clone 2E21	Mouse	IgG2a	WB, IHC-P, FC, ICC/IF	Inquiry
DCABH-2540	Anti-CLEC4E monoclonal antibody, clone 3B9	Mouse	IgG1	WB, IHC-P, FC	Inquiry
DCABH-2541	Anti-SLA2 monoclonal antibody, clone 2G8	Mouse	IgG2b	WB, IHC-P, FC	Inquiry
DCABH-2542	Anti-LDOC1 monoclonal antibody, clone 2B3	Mouse	IgG1	WB	Inquiry

ELISA Kits

Cat. No.	Product Name	Size	Species Reactivity	Application	Detection Method
DEIA-NS2310-9	Epstein-Barr Virus EA IgG ELISA Kit	96T	Human	Quantitative	iELISA	Inquiry
DEIA-NS2310-10	EBV EBNA1 IgG ELISA Kit	96T	Human	Quantitative	iELISA	Inquiry
DEIA-BJ425	Rat Bcl10(B-cell lymphoma/leukemia 10) ELISA Kit	96T	Rat	Quantitative	sELISA	Inquiry
DEIA-BJ426	Rat BCL-3(B-Cell Leukemia/Lymphoma 3) ELISA Kit	96T	Rat	Quantitative	sELISA	Inquiry
DEIA-FN166	Human BCL11B (B-cell lymphoma/leukemia 11B) ELISA Kit	96T	Human	Quantitative	Sandwich ELISA	Inquiry
DEIA-FN167	Human Bcl2L11 (Bcl-2 Like Protein 11) ELISA Kit	96T	Human	Quantitative	Sandwich ELISA	Inquiry
DEIA-FN168	Human Bcl2L2 (Bcl-2 Like Protein 2) ELISA Kit	96T	Human	Quantitative	Sandwich ELISA	Inquiry
DEIA7174	Human Bcl-2(B-cell Leukemia/Lymphoma 2) ELISA Kit	96T	Human	Quantitative	sELISA	Inquiry

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