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Non-Hodgkin's lymphoma

Description

An in-depth report on the causes, diagnosis, and treatment of non-Hodgkin's lymphoma.

Alternative Names

Lymphoma - non-Hodgkin's; NHL; B-cell lymphomas

Highlights

Drug Approvals

• Rituximab (Rituxan) has received approval for three new non-Hodgkin’s lymphoma (NHL) treatments: First-line treatment for diffuse large B-cell, CD20-positive NHL in combination with CHOP chemotherapy; first-line treatment of previously untreated follicular NHL in combination with CVP chemotherapy; and treatment of low-grade NHL in patients who have stable disease or who have benefited from first-line treatment with CVP chemotherapy.
• Bortezomib (Velcade) has been approved for treatment of mantle cell lymphoma.
• Vorinostat (Zolinza) has been approved for treatment of cutaneous T-cell lymphoma.

Drug Warning

In 2006, the FDA updated rituximab’s warnings to include information on the risks for progressive multifocal leukoencephalopathy (PML), a rare and potentially deadly brain infection. As of February 2006, 23 cases of PML had been reported in patients with NHL who were treated with rituximab. In December 2006, the FDA reported 2 fatal cases of PML in patients with lupus who received rituximab. (Rituximab is currently approved only for NHL and rheumatoid arthritis, but is being investigated for other conditions.) The FDA advises that patients on rituximab therapy should immediately contact their doctors if they experience any of the following symptoms:

• Vision problems or unusual eye movements
• Confusion
• Dizziness or loss of balance
• Difficulty talking or walking

Investigational Drugs

Several vaccines are showing promise in late-stage clinical trials for treatment of NHL:

• The BioVaxID vaccine has shown good results in Phase II trials for follicular B-cell NHL and mantle cell lymphoma. It is currently in Phase III trials.
• The MyVax vaccine is currently in Phase III trials for treatment of follicular B-cell NHL.

NHL and Rheumatoid Arthritis

The inflammatory process of rheumatoid arthritis -- rather than its drug treatments -- may be the main reason why patients with this autoimmune condition are at increased risk for lymphoma. A 2006 study indicated that patients with severe and long-term rheumatoid arthritis are especially at risk.

• Review Date: 1/17/2007
• Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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