Putting the Clinical and Biological Heterogeneity of Non-Hodgkin Lymphoma into Context

Abstract

The lymphomas represent one of the most heterogeneous groups of malignancies in all of cancer medicine. Whether one attempts to understand these diseases in the context of their complicated ontogeny, unique biologic features, or clinical presentation, this heterogeneity has been a mixed blessing. On the one hand, it has created an ever-changing way to classify these diseases, as classification schemes have been compelled to reflect the rapidly emerging information that seems to split the disease into smaller and smaller subtypes. On the other hand, the biologic and clinical dissection of these diseases has allowed for the identification of unique biologic features-features that have led to novel targets and generated a plethora of new drugs. Virtually every subtype of non-Hodgkin lymphoma has benefited from these efforts to understand the biology of the different subtypes. This paradigm has led to new clinical trials that tailor novel drug regimens to specific biologic disease subtypes. As a prelude to this CCR Focus section, we attempt to put this evolving heterogeneity into context, bridging historical and modern-day views of classification of these diseases. Then, some of the world's leading lymphoma researchers share their perspectives on how to formulate new concepts of care in this era of biologic discovery. Over a relatively short time, the advances in lymphoma research have been nothing short of stunning. There now seems to be little doubt that these recent breakthroughs will redound favorably on the majority of patients diagnosed with a lymphoproliferative malignancy.

Menopausal estrogen therapy and non‐Hodgkin's lymphoma: A post‐hoc analysis of women's health initiative randomized clinical trial

“…33 Some investigators postulate that the effects of female sex hormone may differ by subtypes of NHL which is considered to be the most heterogeneous malignancy. 34 Based on sex ratios and age-specific incidence patterns by subtype, it has been hypothesized that estrogen alone or combined with progestin may be positively associated with follicular lymphoma (FL), but inversely with DLBCL. 17,20 Some studies verified the inverse association for DLBCL, 15,33 but in the others the RRs for both subtypes were almost equally increased 22 or decreased.…”

A modular transcriptome map of mature B cell lymphomas

“…Germinal center-derived B cell lymphomas are tumors of the lymphoid tissues representing one of the most heterogeneous malignancies in terms of their molecular and cellular phenotypes [1]. Frequent B cell lymphomas in adulthood are follicular lymphomas (FL) and diffuse large B cell lymphomas (DLBCL), and, in children, Burkitt’s lymphomas (BL).…”

Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score

“…Furthermore, depending on other coexisting factors, this risk is estimated as intermediate or high in the Khorana VTE risk assessment model. Lymphomas represent one of the most heterogeneous groups of malignancies [ 9 ]. Due to this heterogeneity, unique biological and clinical features and different risks of thrombosis, a single-risk model may not be suitable for all subtypes of lymphomas [ 10 ].…”