NON-HODGKIN
LYMPHOMA (NHL)

Exploring dysfunctional pathways, mechanisms, and biomarkers in non-
Hodgkin lymphoma to discover new insights into the progression of the
disease.

544,000

About 544,000 cases of NHL are diagnosed globally each year5

‚ģ≠ 45%

Incident cases from 2006 to 2016 increased by 45% globally1

60%/40%

~60% of NHL are aggressive subtypes and 40% are indolent subtypes7

INCIDENCE AND MORTALITY

There were an estimated 544,000 new cases of NHL and 260,000 deaths worldwide in 2020.5

  • An estimated 80,500 people in the US will be diagnosed with NHL during 2023 (4.1% of all new cancer cases).41
  • An estimated 20,180 people in the US will die from NHL during 2021 (3.3% of all cancer deaths).41

People older than 44 years abount for 90% of NHL cases that are diagnosed.41

  • NHL is most frequently diagnosed among people aged 65 to 74 years.
  • The median age at diagnosis is 68 years.

Survival varies widely by cell type and stage of the disease.3

  • In the US, 74.3% of patients will survive 5 years past diagnosis.41
  • Five-year survival by subtype:2
    • Diffuse large B‚Äďcell lymphoma (aggressive) = ~64%
    • Follicular lymphoma (iindolent) = ~89%
    • Mantle cell lymphoma (indolent and aggressive features) = ~62%

NHL are a heterogeneous group of neoplasms that originate in any of the lymphoid cells: B cells, T cells, or natural killer (NK) cells.4 There are over 60 subtypes identified by the World Health Organization, each categorized by cell of origin, histological appearance, immunophenotype, and genetic characteristics.4

B‚Äďcell lymphomas account for about 85% of NHL. Major NHL subtypes include7:

  • Diffuse large B-cell lymphoma (DLBCL): ~31%
  • Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): ~6%
  • Follicular lymphoma (FL): ~22%
  • Marginal zone lymphoma (MZL): ~8%
  • Mantle cell lymphoma (MCL): ~6% (US); 7% to 9% (Europe)7
  • Waldenstrom macroglobulinemia (WM): ~<1%

NHL subtypes are further characterized according to how the disease progresses.7

  • Indolent lymphomas
    • Slow-progressing
    • Few signs and symptoms when first diagnosed
    • About 40% of all NHL cases
    • FL is the most common subtype of indolent NHL
  • Aggressive lymphomas
    • Fast-progressing
    • Account for about 60% of all NHL cases
    • DLBCL is the most common subtype of aggressive NHL
  • MCL shares some characteristics of both indolent and aggressive NHLs

Subtypes of NHL have varied epidemiological and genetic risk factors.8 However, in most cases people diagnosed with NHL do not have any obvious risk factors, and many people who have risk factors for the disease never develop the malignancy.9

DLBCL

  • Increased young adult body-mass index (BMI), a history of B cell-activating autoimmune diseases, and Hepatitis C virus (HCV) seropositivity are associated with increased risk of developing DLBCL.9
  • BCL-2 protein overexpression is detected in approximately 30% of DLBCL cases; in approximately 90% of those cases, BCL-2 protein levels are very high.10.11
  • DLBCL with translocations of MYC and BCL2 or BCL6 as detected by fluorescence in situ hybridization (FISH) or standard cytogenetics are known as ‚Äúdouble-hit‚ÄĚ lymphomas. If all three are rearranged, they are referred to as ‚Äútriple-hit‚ÄĚ lymphomas. The vast majority are germinal center B-cell-like lymphomas.23
  • DLBCL may be further classified by its cell of origin.24
    • Germinal center B‚Äďcell (GCB)-type: ~50%
    • Activated B‚Äďcell (ABC)-type (poor prognosis): ~30%
    • The remaining 20% of DLBCL are unclassified
    • Gene expression profiling (GEP) can be used to divide DLBCL into GCB-type or ABC-type DLBCL, with a proportion remaining unclassifiable; attempts to divide by immunohistochemistry (IHC) have produced variable results resulting in the division of DLBCL into GCB-type and non-GCB type.4

FL

  • Family history of NHL and being overweight as a young adult are associated with increased risk of developing FL.8
  • Tumor grade, prognostic index and disease burden help guide therapeutic decision making and determine appropriate candidates for a watch-and-wait approach or active therapy.25
  • BCL-2 protein overexpression is detected in 62.5% of FL cases.10
  • The vast majority of patients with BCL-2 protein overexpression develop chemoresistance and experience higher relapse rates compared with BCL-2-negative patients.10

MCL

  • The etiology of MCL is likely multifactorial.8
  • MCL typically presents as an aggressive disease, with a median survival time of about 5 years.26,27
    • Clinical and biologic prognostic factors are used to stratify patients and assist in treatment decisions
  • MCL is characterized by the t(11,14) translocation that results in constitutive expression of cyclin D1.6,8
  • The BCL-2 pathway is commonly dysregulated in MCL cases and the¬†BCL2¬†gene is often amplified.12,13

MZL

  • MZL is an indolent, mature B‚Äďcell neoplasm.28
  • MZL represents about 8% of NHL. There are three distinct types: extranodal MZL of mucosa-associated lymphoid tissue (MALT lymphoma), nodal MZL and splenic MZL.28
  • Up to ~80% of MZL have been shown to be BCL-2 positive.29

WM

  • WM is a rare indolent B‚Äďcell NHL characterized by the proliferation of B cells that produce an IgM monoclonal protein.30,31
  • Some patients do not need treatment at diagnosis; however most require systemic treatment at some time.30
  • Somatic mutations in MYD88 and CXCR4 are determinants of clinical presentation and overall survival in WM.32
  • BCL-2 overexpression has been observed in WM patient samples, regardless of MYD88 or CXCR4 mutational status, suggesting an independent pathophysiologic mechanism.32

Presentation of NHL varies greatly depending on the type and aggressiveness of the lymphoma, and the area of involvement.14

An incisional or excisional lymph node biopsy is used to establish a pathologic diagnosis of NHL. Immunophenotypic analysis by flow cytometry and/or immunohistochemistry is essential for the differentiation of various subtypes of NHL.15

NHLs are staged using this general scheme; subtype-specific grading scales are used to more accurately identify the best course of treatment for disease.15

Immunochemotherapy (rituximab or obinutuzumab + chemotherapy) has emerged as the standard of care for most B‚Äďcell NHL.16

DLBCL16

  • Immunochemotherapy is the standard of care for DLBCL in the front-line setting
  • Although DLBCL is curable following front-line treatment, approximately one-third of patients eventually relapse or are initially refractory to these treatments.

FL17,18,19

  • Due to the heterogeneity of FL, there is no uniform standard approach for treating FL and patient factors must be considered when deciding therapy.
  • While most patients have disseminated disease at diagnosis, they are frequently asymptomatic and have historically been observed without initial therapy ("watch-and-wait").19,20
  • For patients with symptomatic disease who are likely to be treated, immunochemotherapy is the standard of care.25
  • Despite the improved effectiveness of immunochemotherapy regimens, FL is considered incurable and¬†approximately 20% of patients with FL experience progression of disease within 2 years of first-line therapy.17,18
  • In particular, progression within 24 months of the start of 1L therapy (POD24) is a predictor of poor survival, with only 34%‚Äď50% of patients alive at 5 years (vs ~90% in late-relapsed FL).18

MCL

  • For patients with asymptomatic newly diagnosed MCL and low tumor burden, close observation is acceptable,¬†therapy is deferred to the time of disease progression.6,21
  • In general, young and/or fit patients are considered for intensive immunochemotherapy strategies.6
  • Older MCL patients should be spared intensive strategies because the risk-to-benefit profile is not favorable.6,21
  • Although high overall response rates (ORRs) of 60% to 97% are observed after initial therapy, most often they are short lived, and almost all patients will eventually relapse.22

MZL

  • The standard of care for MZL can depend on the subtype; some MZLs can be associated with chronic immune stimulation due to infectious pathogens or inflammation.¬†However, immunochemotherapy with rituximab is generally recommended for advanced-stage MZL.33,35,36

WM

  • Although no clear standard of care for WM has emerged, BTK-inhibitor, alkylating agents, nucleoside analogues, anti-CD20 monoclonal antibodies and proteasome inhibitors can be used with high response rates.32,37,38,39

Multiple research groups have independently found that BCL-2 overexpression in DLBCL is associated with more advanced disease, poor prognostic features, and significantly lower survival rates.40

AbbVie is committed to helping address these challenges and is actively conducting research in this area to help address the unmet need.

Relevant Cancer Targets

BCL-2

Learn about how BCL-2 plays a role in tumor survival and is a rational target for therapeutic intervention.MORE>


CD19

Learn about CD19 and its expression on B cells signaling MORE>


BTK

Learn about BTK and B cell signaling MORE>

CD3xCD20 BISPECIFICS

Learn about CD3 on T cells and bispecific targeting of CD20 MORE>
 


MALT1

Learn about MALT1 and NF-őļB signaling.¬†MORE>

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