The Indian Council of Medical Research (ICMR) has issued the consensus document for management of non-Hodgkin’s lymphoma (high grade) which will provide guidance to practicing doctors and researchers for the management of patients suffering from non- Hodgkin’s lymphoma – high grade and also focusing their research efforts in Indian context.
Lymphoma is a type of cancer that develops in the lymphatic system, the body’s disease fighting network. It is estimated that around 1,000 people worldwide are diagnosed with lymphoma every day. Globally the incidence of disease is 385741 cases with mortality of 199650 cases. India accounts for 23801 cases with a mortality of 16597 cases.
This document will help practicing doctors, clinicians, researchers and patients in complex decision making process in management of the disease. It represents the current thinking of national experts on subject based on available evidence.
The ICMR had earlier constituted sub-committees to prepare consensus document for management of various cancer sites. This document is the result of the hard work of various experts across the country working in the area of oncology. This consensus document on management of non- Hodgkin’s lymphoma – high grade summarizes the modalities of treatment including the site-specific anti-cancer therapies, supportive and palliative care and molecular markers and research questions. It also interweaves clinical, biochemical and epidemiological studies.
The purpose of this document is to revamp recommendations for evaluation, staging and response assessment of patients with non-Hodgkin’s lymphoma. The availability of more effective therapies for lymphoma and the increasingly sensitive and specific technologies has made this consensus the need of hour. However, good clinical judgement, a careful history and physical examination are the cornerstones of patient follow up. The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with Non Hodgkin Lymphoma – High Grade. The guidance may not be appropriate for all patients with NHL but this compilation of Indian Data gives us an insight to best practice. This disease strata is currently undergoing extensive investigations and it is likely that paradigms will shift over the next several years.
Lymphomas are a very complex group of diseases with differing behaviours and treatment options. It is typically classified into two groups, Hodgkins lymphoma (HL) and non-Hodgkins lymphoma (NHL). NHL’S are subclassfied as low grade (indolent) and high grade. The high grade NHL is generally curable with cytotoxic therapy while the low grade lymphomas are controllable for long periods.
While lymphoma is potentially fatal, some forms are curable and a patient’s survival may be greatly enhanced by early diagnosis. Almost all lymphoma types can be cured or managed as a chronic disease, but its complexity and variation do not allow for a one-size-fits-all treatment approach. Instead, it necessitates highly specialized and individualized approaches. The cause of the majority of lymphoma cases is unknown, however, there could be several factors that may influence one’s risk of developing lymphoma. The relative effects of these factors in any given case of cancer vary and are very difficult to determine with accuracy at present.