Why a lymphoma blog? Lymphoma is a disease which in my view is endlessly fascinating. Some people don't like to use the term 'fascinating' when it comes to a disease as clearly for those affected, it is a source of worry, stress and illness. I don't want to minimise this at all. However, if you are affected by a disease then it is much better to have a specialist who is interested by the disease rather than someone who is bored by it! I hope these blogs will inform, educate and interest people in all the many and various subtype of lymphoma. I hope it will be accessible to patients but also of interest trainees and more senior clinicians.
Lymphoma in simple terms is a cancer of the adaptive immune system. In particular, the cells of adaptive immune response - lymphocytes - have become cancerous and grow and divide in a poorly controlled way. Lymphocytes (and we have 2 main types - B lymphocytes and T lymphocytes) coordinate and effect the immune response to many different micro-organisms. B lymphocytes are involved in the production of antibodies and are vital for fighting various bacteria and viruses. Certain types of B-cells (memory B cells) also enable the adaptive immune system to have a memory so it can respond faster second time around. T-lymphocytes can be thought of as the conductors of the immune orchestra, coordinating the immune response. Certain subtypes however kill infected cells whilst other subtypes actually damp down immune responses.
The majority of lymphomas we see in the UK, Europe and the US are B-cell lymphomas with T-cell lymphomas making up < 10% of cases. This is because during their life-time B-cells have to transit a structure within lymph nodes called the germinal centre. Here, 2 forms of physiological DNA damage occur. Class switch recombination involves a double strand DNA break and results in a change in the subclass of antibody. Somatic hypermutation involves single base-pair mutations in an attempt to refine the specificity of the antibody being produced. In order for this to happen quickly in response to micro-organisms, mechanisms to identify damaged DNA (such as p53 expression) are repressed. This makes the germinal centre a dangerous place for B-cells as if these genetic changes go wrong they are not recognised. If they affect genes that can induce cancer (oncogenes) then normal healthy lymphocytes can turn into lymphoma cells.
There are 2 broad categories of lymphoma: Hodgkin and non-Hodgkin lymphoma. Thomas Hodgkin was a pathologist at Guys hospital in London in the 19th century and described the first cases of what became known as Hodgkin Lymphoma (although some of his original cases turned out to have TB instead!). I won't go into the details of the different types in this blog but suffice to say Hodgkin lymphoma predominantly affects young people whereas non-Hodgkin lymphoma increases in incidence as you get older. There are high and low grade versions of non-Hodgkin lymphoma.
I hope you enjoy these posts and find them interesting. I'm not sure yet what shape they'll take and I would very much appreciate feedback or suggestions for future topics.
Thank you Dr Graham for sharing your knowledge. I hope this is a meeting place for all the hematologist of the world to share cases, comentaries and experiences about this disease. From Medellin- Colombia we wish you good luck in this new project.
ReplyDeleteThank you for this. My husband had NHL 14 years ago and is keeping well. U look forward to reading more from you though I may not understand it all. Thank you and your colleagues for the work you do.
ReplyDeleteThanks for the interesting blog indeed. I enjoyed the three posts and they were very helpful.
ReplyDeleteKeep it up.
Thank you Dr, I enjoy all your posts very much. I’m a hematology resident in Mexico, and many drugs are not available in my institution, but your tweets and posts keep me updated and help me in my everyday practice. I would very much like to meet you some day in person. Keep being so passionate about your work .
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