Management of Aggressive Non-Hodgkins Lymphoma: Case-Based Approach

Aggressive non-Hodgkin’s lymphoma (NHL) represents a diverse group of rapidly proliferating hematologic malignancies, with diffuse large B-cell lymphoma (DLBCL) being the most common subtype, followed by Burkitt lymphoma and peripheral T-cell lymphomas (PTCLs). These cancers, although treatable with chemotherapy and immunotherapy, remain a significant cause of morbidity and mortality, especially in patients who present with advanced disease or experience relapse. Advances in molecular biology have provided insights into the pathogenesis of these cancers, paving the way for more personalized treatment strategies. This chapter explores the clinical management of aggressive B-cell and T-cell NHLs, focusing on treatment strategies for both newly diagnosed and relapsed/refractory patients. In addition, it examines the role of molecular profiling in risk stratification, emphasizes the importance of emerging therapies such as CAR T-cell therapy, bispecific antibodies, and antibody-drug conjugates (ADCs), and discusses global guidelines for the treatment of NHL, with particular attention to the adaptation of these guidelines in resource-limited settings. Illustrative case studies are used to underscore the clinical decision-making process, guiding the practitioner in tailoring treatment to the individual patient’s needs. The chapter concludes with a discussion on future research directions and the ongoing challenges in the management of aggressive NHL.