At present, malignant lymphoma is one of the top ten tumors with the highest morbidity and mortality rate in China. The annual incidence rate has increased by an average of 4%, and according to the data, there are about 84,000 new lymphoma patients and more than 47,000 deaths each year in China. The incidence rate has increased significantly in recent years, especially in economically developed areas, and the incidence rate in urban population is significantly higher than that in rural areas, and the incidence rate in men is higher than that in women, and the incidence rate in all age groups increases year by year, with the peak incidence age being 30-50 years old. According to the 2008 “World Health Organization (WHO) Pathological Classification of Tumors of the Lymphatic System”, there are nearly 80 known pathological types of lymphoma, which can be broadly divided into two categories: Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL), with NHL being the most common. Each pathological type is an independent disease with different treatment approaches. Early detection, early diagnosis, early treatment and individualized therapy are still the best strategies for treating malignant lymphoma. I. Prevention – Start from understanding the causes of malignant lymphoma The reasons for the gradual increase in the incidence of lymphoma, the causes of lymphoma are extremely complex, and these risk factors will increase the chance of gene mutation in the body and increase people’s risk of developing this disease, usually, the risk factors of malignant lymphoma include the following aspects. Immune dysfunction can increase the risk of lymphoma, for example, HL has been identified as one of the diseases that people infected with HIV, or human immunodeficiency virus (HIV), are susceptible to; congenital immune deficiency or immune deficiency caused by the use of certain drugs after receiving an organ transplant can increase the risk of NHL. Accelerated pace of life, increased work pressure and irregular life can cause immune disorders. 2. Certain infections can increase the risk of lymphoma, such as EBV (Epstein-Barr virus) may be one of the main causes of HL and many malignant diseases of lymphoid tissue and epithelium. EBV, human T-lymphotropic virus type I and human herpesvirus type 8 are known to be associated with the development of NHL. The development of gastric mucosa-associated lymphoid tissue lymphoma is known to be associated with Helicobacter pylori infection; other types of lymphoma are associated with hepatitis B and C and HIV viruses. Recent studies have also found an association between Chlamydia psittaci and ocular appendage lymphomas, with significant evidence of Chlamydia psittaci infection in the tumor tissue and peripheral blood mononuclear cells of these patients. However, lymphoma is not infectious and will not be contracted through other people. 3. Other factors, such as the addition of environmental pollution, excessive exposure to organic solvent dyes, prolonged exposure to electronic radiation such as cell phones and computers, and the use of non-environmentally friendly decorative materials in the home. Many chemical exposures are also related to the increased risk of lymphoma, such as solvents, herbicides, fuels, oils, dichlorodiphenyltrichloroethane (the main component of pesticides) and PCBs (which are carcinogens and mostly originate from waste discharged from factories). II. Prevention and control – the key is early detection and diagnosis of malignant lymphoma Lymphocytes can become malignant both in its birthplace (thymus, bone marrow) and in its fighting post (lymph nodes, spleen, tonsils and lymphatic tissues of other tissues and organs throughout the body), so its clinical manifestations are complex and diverse, with The clinical manifestations are complex and varied, and it is no exaggeration to describe it as “a thousand variations”. And the early symptoms are not obvious, very insidious and easy to be ignored. 1.Local manifestation The most typical manifestation of lymphoma in superficial area is painless enlargement of lymph nodes with smooth surface and tough texture, which feels like ping-pong ball when touched, or the hardness of nose tip. The swollen lymph nodes in the neck and supraclavicular area are the most common, followed by the axillary and inguinal lymph nodes. There are also patients with deep lymph node enlargement as the main manifestation, such as mediastinal, abdominal and pelvic lymph node enlargement, which are more insidious in origin. They may cause symptoms, such as compression of the gastrointestinal tract, ureter, or bile ducts by large pelvic or abdominal lymph nodes, causing intestinal obstruction, hydronephrosis, or jaundice, and abdominal pain and distention. For example, lymphoma of the gastrointestinal tract may behave like stomach or intestinal cancer, resulting in abdominal pain, gastrointestinal ulcers, bleeding, obstruction, and compression; lymphoma of the skin is often misdiagnosed as psoriasis, eczema, or dermatitis; lymphoma of the cranium may cause headache, blurred vision, speech disorders, confusion, personality changes, and paralysis; lymphoma of the skeleton may result in headache, blurred vision, speech disorders, confusion, and paralysis. Invasion of bones may cause bone pain and fracture; Invasion of nasopharynx may cause nasal congestion, runny nose, nasal bleeding, etc., similar to the performance of nasopharyngeal cancer. Systemic symptoms Before or at the same time when lymph node enlargement is detected, patients may have systemic symptoms such as fever, itching, night sweating (sweating during sleep and stop sweating after waking up) and weight loss, which are similar to cold. Some patients have irregular fever for a long time with unknown cause, and the diagnosis is clear only after superficial lymph node enlargement is found for more than 2 years and surgical biopsy. Fine diagnosis is the first step of precise treatment for malignant lymphoma. 1. Tissue biopsy is the only method to confirm the diagnosis of lymphoma. Lymphoma can occur in various parts of the body and has various symptoms, so it is difficult to make diagnosis based on clinical symptoms alone, and the final diagnosis needs to be made by pathologists. The final diagnosis needs to be made by a pathologist. Clinical treatment must be based on accurate pathological diagnosis, and without accurate pathological diagnosis, there is no standardized and individualized clinical treatment. Tissue biopsy is the gold standard for confirming the diagnosis of lymphoma. The site and method of biopsy need to be selected according to the patient’s physical condition and the site and size of the swelling. 2. Fine diagnosis of lymphoma The pathological diagnosis of lymphoma is not like other solid tumors, it has many types, wide and changing classifications, which can easily lead to misjudgment of benign and malignant. According to statistics, there are more than 70 classifications, which is more than double than other tumors. The correct diagnosis is directly related to the implementation of treatment plan. Nowadays, the classification of lymphoma is generally based on four aspects: clinical features, histological features, immunophenotype, and molecular genetic features. The refinement of pathological diagnosis of lymphoma requires pathologists not only to be proficient in pathological knowledge, but also to step out of the microscope into the front line of clinical practice to capture the information revealed by clinical lymphoma disease in a timely manner, so that they can better capture the “clues” in pathology and provide the basis for accurate differentiation between good and bad. For example, diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma and a representative of aggressive lymphoma. With the development of immunological research and molecular biology technology, especially the advent of DNA microarray technology, gene expression profiling has been performed on a large sample size of DLBCL cases, and the tumor cells are classified according to different gene expression patterns: germinal center B cells (GCB), activated B cells (GCB), and activated B cells (GCB). cells (GCB), activated peripheral blood B cells (ABC) type and type 3 DLBCL (Type 3-DLBCL) which does not highly express the genes characteristic of the above two cells. Numerous studies have shown that the GCB type has the best prognosis and the ABC type the worst. In terms of genetic studies, DLBCL is a tumor with polygenic effects, showing genetic heterogeneity, and many cases exhibit complex abnormal genetic alterations, which are closely related to prognosis and different treatment strategies. 4. Open the door to cure – rely on precise treatment complemented by standardization and individualization Chemotherapy is the use of chemical drugs to kill tumor cells, which is one of the main means of treating tumors at present. Its purpose is either to completely destroy the tumor, or to reduce the tumor’s burden so as to alleviate the symptoms caused by the tumor or prolong the life span. Chemotherapy for lymphoma is given periodically, usually with an interval after a course of treatment. the length of the interval and the number of courses depend on the stage of the disease and the antitumor drugs used. there are various chemotherapy regimens for HL and NHL. if the patient has gastric lymphoma caused by Helicobacter pylori infection, the patient may be treated with antibiotics. after the drugs control the infection, the lymphoma may also disappear. In the past 5 years, due to the application of molecular targeted drugs, the treatment mode of lymphoma has entered a new stage of immunochemotherapy from simple radiotherapy and chemotherapy targeting drugs + chemotherapy gradually into the first-line treatment. Especially in recent years, the development of fine diagnosis and precise treatment of lymphoma related to prognosis, the research and development of new targeted drugs, as well as new combination drug regimens and new treatment concepts (such as immunotherapy) have been introduced, which have significantly improved the prognosis of lymphoma patients, and some of them even reached cure. 1.Progress in the treatment of diffuse large B-cell lymphoma (DLBCL) Anti-CD20 cell-targeted therapy rituximab has been introduced for 15 years, and the R-CHOP regimen has improved the survival of 60% of patients, and the 10-year OS rate has increased by 20%, but 30% of patients still have relapsed or failed treatment, which has led to the search for new drugs, and the research conducted mainly on molecular typing The research carried out focuses on molecular typing to give the appropriate treatment. For example, for patients expressing P53 protein, it is necessary to apply etoposide, mTOR inhibitors, bortezomib, etc. For patients with ABC subtype and high NF-κB pathway activity, bortezomib improves the efficacy by 30%, so the FDA has approved the proteasome inhibitor bortezomib in combination with R-CHOP for the treatment of ABC subtype DLBCL. 2. Progress in the treatment of peripheral T-cell lymphoma This is a group of diseases mostly seen in Asian populations, and there is basically no first-line regimen at present, and the survival rate after relapse is The survival rate after relapse is very low. From 2009 to 2015, the FDA approved five drugs for the treatment of peripheral T-cell lymphoma, and the efficiency of monotherapy is only about 25%, with a complete remission rate of 8% to 20% and a maximum overall response rate of 28%. Histone deacetylase inhibitors (HDACi) have shown good efficacy in the treatment of peripheral T-cell lymphoma. The combination of 2nd and 3rd generation HDACi with chemotherapy and the immunomodulator lenalidomide has extended the survival time after relapse from several months to 16 months and increased the remission rate after relapse from about 20% to 68%. 3. Advances in the treatment of other types of lymphoma The FDA approved the BTK inhibitor ibrutinib for relapsed/refractory follicular lymphoma and set cell lymphoma. 3 years of application showed good promise with an overall response rate of about 78%, which required about 15 years to obtain the corresponding results. Programmed death molecule 1 (PD-1) inhibitors have only been used in the past for treatment studies of solid tumors such as melanoma and non-small cell lung cancer, and since 2014, US investigators have begun to report good efficacy in HL. 23 patients with relapsed/refractory advanced (stage III-IV) HL were included in the study, with a median follow-up of 40 weeks and an overall response rate of 87%, of which 17% achieved complete remission, with side effects The FDA granted PD-1 inhibitors a “breakthrough therapy designation” for relapsed/refractory HL from the “green channel” and is currently conducting an expanded phase II study. 4, targeted drugs + chemotherapy gradually into the first-line treatment The United States and China have approved bortezomib for MCL treatment, bortezomib combined with RCAP VRCAP program is expected to become the first-line treatment program for primary treatment of set cell lymphoma can not be bone marrow transplantation. The treatment of lymphoma has been dominated by chemotherapy, while nowadays the treatment of relapsed/refractory lymphoma (including Hodgkin’s lymphoma) has achieved good efficacy with targeted drugs combined with chemotherapy or dual-targeted drugs. In the future, in the field of malignant lymphoma, it may be possible to cure some lymphomas (including CLL) with non-chemotherapy regimens. 5.CAR-T immunotherapy Chimeric antigen receptor gene-modified T cells (CAR-T) is a new immunotherapy technology, which makes cellular immunotherapy and biological therapy no longer “silent” and has made a certain breakthrough. It has led to better outcomes for leukemia and lymphoma.