Haematology & Oncology >
Non-Hodgkin’s Lymphoma
“Disorder caused by neoplastic proliferation of lymphocytes, without the presence of Reed-Sternberg cells (large mononuclear neoplastic cells that fuse – “owl eye” appearance)“
Risk Factors
- Family History
Aetiology
- Immunodeficiency (drugs, HIV)
- Congenital
- HTLV-1 virus
- H.pylori
- Toxins
Pathophysiology
- Malignant transformations usually due to errors in gene arrangements of immunoglobulins or T cell receptors. There are B cell (more common) and T cell lymphomas:
- B cell lymphomas (in order of increasing aggression)
- Lymphoplasmacytic: indolent, the involvement of bone marrow, lymph nodes, spleen
- Follicular: slow growing
- Marginal zone: most common, associated with mucosa-associated lymphoid tissue (MALT) in cases of chronic inflammation of stomach lining (chronic H.pylori infection)
- Diffuse large B cell lymphoma: more common, aggressive
- Mantel cell: aggressive
- Burkitt: highly aggressive, characterised by “starry sky appearance”
- T cell lymphomas:
- Adult T cell lymphoma
- Mycosis fungoides: T cell lymphoma of the skin, resembles a fungal infection
- B cell lymphomas (in order of increasing aggression)
Clinical Presentation
- Painless lymphadenopathy (75%)
- Extranodal disease (25%): skin infections, sore throat, gastric cancer symptoms with systemic feature (MALT), fatigue, motor/sensory deficits, recurrent infections, easy bruising
Investigations
- Bloods: FBC, U+E, LFTs (increase in LDH = worst prognosis as it reflects an increase in cell turnover)
- Marrow and nodal biopsy for classification
- CT, PET scan
Management
- Low grade: if no symptoms, no treatment may be necessary. However if symptoms present: radiotherapy + chemotherapy (Chlorambucil, Alpha-interferon, Rituximab, Bendamustine
- High grade: Chemotherapy (R-CHOP regime – Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Vincristine/Oncovin, Prednisolone)