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)
      1. Lymphoplasmacytic: indolent, the involvement of bone marrow, lymph nodes, spleen
      2. Follicular: slow growing
      3. Marginal zone: most common, associated with mucosa-associated lymphoid tissue (MALT) in cases of chronic inflammation of stomach lining (chronic H.pylori infection)
      4. Diffuse large B cell lymphoma: more common, aggressive
      5. Mantel cell: aggressive
      6. 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
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)

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