NHL Flashcards
(25 cards)
What is an NHL?
Non Hodgkin’s Lymphoma which includes all lymphomas without Reed-Sternberg cells.
Which cell lines are NHLs mostly derived from?
B cell lines
e.g. diffuse large B-cell lymphoma is most common
Where do you find NHLs?
In nodes and extranodal tissues such as MALT
What are the causes of NHL?
Immunodeficiency: HIV, EBV, HTLV-1 , drugs
H-Pylori
Toxins
Congenital
What is HTLV-1?
Human T-cell Lymphotrophic Virus -1
Where are the most common places to get extranodal NHL manifestations?
Gut Skin Oropharynx Bone CNS Lung
What are the different types of NHL you can get in the gut?
Gastric MALT - present similarly to gastric cancer.
May regress with H.Pylori eradication
Non-MALT gastric lymphoma - diffuse large-cell B lymphomas. Don’t respond to HP eradication
Small-bowel lymphomas - diarrhoea, vomiting, abdo pain and w/l. Bad prognosis
What does NHL present with?
Lymphadenopathy
Extra-nodal disease
Systemic features
Pancytopoenia if marrow involvement
What are the skin manifestations of NHL?
Mycosis fungoides
And others
What is mycosis fungoides?
T-cell lymphoma causing plaques, erythroderma, patches and nodules on the skin
What is an oropharyngeal manifestation of NHL?
Waldeyer’s ring lymphoma, causing obstructed breathing/sore throat
What are the symptoms of pancytopoenia?
Anaemia, infection and bleeding
What tests do you do for suspected NHL?
FBC Film LFTs LDH UEs
Biopsy:
Lymph node
Bone
Skin
Cytology for any effusion
LP if CNS signs
CT TAP for staging
HIV for CNS lymphoma, Burkitt’s, and Burkitt-like.
What are the main types of NHL?
Low-grade: follicular lymphoma, MALT lymphoma and lymphocytic lymphoma.
High-grade: Diffuse Large B Cell Lymphoma Lymphoblastic lymphoma Primary mediastinal Primary CNS Burkitts Burkitts-like
What is the treatment for low grade NHL?
Low grade:
- Watch and wait if symptomless
- Radiotherapy - R-CVP or
bendamustine with/out rituximab
CVP is
cyclophosphamide
vincristine
prednisolone
What is the main difference for prognosis with low grade and high grade?
Low grade is often not curable but more manageable. 50% 5yr survival
High grade is often curable but is more likely to cause death 30% 5yr survival
What is the treatment for high-grade NHL?
R-CVPD-21 (x6-8)
followed by R-ICE if relapsed
What is R-CVPD-21
Rituximab Cyclophosphamide Vincristin Predinisolone Doxorubicin For 21 days.
What is R-CVPH-21 mostly known as but why are you doing this one?
R-CHOP-21
But I’d rather remember vincristine than Oncovin and doxorubicin is easier than hydrowhatever it was bc it is more closely related to the other treatment names
What gives you a worse prognosis of NHL?
>60 years systemic symptoms bulky masses raised lactate disseminated
What does disseminated mean?
Widespread
Which lymphoma are buttock cells associated with?
Follicular
Lick your buttocks
Which lymphoma is associated with villous lymphocytes?
Splenic marginal zone
What is jaw lymphadenopathy characteristic of?
Burkitt’s lymphoma
