Non-Hodgkin’s Lymphoma

Question 1

Definition of Non-Hodgkin’s lymphoma

Answer 1

Lymphomas are disorders caused by haematological malignant proliferations of lymphocytes (mature B cells). These would accumulate in the lymph nodes causing lymphadenopathy
• Lymphomas as histologically divided into Hodgkin’s and non-Hodgkin’s

• Non-Hodgkin’s lymphoma includes all the lymphomas WITHOUT Reed-Sternberg cells: very diverse group
◦ 85% B cells: Diffuse large B cell lymphoma is the most common
◦ 15% T cell and NK cell
• Is more common that Hodgkin’s lymphoma

Question 2

Aetiology of Non-Hodgkin’s lymphoma

Answer 2

• Non-Hodgkin’s lymphoma has been associated with viruses and bacteria:
◦ Epstein-Barr virus
◦ Hepatitis c
◦ Helicobacter pylori
◦ HIV (immunosuppression)
• It is also a disease of the immune system and is associated with:
◦ Autoimmune diseases
◦ Acquired immunodeficiency states (due to medication, post-transplantation)
• Associated with toxins

Question 3

Pathophysiology of Non-Hodgkin’s lymphoma

Answer 3

B cell lymphoma:
◦ Malignant B cell phenotype is due to multi-step accumulation of genetic mutations
◦ These B cells would then mature into the different types of B cell lymphoma (e.g Burkitt’s lymphoma and diffuse large B cell lymphoma)

Question 4

History and Examination of Non-Hodgkin’s lymphoma

Answer 4

• Lymphadenopathy: present in most cases
• B symptoms: Night sweats, weight loss, fevers, more common in Hodgkins
• Fatigue: likely from anaemia due to bone marrow involvement
• Splenomegaly
• Hepatomegaly
• SOB, cough
• Extra oral disease: abdominal discomfort, skin rashes

Question 5

Investigations for Non-Hodgkin’s lymphoma

Answer 5

• FBC: Likely to have anaemia and thrombocytopenia due to bone marrow involvement . May have pancytopenia as well
• Blood film: nucleated RBCs and early WBC precursors (left shift)
• LYMPH NODE BIOPSY: in order to classify cell type etc
• BONE MARROW BIOPSY: Would have positive result
• PET/CT: to stage using Ann Arbor system
• LDH: is elevated

Question 6

Treatment for Non-Hodgkin’s lymphoma

Answer 6

Less severe/Low grade B cell lymphomas:
• Observation, or rituximab or chemotherapy:
◦ Observation may be carried out for those with asymptomatic disease
◦ If therapy is indicated, then Rituximab is preferred
◦ For more advanced disease, chemotherapy is preferred

More severe/High grade B cell lymphomas:
1) R-CHOP-21 regimen:
‣ Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone is a chemotherapy regimen that can have accompanied radiotherapy as well

Question 7

Complications and prognosis of Non-Hodgkin’s lymphoma

Answer 7

• Chemotherapy associated complications: immunosuppression etc

Worse prognosis indicated by B symptoms, lymphadenopathy, organometallic, extranodal involvement