Non-Hodgkin’s Lymphoma

Question 1

Discuss NHL?

Answer 1

85% of lymphomas
Heterogeneous group of malignant diseases arising from lymphoid tissue
lymph nodes, spleen
Various immune cell types
principally B-cells derivation (>85%)
T-cells derivation
Histiocytes (very rarely)

Question 2

Incidence/ epidemiology

Answer 2

Most common form of haematological malignancy in the developed world .
Represents 5.4% of all cancers.
Predominates in the 40-70 years age group Increases with age.
Slight male predominance overall.
Commoner in whites than in blacks.
Striking increase in NHL incidence rate over the last 4 decades due to HIV pandemic.

Question 3

What are the rifk factors of NHL?

Answer 3

EBV – Endemic Burkit Lymphoma
Helicobacter pylori- MALT ( Mucosa associated Lymphoid Tissue)
HTLV-1 Adult Tcell leukaemia /Lymphoma.
Human herpes virus 8 -Kaposis sarcoma
Herpatitis C Virus – Splenic maginal zone lymphoma.
Pesticides and Herbicides- Organophosphate,benzene
Radiation / chemotherapy

Question 4

What is the Revised European-American Lymphoma (REAL) Classification: B-Cell Neoplasms?

Answer 4

Indolent:
SLL
Lymphoplasmacytic/ IMC/WM
HCL
Splenic marginal zone lymphoma
MZL
- Extranodal (MALT)
- Nodal
Follicle center lymphoma, follicular, grade I-II

Aggressive:
Plasmacytoma/ Multiple myeloma
MCL
Follicle centre lymphoma, follicular, grade III
DLCL
Primary mediastinal large B-cell lymphoma
High-grade B-cell lymphoma/Burkitt’s-like

Very aggressive:
Precursor B-lymphoblastic lymphoma/ Leukemia
Burkitt’s lymphoma/ B-cell acute leukemia
Plasma cell leukemia

Question 5

What is the Modified Ann Arbor Staging of NHL?

Answer 5

Stage I: Involvement of a single lymph node region
Stage II:Involvement of 2 or more lymph node regions on the same side of the diaphragm
Stage III: Involvement of lymph node regions on both sides of the diaphragm
Stage I; VMultifocal involvement of 1 or more extralymphatic sites ± associated lymph nodes or isolated extralymphatic organ involvement with distant nodal involvement.

Answer 7

A— Absence of B symptoms

B—- presence of B symptoms: Fever,Drenching night sweat, weight loss > 10% in 6months

X — Bulky disease , Widening of the mediastinum by > 33% OR Mediastinal mass > 10cm.

Question 8

Treatment

Answer 8

1. Radiation- useful in the relieve of pressure symptoms
2. Chemotherapy- has curative and palliative role.
   CVP (Cyclophosphamide, Vincristine (Oncovin), Prednisone) for low grade lymphoma.
   CHOP (Cyclophosphamide, Hydroxydaunorubicin (another name for Doxorubicin, also known as Adriamycin), Oncovin (Vincristine), Prednisone) for high grade lymphoma.
   Single agent —Cyclophosphamide / Chlorambucil for indolent (slow-growing) lymphomas.
3. Biologic Therapy… Monoclonal antibodies.
   Rituximab —CD 20
   Campath —-CD 52
   R-CHOP (Rituximab + CHOP)
   Stem cell transplantation.
   CNS therapy.
4. Inter feron.

NB: Monoclonal antibodies (mAbs) are lab-produced molecules that can bind to specific antigens (proteins) on cancer cells, helping the immune system recognize and attack these cells.

Question 9

Poor Prognostic Factors

Answer 9

Constitutional B symptoms
Age> 60yrs
Bulky disease.
Disseminated disease, stage III and IV
P53 mutation
Raised serum lactate dehydrogenase.