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Non-Hodgkin's Lymphoma (Diagnosis (Blood film - lymphoma cells (e.g.…
Non-Hodgkin's Lymphoma
Malignant tumour of lymphocytes that are not Hodgkin's. Most common type and can occur at any age but median age of presentation is 50 years.
Classification
Low grade
Smaller better differentiated cells
Indolent but tendency to relapse repeatedly
Slow growing
e.g. most common is Follicular lymphoma
WHO classification: age (paediatric or elderly) and site of involvement, histology, immunophenotype and genotype
High grade
Large poorly differentiated lymphoid cells
Aggressive but curable
Rapidly growing
E.g. most common is Diffuse large B cell
Aetiology
Infection - EBV, human T cell leukaemia virus, Helicobacter pylori, Hep C, HIV infection
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Medical treatment - radiotherapy, chemotherapy, immunosuppression drugs
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Autoimmune disease - Sjogren's, coeliac, RA, SLE
Pathogenesis
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In general, neoplasms of non-dividing mature lymphocytes are ‘indolent’, whereas those of proliferating cells (e.g. lymphoblastic) are much more ‘aggressive’
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Leukaemia vs Lymphoma
Lymphoma - lymph nodes, spleen or other solid organs are involved
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Clinical features
Asymmetrical, painless, rubbery
lymphadenopathy with irregular
spreads and increased extra nodal
spread
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Anaemia, neutropenia and thrombocytopenia
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Diagnosis
Blood film - lymphoma cells (e.g. mantle zone cells, ‘cleaved follicular lymphoma’ or ‘blast’ cells)
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Serum lactate dehydrogenase (LDH) level - raised in rapidly proliferating and extensive disease and is used as a prognostic marker
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Immunophenotype - identify the degree of maturation of the malignant cell and determine whether it is B or T cell origin
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Staging
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National Comprehensive Cancer Network-International prognostic index (NCCN-IPI) for patients with high-grade lymphoma. This includes:
- Age
- LDH
- Anne Arbour
- Extranodal disease
- Performance status
Management
When treatment is started it is usually in the form of a combination of chemotherapy drugs together with a monoclonal antibody directed against the tumour cell
85% of NHL are B cell origin and therefore antibodies against CD20 are useful. Examples include Rituximab, Ofatumumab and obinutuzumab