Skip to main content

Non-Hodgkin's Lymphoma (NHL)

Non-Hodgkin's Lymphoma (NHL)


There is a malignant monoclonal proliferation of lymphoid cells ( majority of B-cells and minority of T-cells ).

Working classification

Three grades ( low, intermediate, high ).

Staging by Ann-Arbor classification

Stage 1

Involvement of a single lymph node region or a single extra - lymphatic origin or site.

Stage 2

Involvement of 2 or more lymph node regions on the same side of diaphragm. 

Stage 3

Involvement of lymph node regions on both sides of the diaphragm.

Stage 4

Diffuse or disseminated involvement of one or more extra - lymphatic organs.

Stage 5

Localised, solitary involvement of extralymphatic tissue excluding liver and bone marrow.

Clinical features

Patients present with lymph node enlargement, which may be associated with systemic upset: weight loss, sweats, fever and itching.
Hepatosplenomegaly may be present.
Site of extranodal involvement include the bone marrow, gut, thyroid, lung, skin, testis  and brain.
Compression syndromes may occur, including gut obstruction, ascites, superior vena cava obstruction and spinal cord compression.

Investgations

  1. Lymph node biopsy under CT guidance
  2. Bone marrow aspiration and trephine.
  3. Immunophenotyping of surface antigens to distinguish T from B cell tumours.
  4. Measurement of uric acid levels: some very aggressive high-grade NHLs are associated with very high urate levels, which can precipitate renal failure when treatment started.
  5. Positive Coombs' test in the presence of complicating hemolytic anaemia
  6. Test for HIV since it may also present with generalised lymphadenopathy.



Mangement

In low grade lymphomas: 

  • Radiotherapy is used for stage 1 and stage 2A.
  • Chemotherapy for stage 2B, 3 and 4.
  • CHLORAMBUCIL 20 mg/m2/day for 3 days every month.
  • Interferons has also been tried.
  • Autologous bone marrow transplant has been done on experimental basis.
  • RITUXIMAB along with CYCLOPHOSPHAMIDE, VINCRISTINE and PREDNISOLONE (R-CVP) is commonly used as first-line therapy.

In high grade lymphomas:

  • Stage 1 disease is treated with radiotherapy.
  • Stage 2, 3 and 4 diseases are treated with intensive combination chemotherapy.
  • R-CHOP regimen is used here ( RITUXIMAB, CYCLOPHOSPHAMIDE, ADRIAMYCIN, VINCRISTINE AND PREDNISOLONE ).
  • HSCT. Autologous HSCT benefits patient with relapsed chemosensitive disease.

Comments

Popular posts from this blog

INFECTIVE ENDOCARDITIS (IE)

INFECTIVE ENDOCARDITIS (IE) It is the colonisation of the heart valves with microbiological organisms, leading to the formation of friable, infected vegetations and frequently valve injury. Types ACUTE INFECTIVE ENDOCARDITIS : caused by highly virulent organisms mainly Staphylococcus Aureus (20-30%), seeding a previously normal valve. SUBACUTE INFECTIVE ENDOCARDITIS : caused by organisms of moderate or low virulence mainly STREPTOCOCCI (60-70%), seeding an abnormal or previously injured valve. ENDOCARDITIS OCCURING IN I/V DRUG ABUSERS : caused predominantly by organisms found on the skin (S. aureus, Candida) and affecting the valves on the right side of the heart. PROSTHETIC VALVE ENDOCARDITIS : This may be early ( symptoms appearing within 60 days of valve insertion ), due to intraoperative infection of the valve or insertion of an infected valve or late ( after 60 days of valve insertion), due to late bacteremia. Predisposing factors to developement of IE Congenital cardiac anoma...

Hodgkin's Lymphoma

Hodgkin's Lymphoma This is progressive, painless enlargement of lymphoid tissues throughout the body. EB virus involvement is thought to be one of the aetiologies. Pathological classification Lymphocyte predominant Nodular sclerosis Mixed cellularity Lymphocyte depleted Characteristically, cells with mirror image nuclei (REED-STERNBERG CELLS) are seen. Clinical features Patient present with enlarged, painless lymph nodes, alcohol induced pain pain over the enlarged nodes, and features due to the mass effect of the node. 25% have constitutional symptoms like fever, weight loss, night sweats and pruritus. Hepatosplenomegaly may also be present. Investigations Lymph node biopsy  Bone marrow biopsy Liver biopsy Lymphopenia indicates bad prognosis. Moderate eosinophilia may occur in 10 to 15% of the patients. Clinical staging (Ann-Arbor Classification) Stage 1 Involvement of a single lymph node region (1) or extra-lymphatic site (E) Stage 2 Involvement of two or more lymph node regions ...

Rheumatoid arthritis (RA)

  Rheumatoid arthritis  is a chronic inflammatory, destructive and deforming symmetrical polyarthritis associated with systemic involvement. The individuals with HLA-D4 and HLA-DR4 are more prone to RA. It starts when your immune system, which is supposed to protect you, goes awry and begins to attack your body’s own tissues. It causes  inflammation   in the lining of your joints (the synovium). As a result, your joints may get red, warm, swollen, and painful. Symptoms of Rheumatoid Arthritis Joint pain and swelling Stiffness, especially in the morning or after you sit for a long time Fatigue Who Gets Rheumatoid Arthritis? Anyone can get RA. It affects about 1% of Americans. The disease is 2 to 3 times more common in women than in men, but men tend to have more severe symptoms. It usually starts in middle age. But young children and the elderly also can get it. Pathogenesis Synovitis (synovial cell hyperplasia, hypertrophy with CD4 lymphocytic infiltration and synovi...