Lymphoma - Non-Hodgkin

Question 1

How does lymphoma differ from leukaemia

Answer 1

The neoplastic cells predominantly involved the lymph nodes and extra nodal sites, unlike leukaemia which mainly involves the bone marrow + blood

Question 2

Epidemiology

Answer 2

50+
MALE

Question 3

Risk Factors

Answer 3

Infection: HIV, EBV, H.pylori
Autoimmunity: Hashimotos, Sjorgrens
Immunodeficiency: HIV as well as hereditary immunodeficiency e.g. Wiskott-Aldrich syndrome

Question 4

Pathophysiology

Answer 4

Non-Hodgkin’s Lymphoma can be divided by cell type: proliferation of B cells, T cells, or NK cells or grade: High or Low
- B cell is the most common type (85%)
* Low grade = follicular lymphoma, marginal zone lymphoma, hairy cell leukaemia
* High grade = diffuse large B cell lymphoma (80%)
* High grade = Burkett’s lymphoma (linked to EBV in Africa causes MASSIVE JAW LYMPHADENOMPATHY)
* Mantle cell lymphoma

Question 5

Signs

Answer 5

Lymphadenopathy
- PAINLESS, hard, rubbery, fixed, non-contiguous spread unlike in HL - NOT AFFECTED BY ALCOHOL
Splenomegaly - more common in NHL
Extra nodal disease - bone marrow, thyroid, salivary gland, GI tract, CNS

Question 6

Symptoms

Answer 6

B symptoms:
- Fever, weight loss, night sweats

Question 7

Investigations

Answer 7

FIRST LINE:
- FBC = Low Hb, Platelets, High ESR, lactose dehydrogenase
GOLD STANDARD:
- Lymph node biopsy = will NOT show Reed-Sternberg cells
CT chest, abdo, pelvis
- Ann Arbour Criteria

Question 8

Treatment

Answer 8

R-CHOP
- Rituximab
- Cyclophosphamide
- Hydroxydaunorubicin
- Vincristine (Oncovin)
- Prednisolone
CNS involvement = intrathecal methotrexate
Low grade = radiotherapy may be curative

Question 9

How does rituximab work?

Answer 9

Monoclonal antibodies which binds to CD20 receptors on B cells to cause apoptosis.

Question 10

Complications

Answer 10

Myelosupression + neutropenia sepsis
Tumour lysis syndrome