NHL

Question 1

What is an NHL?

Answer 1

Non Hodgkin’s Lymphoma which includes all lymphomas without Reed-Sternberg cells.

Question 2

Which cell lines are NHLs mostly derived from?

Answer 2

B cell lines

e.g. diffuse large B-cell lymphoma is most common

Question 3

Where do you find NHLs?

Answer 3

In nodes and extranodal tissues such as MALT

Question 4

What are the causes of NHL?

Answer 4

Immunodeficiency: HIV, EBV, HTLV-1 , drugs
H-Pylori
Toxins
Congenital

Question 5

What is HTLV-1?

Answer 5

Human T-cell Lymphotrophic Virus -1

Question 6

Where are the most common places to get extranodal NHL manifestations?

Answer 6

Gut
Skin
Oropharynx
Bone
CNS
Lung

Question 7

What are the different types of NHL you can get in the gut?

Answer 7

Gastric MALT - present similarly to gastric cancer.
May regress with H.Pylori eradication

Non-MALT gastric lymphoma - diffuse large-cell B lymphomas. Don’t respond to HP eradication

Small-bowel lymphomas - diarrhoea, vomiting, abdo pain and w/l. Bad prognosis

Question 8

What does NHL present with?

Answer 8

Lymphadenopathy
Extra-nodal disease
Systemic features
Pancytopoenia if marrow involvement

Question 9

What are the skin manifestations of NHL?

Answer 9

Mycosis fungoides

And others

Question 10

What is mycosis fungoides?

Answer 10

T-cell lymphoma causing plaques, erythroderma, patches and nodules on the skin

Question 11

What is an oropharyngeal manifestation of NHL?

Answer 11

Waldeyer’s ring lymphoma, causing obstructed breathing/sore throat

Question 12

What are the symptoms of pancytopoenia?

Answer 12

Anaemia, infection and bleeding

Question 13

What tests do you do for suspected NHL?

Answer 13

FBC 
Film
LFTs
LDH
UEs

Biopsy:
Lymph node
Bone
Skin

Cytology for any effusion
LP if CNS signs

CT TAP for staging

HIV for CNS lymphoma, Burkitt’s, and Burkitt-like.

Question 14

What are the main types of NHL?

Answer 14

Low-grade: follicular lymphoma, MALT lymphoma and lymphocytic lymphoma.

High-grade: 
Diffuse Large B Cell Lymphoma
Lymphoblastic lymphoma
Primary mediastinal
Primary CNS
Burkitts
Burkitts-like

Question 15

What is the treatment for low grade NHL?

Answer 15

Low grade:
- Watch and wait if symptomless
- Radiotherapy - R-CVP or
bendamustine with/out rituximab

CVP is
cyclophosphamide
vincristine
prednisolone

Question 16

What is the main difference for prognosis with low grade and high grade?

Answer 16

Low grade is often not curable but more manageable. 50% 5yr survival

High grade is often curable but is more likely to cause death 30% 5yr survival

Question 17

What is the treatment for high-grade NHL?

Answer 17

R-CVPD-21 (x6-8)

followed by R-ICE if relapsed

Question 18

What is R-CVPD-21

Answer 18

Rituximab
Cyclophosphamide
Vincristin
Predinisolone
Doxorubicin
For 21 days.

Question 19

What is R-CVPH-21 mostly known as but why are you doing this one?

Answer 19

R-CHOP-21

But I’d rather remember vincristine than Oncovin and doxorubicin is easier than hydrowhatever it was bc it is more closely related to the other treatment names

Question 20

What gives you a worse prognosis of NHL?

Answer 20

>60 years
systemic symptoms
bulky masses
raised lactate
disseminated

Question 21

What does disseminated mean?

Answer 21

Widespread

Question 22

Which lymphoma are buttock cells associated with?

Answer 22

Follicular

Lick your buttocks

Question 23

Which lymphoma is associated with villous lymphocytes?

Answer 23

Splenic marginal zone

Question 24

What is jaw lymphadenopathy characteristic of?

Answer 24

Burkitt’s lymphoma

Question 25

How does rituximab work?

Answer 25

It kills CD20+ve cells by direct cytotoxicity and apoptosis.
Sensitises cells to CHOP so is cost effective. Also sensitises them to CVP and CVPi (INF-alpha)