Non-Hodgkin Lymphoma Flashcards
what is non-hodgkin lymphoma (NHL)?
a diverse group of malignant lymphoid neoplasms originating from B cells, T cells, or natural killer (NK) cells that do not exhibit the characteristic reed-sternberg cells, which are present in HL
what are the potential causes of NHL?
- HTLV-1
- EBV
- HBV
- HCV
- HIV
- HHV-8
- h. pylori
what is the origin of most NHLs?
- most MHLs arise from B lymphocytes, while the remainder originate from T lymphocytes or natural killer (NK) cells
- the stage of lymphocyte differentiation at which the oncogenic event occurs influences disease presentation and outcome
where do most lymphomas originate?
- most lymphomas are nodal, with variable involvement of the bone marrow and peripheral blood
- however, some lymphomas arise in or involve extranodal sites (e.g. skin, gastrointestinal tract, lung, and CNS)
how do NHL and leukaemia overlap?
both may present with peripheral lymphocytosis and bone marrow involvement
how may NHLs be commonly categorised?
- indolent: slowly progressive and responsive to therapy but not typically curable with standard approaches
- aggressive: rapidly progressive but responsive to chemotherapy and often curable
what is the most common symptom of NHL?
- asymptomatic peripheral lymphadenopathy
- enlarged lymph nodes are typically rubbery and discrete, later coalescing into masses
- unlike viral infections, affected nodes are usually not painful
- nodal involvement may be localised in some patients, but most have multiple areas affected
what symptoms can arise from enlarged mediastinal and retroperitoneal nodes in NHL?
- compression of the SVC: SOB, and facial oedema (e.g. SVC syndrome)
- compression of the external biliary tree: jaundice
- compression of the ureters: hydronephrosis
- bowel obstruction: vomiting, obstipation
- interference with lymph drainage: chylous pleural or peritoneal fluid or lymphoedema of a lower extremity
how can NHL affect the skin?
- B-cell NHL: follicular NHL (e.g. erythematous nodules on the scalp), large cell NHL (e.g. erythematous nodules on the legs)
- cutaneous T-cell NHL (e.g. diffuse, nonpalpable erythema or discrete papules, plaques, or tumours)
what systemic symptoms may be the first manifestations of NHL, especially in aggressive cases?
B symptoms (e.g. fever, night sweats, weight loss)
what are the potential causes of anaemia in NHL?
- bleeding (e.g. gastrointestinal lymphoma)
- haemolysis (e.g. hypersplenism)
- bone marrow infiltration
- bone marrow suppression (e.g. chemotherapy)
what are the manifestations of adult T-cell leukaemia-lymphoma (ATLL)?
ATLL (e.g. HTLV-1) has a fulminating clinical course with:
- skin infiltrates
- lymphadenopathy
- hepatosplenomegaly
- leukaemia (e.g. malignant T cells with convoluted nuclei)
- hypercalcaemia
what are the manifestations of anaplastic large cell lymphoma?
- rapidly progressive skin lesions
- lymphadenopathy
- visceral lesions (e.g. liver, spleen, lungs)
what are the investigations for NHL?
- FBC
- U&Es
- LFTs
- LDH
- ESR
- CXR
- contrast-enhanced CT neck, chest, abdomen + pelvis
- FDG-PET/CT
- lymph node biopsy
- bone marrow excision biopsy
what is the staging system used for NHL?
lugano
what is a commonly used chemotherapy regimen in NHL?
R-CHOP
- rituximab
- cyclophosphamide
- doxorubicin
- vincristine
- prednisolone
what are the options for management of NHL?
- limited indolent disease may be treated with radiation therapy
- teat more advanced disease (indolent or aggressive) with immunotherapy, chemotherapy, hematopoietic stem cell transplantation, or a combination depending on the type and stage of NHL
what are the long-term complications of NHL?
- spinal cord compression/CAS
- ‘richter’s transformation’
- TLS
- hypercalcaemia
- hypogammaglobulinemia
- hyperviscosity syndrome
- paraneoplastic autoimmune conditions (e.g. ITP)
- neutropenic sepsis
