Non-Hodgkin's lymphoma

Question 1

Who is most affected?

Answer 1

· Males.
· White people.
· Uncommon before age 50 (incidence increases with age).

Question 2

What is the pathophysiology of B cell lymphoma?

Answer 2

· Normal B cells originate and mature in the bone marrow.
· They leave the narrow to undergo differentiation and perform their function in the lymph nodes and spleen.
· B cell lymphomas arise during the different stages of B cell maturation as a result of abnormal genetic mutations.

Question 3

What is the pathophysiology of T cell lymphoma?

Answer 3

· T cells also originate from the bone marrow.
· But they then migrate to the thymus, where they develop into mature cells.
· They develop into CD4 or CD8 cells.
· The abnormal mutations can happen at different stages of T cell development and lead to different malignant phenotypes.

Question 4

What signs and symptoms suggest a worse prognosis?

Answer 4

· B symptoms.
· Lymphadenopathy.
· Organomegaly.
· Skin changes.

Question 5

What is the aetiology of NHL?

Answer 5

· NHL has been associated with many viruses and bacteria, including:

• EBV - Burkitt’s lymphoma and T cell lymphoma.
• Hep C - Diffuse large B cell lymphoma.
• H pylori - Gastric Mucosa-Associated Lymphoid Tissue (MALT).

· Linked to autoimmune disorders such as:

• Sjogren’s syndrome.
• Rheumatoid arthritis.
• SLE.
• Coeliac disease.

· Immunodeficient states.

Question 6

List the potential risk factors for NHL.

Answer 6

· Age >50 years.
· Male. 
· Immunocompromised. 
· EBV. 
· H pylori. 
· HIV and Hep C.
· RA and SLE.

Question 7

What are the typical signs and symptoms?

Answer 7

· Fatigue. 
· Lymphadenopathy. 
· B symptoms:
	- Unexplained fevers.
	- Night sweats. 
	- Weight loss.
· Hepatomegaly/Splenomegaly.

Question 8

What investigations would you request if you suspected a patient had NHL? What would they show?

Answer 8

· FBC:
	- Thrombocytopenia.
	- Pancytopenia.
	- Lymphocytosis.
· U&Es and LFTs. 
· Blood smear - nucleated RBCs.
· Lymph node biopsy - positive. 
· Bone marrow biopsy - positive.

Question 9

Differentials?

Answer 9

· Hodgkin’s lymphoma.
· Acute lymphocytic leukaemia.
· Glandular fever.
· Hep C, CMV, TB or HIV.

Question 10

What treatment options are available for NHL?

Answer 10

Treatment varies for all of the different lymphomas. Common themes are:
· R-CHOP-21 chemotherapy regimen - rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone.
· With or without radiotherapy.
· Growth factor.
· Anti-microbial prophylaxis.

Question 11

What complications can occur?

Answer 11

· Chemotherapy-related complications.
· Radiation-related complications.
· Bone marrow transplant-related complications.
· Tumour lysis syndrome - life-threatening complication of Burkitt’s lymphoma.