non-hodgkins lymphoma

Question 1

types of non-Hodgkins lymphoma

Answer 1

• Diffuse large B cell lymphoma typically presents as a rapidly growing painless mass in older patients
• Burkitt lymphoma is particularly associated with Epstein-Barr virus and HIV
• MALT lymphoma affects the mucosa-associated lymphoid tissue, usually around the stomach

Question 2

risk factors

Answer 2

HIV
Epstein-Barr virus
Helicobacter pylori (H. pylori) infection is associated with MALT lymphoma
Hepatitis B or C infection
Exposure to pesticides
Exposure to trichloroethylene (a chemical with a variety of industrial uses)
Family history

Question 3

management

Answer 3

depends on the type and stage:
- Watchful waiting
- Chemotherapy
- Monoclonal antibodies (e.g., rituximab, which targets B cells)
- Radiotherapy
- Stem cell transplantation

Question 4

high grade NHL types

Answer 4

Commonest high grade NHL
- DIFFUSE LARGE B CELL LYMPHOMA

Most aggressive high grade NHL - Burkitt lymphoma

Question 4

subcatagories

Answer 4

high grade:
- aggressive
- need immediate treatment
- cured with intensive treathement

low grade:
- indolent / slow growing
- relapsing / remitting
- cant be cured
- may go for years without treatment

Question 5

low grade NHL types

Answer 5

Commonest low grade NHL:
- FOLLICULAR LYMPHOMA
-Marginal zone lymphomas

Other important low grade types:
- Mantle cell lymphoma – not curable but can be aggressive
- Waldenstrom macroglobulinaemia

Question 6

High grade NHL risk factors

Answer 6

Immunosuppression
HIV
EBV – post transplant lymphoproliferative disorder

Question 7

High grade NHL presentation

Answer 7

• LYMPHADENOPATHY – anywhere
• Extranodal involvement – anywhere!
• Compressive symptoms due to lymphadenopathy – esp GI, mediastinal
• Organomegaly
• B symptoms
• FBC – may be normal, cytopenias if marrow involvement (<10%)
• Serum LDH often elevated

Question 8

High grade NHL most important diagnostic test

Answer 8

LYMPH NODE CORE BIOPSY

Question 9

High grade NHL treatment aand prognosis

Answer 9

Diffuse large B cell lymphoma

Prognosticate with IPI score

Approx 75% cured with 1st line intensive chemotherapy e.g R-CHOP or Pola-R-CHP

Palliative chemo or radiotherapy may give prognosis in months – years - if cant get on with normal chemo

Without treatment –prognosis weeks

2nd and 3rd line curative treatments available if fit (including autologous stem cell transplants and CAR T cell therapy) if chemo ineffective

Question 10

Low grade NHL risk factors

Answer 10

Immunosuppression
HIV
H.pylori – gastric marginal zone lymphoma
Hepatitis C – splenic marginal zone lymphoma

Question 11

Low grade NHL clinical presentation

Answer 11

LYMPHADENOPATHY – anywhere
Extranodal involvement – anywhere!
Compressive symptoms due to lymphadenopathy – esp GI, mediastinal
Organomegaly
B symptoms – less common
FBC – may be normal, lymphocytosis can be seen, cytopenias if marrow involvement
IgM paraprotein – seen with Waldenstrom’s

Question 12

Low grade NHL treatment and prognosis

Answer 12

Treat if problematic or localised to one area
B symptoms, severe cytopenias, symptomatic/bulky organomegaly or lymphadenopathy – treat with chemotherapy
Radical radiotherapy if only one area involved

Follicular lymphoma
Prognosticate with FLIPI score
Median survival ~10 years
3% per year transform to high grade NHL
Treatment is with chemotherapy e.g R-CVP x 6 + 2 years antibody therapy maintenance e.g rituximab

Question 13

Low grade NHL most important diagnostic test

Answer 13

LYMPH NODE CORE BIOPSY

Question 14

cellular malignancy origin

Answer 14

B / T / NK
B most common

Question 15

risk factor - occupation

Answer 15

pesticides
trichloroethylene (a chemical with a variety of industrial uses)