What is it?
Almost 85% of NHLs are of B-cell origin; only 15% are derived from T/NK cells, and the small remainder stem from macrophages.
Represents a progressive clonal expansion of B cells or T cells and/or NK cells arising from an accumulation of lesions affecting proto-oncogenes or tumor suppressor genes, resulting in cell immortalization.
NHLs may result from:
-Epstein-Barr virus (EBV)
-Human T-cell leukemia virus type 1 (HTLV-1)
-Hepatitis C virus (HCV)
-Kaposi sarcoma–associated herpesvirus (KSHV)
-Congenital immunodeficiency states (eg, severe combined immunodeficiency disease [SCID], Wiskott-Aldrich syndrome),
-acquired immunodeficiency states (eg, AIDS),
-chemicals (eg, pesticides, herbicides, solvents, organic -chemicals, wood preservatives, dusts, hair dye)
maternal smoking during pregnancy
Peripheral adenopathy, painless
Primary extranodal involvement and B symptoms (ie, temperature >38°C, night sweats, weight loss >10% from baseline within 6 mo) are not common at presentation,
Bone marrow is frequently involved and may be associated with cytopenia or cytopenias.
Intermediate- and high-grade lymphomas
GI) tract (including the Waldeyer ring), skin, bone marrow, sinuses, genitourinary (GU) tract, thyroid, and central nervous system (CNS). -B-symptoms are more common, occurring in approximately 30-40% of patients.
-Lymphoblastic lymphoma, a high-grade lymphoma, often manifests with an anterior superior mediastinal mass, superior vena cava (SVC) syndrome, and leptomeningeal disease with cranial nerve palsies.
Intermediate / high grade:
-Rapidly growing and bulky lymphadenopathy
-Large abdominal mass : this usually occurs in Burkitt lymphoma
The Ann Arbor staging system.
Divide into 4 stages.
-International Prognostic Index (IPI)
-Follicular Lymphoma International Prognostic Index, (FLIPI)
The 5-year relative survival rate of patients with NHL is 71%.
Potential chemotherapy and other treatment-related complications:
-Nausea or vomiting
-Dehydration after diarrhea or vomiting
-Cardiac toxicity from doxorubicin
-Tumor lysis syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and renal failure
(Measures to prevent this complication include aggressive hydration, allopurinol administration, and urine alkalinization)
-Bleeding secondary to thrombocytopenia, disseminated intravascular coagulation (DIC), or vascular invasion by the tumor
-Infection secondary to leukopenia, especially neutropenia
-Cardiac problems secondary to large pericardial effusion or arrhythmias secondary to cardiac metastases
-Respiratory problems secondary to pleural effusion and/or parenchymal lesions
-Superior vena cava (SVC) syndrome secondary to a large mediastinal tumor
-Spinal cord compression secondary to vertebral metastases
-Neurologic problems secondary to primary CNS lymphoma or lymphomatous meningitis
-GI obstruction, perforation, and bleeding in a patient with GI lymphoma (may also be caused by chemotherapy)
-Pain secondary to tumor invasion
-Leukocytosis (lymphocytosis) in leukemic phase of disease
-tumor or cancer, mets
-other hematologic malignancies
-FBC, look for cytopenias in advance disease, bone marrow infiltration
-LDH, high indicate poor prognosis, high tumor burden
-LFT, hepatic involvement
-Hypercalcemia, Acute form ATLL( adult T cell lymphoma leukemia)
-CXR, mediastinal enlargement, pericardial effussion, mediastinal adenopathy
-CT scan, staging
-Gallium scan, detect initial sites of disease, reflect therapy response, and detect early recurrences.
-Obtain an ultrasound image of the opposite testis in male patients with a testicular primary lesion.
-MRI of the brain and spinal cord of patients who are suspected of having primary CNS lymphoma, lymphomatous meningitis, paraspinal lymphoma, or vertebral body involvement by lymphoma.
-Bone marrow aspirate and biopsy, staging
-Biopsy of extranodal sites, e.g. GI tract.
–Lumbar puncture for cerebrospinal fluid (CSF) examination in selected cases.
-Depend on subtypes
-Surgical in GI or testicular involvement
-neutropenia – avoid contact with communicable disease
-thrombocytopenia- soft toothbrush, avoid razor