Non-Hodgkin lymphoma (NHL) consists of a diverse group of malignant neoplasms variously derived from B cell progenitors, T cell progenitors, mature B cells, mature T cells, or (rarely) natural killer cells.
Overview Lymphomas are derived from B and T lymphocytes or natural killer (NK) cells at varying stages of maturation. B cell lymphomas can arise at any stage of normal B cell development, but most are derived from cells that have been exposed to the germinal center reaction. T and natural killer (NK) cell lymphomas can arise at any stage of normal T or NK cell development. B cell lymphoma are more common.
Epidemiology
Acute lymphoblastic leukaemia tetrad: acute onset, purpura, bleeding, and infection |
Immunological
Genetic
Viral
Environmental
Diagnosis Lymph, Skin or Bone Marrow Biopsy can be used for diagnosis depending on the type of NHL. Imaging for monitoring progression (CT, PET)
Ann Arbor Staging System for NHL |
I: Single lymph node group |
II: Multiple lymph node groups on same side of diaphragm |
III: Multiple lymph node groups on both sides of diaphragm |
IV: Multiple extranodal sites |
B and T cells have different stages of development. Accumulation of multiple genetic lesion affecting proto-oncogenes and Tumour Suppressor Genes (TGS) during stages of lymphocyte development leads to Lymphoma
B cell Lymphoma
T cell Lymphoma
Aggressive B-cell non-hodgkins Lymphoma
R-CHOP-21 (Rituximab, cyclophosphamide, doxorubicin, vincristine, prenisolone) +/- radiotherapy
Adjuncts
Methotrexate (CNS prophylaxis)
Mesna (high dose cyclophosphamide or ifosfamide are at risk of haemorrhagic cystitis)
Relapse on R-CHOP-21
R-ICE (Rituximab, phosphamide, carboplatin, etoposide)
Complications
Prognosis In general, prognosis depends on the type of lymphoma, stage of disease, treatment, and comorbidities.
Worse prognosis is indicated by the following:
Diffuse Large B-Cell Lymphoma (most common NHL)