Non Hodgkin’s lymphoma

Rakesh Biswas

MD, Professor, Department of Medicine,

People's College of Medical Sciences,
Bhanpur, Bhopal, India
 Staging
 Stage I : Involvement of single LN region (I) or extra
lymphatic site (IAE )
 Stage II : Two or more LN regions involved (II) or an
extra lymphatic site and lymph node regions on the
same side of diaphragm
 Stage III : Involvement of lymph node regions on both
sides of diaphragm, with (IIIE) or without (III) localized
extra lymphatic involvement or involvement of the
spleen (IIS) or both (IISE)
 Stage IV : Involvement outside LN areas (Liver, bone
marrow)

A : Absence of ‘B’ symptoms

B : B symptoms present
 Non Hodgkin’s lymphoma
 Incidence is increasing
 NHL>HD
 Median age of presentation is 65-70 yrs
 M>F
 More often clinically disseminated at
diagnosis
 B-cell-70% ; T-cell-30%
 Clinical features
 Widely disseminated at presentation
 Nodal involvement:
Painless lymphadenopathy, often cervical region
is the most common presentation
 Hepatospleenomegaly
 Extranodal :
Intestinal lymphoma ( abdominal pain, anemia,
dysphagia);
CNS ( headache, cranial nerve palsies, spinal
cord compression) ;
Skin, Testis; Thyroid; Lung
Bone marrow (low grade): Pancytopenia
 Clinical features contd
 Systemic symptoms
 Sweating, weight loss, itching
 Metabolic complications:
hyperuricemia,
hypercalcemia,
renal failure
 Compression syndrome:
 Gut obstruction
 Ascites
 SVC obstruction
 S/C Compression
 Classification
 REAL
 Clinical / Working Formulation
 Low grade
 Intermediate grade
 High grade
 Classification
Low grade High grade

Proliferation: Low High

Course: Indolent Rapid, fatal(un-Rx)
Symptoms: -ve +ve
Treatment: Not curable Potentially Curable
 Etiology
 Cannot be attributed a single cause
 Chromosomal translocations: t
(14, 18)

 Infection:
 Virus:EBV, HTLV,HHV-8, HIV
 Bacteria: H.Pylori - Gastric lymphoma

 Immunology:
 Congenital immunodeficiency,
 Immunocompromised patients - HIV, organ
transplantation
 Management
Low grade:
 Asymptomatic : No treatment ;
 Radiotherapy for localised disease (Stage 1);
 Chemotherapy: mainstay is
Chlorambucil; Initial response good , but
repeated relapses, median survival 6-10 yrs;
 Newer: Fludarabine, 2-CdA (Chlorodeoxyadenosine)
 Monoclonal antibody: Rituximab
 SCT/BMT
Aggressive ( high / intermediate grade):

 Chemotherapy: mainstay
CHOP
-every 3 weeks, at least 6 cycles
Cyclophosphamide,
Doxorubicin Hydrochloride,
Vincristine,
Prednisolone
 High risk cases with poor prognostic
factors or relapse :
High dose chemotherapy combined with
autologous BMT / SCT

 Monoclonal antibody

 With CNS involvement / leukemic relapse :

Similar to ALL
 Prognosis
 Low grade : Median survival –10 yrs
 High Grade:
 Increasing age, advanced stage, concomitant
disease, raised LDH,T- cell phenotype : Poor
prognosis