Non-Hodgkin’s lymphoma
Introduction
NHLs are a heterogeneous group of diseases which are mainly linked by their origin within the lymphoid system and its different cellular components. They are sub classified based on the stage of maturation (immature vs. mature) and cell of origin [B cell, T cell, or natural killer cell (NK) cell].
Signs and Symptoms
Diagnostic criteria
• Peripheral Lymph node enlargement (commonest site-neck)
• Hepatomegally and/or splenomegally in advanced stages
• B-symptoms :Unexplained weight loss, fever, night sweats
• Coughing, trouble breathing, or chest pain in case of Superior vena cava obstruction (SVCO)
Investigation
• CXR
• Chest and abdominopelvic computed tomography (CT)
• FBC, differential and film
• Bone marrow aspirate and trephine
• Immunohistochemistry
• LDH, urea and electrolyte, creatinine, albumin, aspartate transaminase (AST), bilirubin, alkaline phosphatase, serum calcium, uric acid
• Pregnancy test in females of child–bearing age
• Hepatitis B and C
• HIV status
• Tissue Biopsy for histopathology
Staging: Ann Arbor classification.
Treatment
-
Pharmacological
- NHL diseases are sensitive to both chemotherapy and radiotherapy
Indolent lymphoma
CHOP regimen which include:
• Cyclophosphamide IV day1 750 mg/m2 AND Adriamycin IV 50 mg/m2 day AND Vincristine IV 1.4 mg/m2 (maximum 2mg) day, AND Prednisolone 100mg (PO) once a day, day 1–5, every 3 weeks for 6–8 cycles.
Aggressive lymphoma with CD 20 positive
R–CHOP
• Rituximab IV 375 mg/m2 Day1 AND Cyclophosphamide IV 750 mg/m2 Day1 AND Adriamycin IV 50 mg/m2 Day1 AND Vincristine IV 1.4 mg/m2 (max 2mg) D1 AND Prednisolone 100 mg (PO) Once a day D1–D5, every 3 weeks for 6–8 cycles.
-
Non-pharmacological
- Radiotherapy
• Radiotherapy is directed to genuinely stage IA and IIA Disease
• Mantle or inverted Y: 40Gy/20fr/4weeks with shielding of the critical organs.
• Involved field RT (IFRT): 45Gy/23fr/4.5wks
Prevention
Updated on,
5 Novemba 2020 12:40:19
References
1.STG