Non-Hodgkin’s Lymphoma (NHL)

Etiology, pathophysiology and prognostic factors of Non-Hodgkin’s lymphoma (NHL).

  • Non-Hodgkin’s Lymphoma
    • Far more common than Hodgkin’s & is usually seen at much high age (~67)
    • More common in males & whites
    • Risk factors:  H. pylori, HIV< EBV, herpes, herbicides, smoking, EtOH, immune dysregulation, chromosomal abnormalities
    • Histopathology:  monoclonal proliferation of malignant B or T lymphocytes (B cell more common)

Signs and symptoms of Non-Hdogkin’s lymphoma (NHL).

  • Non-Hodgkin’s Lymphoma
    • S/S:  lymphoadenopathy, hepatomegaly, splenomegaly, not conitguously spread (doesn’t spread from lymph node to lymph node like Hodgkin’s), B symptoms are less common than HD, Mesenteric organ involvement (N/V, abdominal pain, abdominal mass), at advanced stages of the disease there may be bone marrow involvement

Principles behind various staging systems for Non-Hodgkin’s Lymphoma (NHL) and its prognostic importance

  • Non-Hodgkin’s Lymphoma
    • Staging isn’t reliable
    • Diffuse Large B-Cell (DLBC) is the most common type of NHL & usually requires aggressive treatment (curable)
    • Follicular lymphoma is the 2nd most common type of NHL & usually utilizes more of an indolent treatment (indolent = hard to cure aka we will only be treating to improve QOL)
    • Diagnosis is based of a tissue biopsy & staging is primarily accomplished via labs, CSF, bone marrow biopsy, abdominal CT/PET scan

Expected outcomes (including overall and disease-free survival) based on stage, treatment and risk factors

  • Non-Hodgkin’s Lymphoma
    • Adverse risk factors:  age > 60, having stage 3 or 4 (ann arbor staging), 2(+) extranodal sites, performance status > 2, elevated LDH
Risk Group

All ages

# of Factors

5- year survival

10-year survival

Low

0, 1

91

71

Intermediate

2

78

51

High

>3

58

36

  • NHL has slightly better prognosis in patients less than 60
  • Goal & choice of the treatment depends on the type
    • Indolent lymphoma (limited disease–stage 1 or 2)
      • Follicular cell lymphoma
        • No cure, median survival is 8-10 years so your goal is to improve QOL & limit spread of the disease
        • Radiation is the standard of treatment
    • Indolent Non-Hodgkin’s lymphoma (advanced disease–stage 3 or 4)
      • No cure available, may try to either be conservative (watch & wait) & treat symptoms as they arrive or be aggressive
    • Aggressive Non-Hodgkin’s lymphoma (aka Diffuse Large B Cell)
      • Use R-CHOP regimen for 3 cycles then RT
    • Aggressive lymphoma (stage 3 or 4)
      • No standard of therapy for aggressive treatment but usually use R-CHOP for 6 cycles in stage 3 or 4 cancer
        • R-CHOP cures about 30-40%
        • R = Rituximab which is good for B cell tumors
  • Hyperuricemic agents
    • Allopurinol inhibits xanthine oxidase (only affects new uric acid production)
    • Rasburicase is a form of urate oxidase that decreases the concentration of uric acid
  • Things to monitor in chemo patients: LVEF (ejection fraction), renal function, liver function, neuropathies, blood sugar

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: