Bhalwanti
3rd year mbbs
Objective- NON HODGKIN
LYMPHOMA
• Investigation
• Management
• Prognosis
Investigation
• CBC – low blood count, Lymphocytosis,Thromocytosis.
• ESR level raised.
• Renal function test are required to ensure function is normal prior to treatment.
• Liver function test may be abnormal in the absence of disease.
• Chest x-ray may show mediastinum mass.
• CT scan of chest ,abdomen and pelvis permit staging.
• PET scan identify for node involvement.
• Bone marrow aspiration –to Identify bone marrow involvement.
Cont..
• Immunophenotyping of surface antigen to distinguish T cell from B cell tumor.
• Cytogenetic analysis to detect chromosomal translocation.
• Immunoglobulin determination.
• Measurement of uric acid level-high grads (NHL) associate with very high urate
level .
• HIV testing.
• Hepatitis B and C testing.
Management..
• Low grade NHL
• Radiotherapy: This can be used to localised stage l disease.
• Chemotherapy: most patient will respond to oral therapy with chlorambucil
which is well tolerated but not curative.
• Monoclonal antibody therapy humanised Monoclonal antibody can be used to
target surface antigen on tumor cells. Commonly used R-CHOP or R-
bendamustine are first line therapy.
• Kinase inhibitor :Idelalisib for relapsed follicular lymphoma
• :Ibrutinib for relapsed mantle cell lymphoma.
• Transplantation.
• High grade NHL
• Chemotherapy: the majority (>90%) are treated with intravenous combination
Chemotherapy. Eg: typically with the CHOP regimen .
• Monoclonal antibody therapy: when combined with CHOP therapy, Rituximab
improve overall survival .
• Radiotherapy: is indicated for residual localised site for bulk disease after
Chemotherapy.
• Autologous HSCT benefits patient with relapse disease.
Prognosis...
- Low grade NHL runs an indolent remitting and relapsing course ,with an overall
survival of 12 yrs . Tranform to a high grade NHL occur in 3 % per annum
associate with poor survival .
- The prognosis for patient with NHL is further refined according to the
international prognostic index (IPI) .For high grade NHL ,5 Year survival from
over 70 %in those with Low risk score (age <60 Yr, stage l or ll ,normal LDH )to
25% in those with high risk score .
- Relapse is associated with a poor response with further chemotherapy, but in
patient under 65 yrs HSCT improve survival.
