Non hodgkin's lymphoma

Non hodgkin's lymphoma

1. NON-HODGKIN’S LYMPHOMA Medrockets.com

2. The neoplastic transformation of either B or T cell lineages of lymphatic cells. NHL causes the accumulation of neoplastic cells in both the lymph nodes as well as more often diffusely in extralymphatic organs and the bloodstream. Absent reed-Sternberg cells. Definition: Medrockets.com

3. 60% of all lymphomas in children 8-10% of all malignancies in children between 5-19 yrs of age Secondary causes of NHL include; Inherited / acquired immune deficiencies Viruses HIV EBV Genetic Syndromes Ataxia Telangiectasia Bloom syndrome EPIDEMIOLOGY Medrockets.com

4. Risk factors INFECTIONS: Human immunodeficiency virus (HIV) Epstein-Barr virus (EBV): linked to Burkitt lymphoma . Helicobacter pylori: Extranodal tissues generating lymphoma include MALT ( Mucosa associated lymphoid tissue) Human T-cell leukemia/lymphoma virus ( HTLV-1 ) Hepatitis C virus Age : Most people with non-Hodgkin lymphoma are older than 60. Medrockets.com

5. Burkitt Lymphoma 40% of NHL B Cell Origin Lymphoblastic Lymphoma 30% of NHL 80% T Cell Origin & 20% B Cell Origin Diffuse Large B Cell Lymphoma 20% of NHL B Cell Origin Anaplastic Large Cell Lymphoma 10% of NHL 70% T Cell Origin PATHOLOGICAL SUB TYPES OF NHL Medrockets.com

6. Burkitt Lymphoma

7. Clinical Presentation Clinical presentation is the same as for Hodgkin lymphoma. The difference is that Hodgkin is localized to cervical and supraclavicular nodes 80%-90% of the time. Whereas NHL is localized 10-20% of the time. CNS involvement is more common with NHL. HIV positive patients often have CNS involvement. Medrockets.com

8. Burkitt Lymphoma Abdominal Tumor Head & Neck Disease Involvement of bone marrow & CNS Lymphoblastic Lymphoma Intrathoracic / mediastinal supradiaphragmatic mass Involvement of bone marrow & CNS Diffuse Large B Cell Lymphoma Abdominal Mass Mediastinal Mass Anaplastic Large Cell Lymphoma Primary cutaneous manifestation Systemic disease ( fever , weight loss) Dissemination to liver , spleen , lung , mediastinum & skin Clinical Presentation Medrockets.com

9. Other clinical features include; Lymphadenopathy Superior vena cava syndrome Dyspnea Abdominal Mass Intestinal obstruction / intussusception Ascites Nasal Stuffiness Earache Tonsil enlargement Localised bone involvement Acute paraplegia secondary to CNS / spinal cord compression Tumor Lysis Syndrome Clinical Presentation Medrockets.com

10. Staging system for Non-Hodgkin lymphoma Stage Description I A single tumor ( extranodal ) or single anatomic area (nodal) with the exclusion of mediastinum or abdomen II A single tumor ( extranodal ) with regional node involvement two or more nodes areas on the same side of diaphragm Two single ( extranodal ) tumors with or without the regional node involvement on same side of diaphragm A primary gastrointestinal tract tumor usually in the ileocecal area, with or without involvement of associated mesenteric nodes, which may must bemgrossly ( > 90%) resected Medrockets.com

11. Stage III Two single tumors ( extranodal ) on opposite side of the diaphragm Two more nodal areas above and below the diaphragm Any primary intarthoracic tumor ( mediastinal , pleural, or thymic ) Any extensive primary intra – abdominal disease IV Any of the above, with initial involvement of central nervous system or bone marrow t time of diagnosis Medrockets.com

12. DIFFERENTIAL DIAGNOSIS Hodgkin Disease Leukemia Germ Cell Tumor Wilms Tumor Neuroblastoma Rhabdomyosarcoma Reactive lymphadenitis Medrockets.com

13. Tissue biopsy for; Flow cytometry Karyotyping Bone marrow biopsy is more central in the initial staging of NHL Complete Blood Count Serum Electrolytes, Calcium , Phosphorus , Uric acid LFT’s & RFT’s Bone Marrow Aspiration & Biopsy CSF Examination Chest X Ray CT Scan Head & Neck Chest Abdomen & Pelvis PET Scan & Bone Scan Diagnosis Medrockets.com

14. Grades NHL divided into Low and high grade A high grade lymphoma has cells which look quite different from normal cells. They tend to grow fast (aggressive). usually look follicular. Incurable . Wider dissemination at presentation . Low grade lymphomas have cells which look much like normal cells and multiply slowly(indolent).usually look diffuse. Long term treatment maybe achievable. Medrockets.com

15. Many low-grade lymphomas remain indolent for many years. Treatment of the non-symptomatic patient is often Avoided . In this case watchful waiting is often the initial course of action. This is carried out because the harms and risks of treatment outweigh the benefits. If a low-grade lymphoma is becoming symptomatic , radiotherapy or chemotherapy are the treatments of choice. They don’t cure the lymphoma, they can alleviate the symptoms. Patients with these types of lymphoma can live near-normal lifespans, but the disease is  Incurable . Low-grade lymphomas Medrockets.com

16. High-grade lymphomas Treatment of the aggressive, forms of lymphoma can result in a cure in the majority of cases. However, the prognosis for patients with a poor response to therapy is worse. Treatment for these types of lymphoma typically consists of aggressive chemotherapy, including the  CHOP or R-CHOP regimen. Medrockets.com

17. Treatment The initial chemotherapeutic regimen is CHOP ( cyclophosmamide , hydroxy-adriamycine , oncovin and prednisolone). CNS lymphoma is often treated with radiation in addition to CHOP. Relapses can be controlled with BM transplantation. Some pts express CD-20 antigen in greater amount. In this case, monoclonal antibody Rituximab should be used. Rituximab is an anti-CD20 antibody that has limited toxicity and add survival benefit to the use of CHOP. Medrockets.com

18. Duration of Treatment Burkitt Lymphoma & Diffuse Large B Cell Lymphoma ………. 6 weeks to 6 months Lymphoblastic Lymphoma …..24 months Medrockets.com

19. COMPLICATIONS Infections Mucositis Pancytopenia Electrolyte imbalance Poor nutrition Growth retardation Cardiac Toxicity Gonadal Toxicity with Infertility Secondary malignancies Medrockets.com

20. Thank you Medrockets.com