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Non Hodgkin’s lymphoma Rakesh Biswas MD, Professor, Department of Medicine, People's College of Medical Sciences, Bhanpur, Bhopal, India.

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Presentation on theme: "Non Hodgkin’s lymphoma Rakesh Biswas MD, Professor, Department of Medicine, People's College of Medical Sciences, Bhanpur, Bhopal, India."— Presentation transcript:

1 Non Hodgkin’s lymphoma Rakesh Biswas MD, Professor, Department of Medicine, People's College of Medical Sciences, Bhanpur, Bhopal, India

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5 Staging Stage I : Involvement of single LN region (I) or extra lymphatic site (IA E ) Stage I : Involvement of single LN region (I) or extra lymphatic site (IA E ) 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 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 (III E ) or without (III) localized extra lymphatic involvement or involvement of the spleen (II S ) or both (IIS E ) Stage III : Involvement of lymph node regions on both sides of diaphragm, with (III E ) or without (III) localized extra lymphatic involvement or involvement of the spleen (II S ) or both (IIS E ) Stage IV : Involvement outside LN areas (Liver, bone marrow) Stage IV : Involvement outside LN areas (Liver, bone marrow) A : Absence of ‘B’ symptoms A : Absence of ‘B’ symptoms B : B symptoms present B : B symptoms present

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7 Non Hodgkin’s lymphoma Incidence is increasing Incidence is increasing NHL>HD NHL>HD Median age of presentation is yrs Median age of presentation is yrs M>F M>F More often clinically disseminated at diagnosis More often clinically disseminated at diagnosis B-cell-70% ; T-cell-30% B-cell-70% ; T-cell-30%

8 Clinical features Widely disseminated at presentation Widely disseminated at presentation Nodal involvement: Painless lymphadenopathy, often cervical region is the most common presentation Nodal involvement: Painless lymphadenopathy, often cervical region is the most common presentation Hepatospleenomegaly Hepatospleenomegaly Extranodal : Intestinal lymphoma ( abdominal pain, anemia, dysphagia); CNS ( headache, cranial nerve palsies, spinal cord compression) ; Extranodal : Intestinal lymphoma ( abdominal pain, anemia, dysphagia); CNS ( headache, cranial nerve palsies, spinal cord compression) ; Skin, Testis; Thyroid; Lung Bone marrow (low grade): Pancytopenia Skin, Testis; Thyroid; Lung Bone marrow (low grade): Pancytopenia

9 Clinical features contd  Systemic symptoms Sweating, weight loss, itching Sweating, weight loss, itching Metabolic complications: hyperuricemia, hypercalcemia, renal failure Metabolic complications: hyperuricemia, hypercalcemia, renal failure Compression syndrome: Compression syndrome: Gut obstruction Gut obstruction Ascites Ascites SVC obstruction SVC obstruction S/C Compression S/C Compression

10 Classification REAL REAL Clinical / Working Formulation Clinical / Working Formulation Low grade Low grade Intermediate grade Intermediate grade High grade High grade

11 Classification Low grade Low grade Proliferation: Low Course: Indolent Symptoms: -ve Treatment: Not curable High grade High Rapid, fatal(un-Rx) +ve Potentially Curable

12 Etiology Cannot be attributed a single cause Cannot be attributed a single cause Chromosomal translocations: t (14, 18) Chromosomal translocations: t (14, 18) Infection: Infection: Virus:EBV, HTLV,HHV-8, HIV Virus:EBV, HTLV,HHV-8, HIV Bacteria: H.Pylori - Gastric lymphoma Bacteria: H.Pylori - Gastric lymphoma Immunology: Immunology: Congenital immunodeficiency, Congenital immunodeficiency, Immunocompromised patients - HIV, organ transplantation Immunocompromised patients - HIV, organ transplantation

13 Management Low grade: Low grade: Asymptomatic : No treatment ; Asymptomatic : No treatment ; Radiotherapy for localised disease (Stage 1); Radiotherapy for localised disease (Stage 1); Chemotherapy: mainstay is Chlorambucil; Initial response good, but repeated relapses, median survival 6-10 yrs; Chemotherapy: mainstay is Chlorambucil; Initial response good, but repeated relapses, median survival 6-10 yrs; Newer: Fludarabine, 2-CdA (Chlorodeoxyadenosine) Newer: Fludarabine, 2-CdA (Chlorodeoxyadenosine) Monoclonal antibody: Rituximab Monoclonal antibody: Rituximab SCT/BMT SCT/BMT

14 Aggressive ( high / intermediate grade): Chemotherapy: mainstay CHOP -every 3 weeks, at least 6 cycles Cyclophosphamide, Doxorubicin Hydrochloride, Vincristine, Prednisolone Chemotherapy: mainstay CHOP -every 3 weeks, at least 6 cycles Cyclophosphamide, Doxorubicin Hydrochloride, Vincristine, Prednisolone

15 High risk cases with poor prognostic factors or relapse : High dose chemotherapy combined with autologous BMT / SCT High risk cases with poor prognostic factors or relapse : High dose chemotherapy combined with autologous BMT / SCT Monoclonal antibody Monoclonal antibody With CNS involvement / leukemic relapse : Similar to ALL With CNS involvement / leukemic relapse : Similar to ALL

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


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