Non-Hodgkins Lymphoma

  • No Reed-Sternberg cells

  • Haematological spread

    • early to bone marrow, extra-nodal involvement

  • Prognosis depends on grade

  • Treatment

    • chemotherapy

    • radiotherapy only to significant lesions

Cells

  • 80% B-cell

  • 20% T-cell

    • often includes skin

    • Sezary syndrome or Mycosis Fungoides

Incidence

  • 14/100,000 and rising

  • rises with age

Aetiology

  • ? immunosuppression

  • viruses

  • environmental

    • pesticides

    • hair dyes

    • benzenes

    • UV light

  • Familial

Staging

Ann Arbor classification

  • Stage I - 1 nodal group involved

  • Stage II - 2+ nodal areas, same side of diaphragm

  • Stage III - nodal groups both sides of diaphragm, restricted to lymph nodes or spleen

  • Stage IV - Extra-nodal spread

  • +A (absence) / +B (presence) of

    • fever >38°C,

    • Weight Loss >10% over 6 months

    • night sweats

  • +E extra-nodal involvement

Grading

  • low-grade - follicular

  • intermediate - large cell (50% cure)

  • high grade - Burkitts, T-lymphoblastic (80% cure)

Classification

  • immunological

  • cytogenetic

    • common translocations t(14,18), t(8,14)

  • molecular

Treatment

  • low grade

    • single chemotherapy agent

  • Intermediate

  • High Grade

    • intensive

 

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