Non-Hodgkin’s Lymphoma (NHL)

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🌱 來自: Huppert’s Notes

Non-Hodgkin’s Lymphoma (NHL)🚧 施工中

Non-Hodgkin’s Lymphoma (NHL)

•   Risk factors: HIV, immunosuppression, EBV/HTLV-1 infection, H. pylori (MALT lymphoma), autoimmune conditions

•   Clinical features: Bulky lymphadenopathy (painless, firm, mobile), hepatosplenomegaly; B symptoms less common than with Hodgkin’s lymphoma, hepatosplenomegaly

•   NHL Subtypes:

-   See Table 7.3 – generally divided into indolent and aggressive subtypes

•   Follicular lymphoma is the most common indolent NHL (see details below)

•   Diffuse large B cell lymphoma (DLBCL) is the most common aggressive NHL (see details below)

Follicular lymphoma (FL)

•   Epidemiology: Most common indolent NHL

•   Clinical features: Typically, indolent course. However, it is incurable and can relapse despite prolonged remission. Life expectancy 12–15 yr from time of diagnosis.

•   Treatment:

-   For asymptomatic FL: Typically, observe if low tumor burden, particularly in elderly patients. Watchful waiting vs. up-front treatment with rituximab does not affect overall survival. However, in some patients initial treatment with rituximab may improve quality of life and postpone cytotoxic chemotherapy.

-   For symptomatic FL: Consider treatment with anti-CD20 therapy (rituximab) if more lymph node involvement, splenomegaly, pleural effusions, systemic symptoms, large tumor causing organ dysfunction, etc. If severe disease, can consider cytotoxic chemotherapy with R-CHOP.

-   Relapsed disease: Restage, many treatment approaches

•   Transformation: It is possible for FL to transform to a more aggressive lymphoma

-   All low-grade lymphomas can transform, but most literature focuses on FL. Risk of transformation to aggressive lymphoma (typically DLBCL) is 1–2% per year, with a lifetime risk of 30%.

Diffuse large B-cell lymphoma (DLBCL)

•   Epidemiology: Most common aggressive NHL

•   Clinical features: Lymphadenopathy; up to 40% present with disease in extranodal locations, most commonly in the GI tract, but also can involve the CNS, lungs, GU tract, and reproductive tract

•   Morphology: Diffuse effacement of the normal lymph node architecture by intermediate to large-sized cells. Significant genetic heterogeneity.

•   Treatment: R-CHOP or R-EPOCH chemotherapy

-   R-CHOP: Rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine (Oncovin), prednisone

-   R-EPOCH: Rituximab, etoposide, prednisone, vincristine (Oncovin), cyclophosphamide, doxorubicin hydrochloride

-   CNS prophylaxis is needed for patients with DLBCL who have high-risk features and for all patients with Burkitt’s, lymphoblastic lymphoma, or HIV-associated aggressive lymphomas