LymphomaRob Jones

Aim and learning outcomesAim

◦To revise the key points of lymphoma Learning outcomes

◦Revise the basics of haemopoiesis◦Understand what a lymphoma is ◦Know the difference between lymphoma

and leukaemia ◦Know the difference between Hodgkin

and non-Hodgkin lymphoma◦Know some key facts about Hodgkin and

non-Hodgkin lymphoma

Haemopoiesis

What’s a lymphoma?!Lymphomas are clonal

malignant disorders that derive from lymphoid cells (either precursor or mature T-cells or B-cells)

Lymphoma vs. leukaemia

Lymphoma Leukaemia

Cells Lymphoid cells Lymphoid and myeloid cells

Solid/liquid Solid (lumps) Liquid (malignant cells spill into the peripheral blood)

Hodgkin vs. non-Hodgkin lymphomaHistological divisionHodgkin: Reed-Sternberg cells Non-Hodgkin: no Reed-Sternberg

cells

Key facts about Hodgkin and non-Hodgkin lymphoma

Aetiology Unknown Infections may cause certain types of

lymphoma ◦EBV: HL, Burkitt lymphoma (a type of NHL)◦H. pylori: gastric MALT lymphomas (a type of

NHL)◦HTLV-1: adult T-cell lymphoma (a type of

NHL)Risk factors

◦Age◦Family history ◦ Immunosuppression

Epidemiology Incidence

◦Uncommon, but not rare! Age

◦Hodgkin: incidence peaks in 30s ◦Non-Hodgkin: older people

Gender◦Males > females

Location◦Certain subtypes more common in certain

areas e.g. Burkitt lymphoma more common in Africa

Clinical features

LymphoidNodal (75%)

◦ Lymphadenopathy Cervical, axillary,

inguinal, mediastinal

◦ Alcohol-induced pain virtually diagnostic of Hodgkin lymphoma

Extra-nodal (25%)◦ Lymphoid tissue in

other organs Oropharynx, skin,

bone, gut, CNS, lung

SystemicFeverWeight loss Night sweatsItch Fatigue

Differential diagnosis Other haematological

malignancy: leukaemia, myeloma TBHIV/AIDS Other systemic causes of itch…

Investigations Bloods

◦FBC◦Blood film ◦ESR◦LFT◦LDH

Diagnosis ◦Biopsy and histology of lymph

node/affected tissue Staging

◦CT chest/abdomen/pelvis

Diagnosis: classification of HL Subgroup Characteristics Cases (%) Surviving 5yrs (%)

Lymphocyte rich Infiltrate consists largely of small lymphocytes

15 70

Nodular sclerosing Node divided by broad bands of connective tissue into nodules containing a mixture of cells

40 60

Mixed cellularity Same as above, but there are no broad bands of connective tissue

30 30

Lymphocyte depleted Few lymphocytes, many Hodgkin’s and Reed-Sternberg cells

15 20

Diagnosis: classification of NHLB-cell

 Follicular lymphomaDiffuse large B-cell lymphomaWaldenström’s macroglobulinaemiaMantle cell lymphoma Hairy cell leukaemia Burkitt lymphoma 

T-cell

 Peripheral T-cell lymphomasAnaplastic large cell lymphomaAngioimmunoblastic T-cell lymphoma 

Follicular lymphoma and diffuse large B-cell lymphoma account for 2/3 of NHL

Staging: Ann Arbor system Stages Characteristics

I Involvement of one lymph node area

II Involvement of two or more lymph node areas on the same side of the diaphragm

III Involvement of lymph nodes on both sides of the diaphragm ± splenic involvement

IV Involvement of ≥1 extra-nodal site (e.g. liver, bone marrow, lung)

A Without systemic symptomsB With systemic symptoms (night sweats, fever, weight loss)

Management Chemotherapy

◦ HL: ABVD Adriamycin Bleomycin Vinblastine Dacarbazine

◦ Diffuse large B-cell lymphoma (subtype of NHL): R-CHOP Rituximab Cyclophosphamide Hydroxydaunorubicin Oncovin Prednisolone

Radiotherapy Bone marrow transplantation

Prognosis Depends on histological subtype

and stage, but there are some independent prognostic markers:◦Extra-nodal disease◦Bloods: Hb, ESR, LDH◦Older age◦Poor WHO performance status

The end