non-hodgkin's%20lymphoma
NON-HODGKIN'S LYMPHOMA

Non-Hodgkin's lymphoma is a heterogeneous group of lymphoproliferative malignancies.
It is the most common hematologic cancer.
The most common subtypes are the diffuse large B-cell and follicular lymphoma. The subtypes are based on the malignant cell's morphology, genetic features, immunohistological characteristics, and stage of maturation.

Non-hodgkin's%20lymphoma Signs and Symptoms

Introduction

  • The most common hematologic cancer
  • B-cell non-Hodgkin's lymphoma (NHL) are 80-85% more common than T-cell/natural killer (NK) cell NHLs (15-20%)
  • Advances in molecular genetics allowed better understanding of the pathophysiology and further identification of the different subtypes of NHL
  • NHL subtypes are based on the malignant cell's morphology; genetic features, immunohistological characteristics and stage of maturation

Definition

  • A heterogenous group of lymphoproliferative malignancies formed by either B-cells or T-cell/NK cells

Etiology

Causes of Non-Hodgkin's Lymphoma (NHL)
  • Genetic aberrations and lesions
    • p53 tumor suppressor gene deletions/alterations (eg Burkitt lymphoma, follicular lymphoma, mantle cell lymphoma)
    • Chromosomal deletions (eg chromosome 6q, chromosome 13q14)
    • Chromosomal translocations (eg follicular lymphoma - t[14;18][q32;q21], MCL - t[11;14][q13;q32])
  • Oncogenic viruses (eg Epstein-Barr virus, Human T cell lymphotropic virus I, Human Herpes virus-8)

Signs and Symptoms

Clinical Evaluation
  • Assess patient’s performance status based on the clinical presentation
  • Systemic B-cell symptoms
    • Present in aggressive types of NHLs
    • Fever
    • Night sweats
    • Weight loss
  • Indolent types of NHL
    • Splenomegaly
    • Hepatomegaly
    • Lymphadenopathy
    • Cytopenia
  • Nonspecific signs and symptoms
    • Skin rash
    • Generalized fatigue
    • Fever of unknown origin
    • Pleural effusion
    • Pruritus
    • Malaise
    • Ascites
  • Lymphoma with gastrointestinal tract involvement
    • Anorexia
    • Weight loss
    • Bloatedness
    • Pallor
    • Nausea/vomiting
    • Abdominal pain
    • Early satiety
    • Intestinal bleeding
  • Lymphoma with central nervous system involvement
    • Headache
    • Blurred vision
    • Paralysis
    • Dizziness
    • Seizures
    • Focal neurologic symptoms
  • Adult T-cell leukemia/lymphoma
    • Lymphadenopathy
    • Fatigue
    • Anorexia
    • Splenomegaly
    • CNS involvement
    • Pulmonary complications
    • Skin eruptions
    • Abdominal pain
    • Hepatomegaly
    • Bone marrow involvement
  • Burkitt lymphoma
    • Bone marrow (70%) involvement
    • Leptomeningeal CNS involvement (40%)
  • Extranodal NK/T-cell lymphomas (ENKL), nasal type
    • Nasal obstruction
    • Nasal bleeding secondary to mass lesion
    • Elevated lactate dehydrogenase (LDH) levels

Risk Factors

  • Acquired immunosuppression (previous organ/bone marrow/stem cell transplant, HIV, AIDS)
  • Congenital immunodeficiency syndromes
  • Old age
  • Positive family history of NHL
  • Positive medical history of Hodgkin lymphoma
  • Chemical exposures (pesticides, wood dust, epoxy glue, organic solvents, medication [eg Methotrexate, TNF-α inhibitors])
  • Radiation exposure
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Oncology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
13 Feb 2020
At the recent National Haematology Expert Meeting 2019, a panel of experts was convened to discuss the role of targeted therapy in the management of haematological malignancies. Highlights of their lectures are summarised below.
12 Jun 2020
Drawing from experience as a key investigator in landmark clinical trials (including PALOMA, MONALEESA and MONARCH), and his clinical experience with CDK4/6 inhibitors, Dr Rafael Villanueva Vázquez shares his insights into the current evidence of using CDK4/6 inhibitors to treat HR+/HER2- ABC.