This document provides an overview of non-Hodgkin's lymphoma (NHL), including:
1. NHL is a heterogeneous group of malignant diseases of the lymphoid system that is defined and has varying epidemiology, classification, risk factors, pathogenesis, clinical features, investigations, and treatment.
2. NHL is classified in several systems, most recently the WHO system from 2008, which categorizes NHL into B-cell and T/NK-cell lymphomas that can be indolent or aggressive.
3. Specific subtypes like diffuse large B-cell lymphoma, follicular lymphoma, and Burkitt's lymphoma have unique characteristics and clinical presentations.
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
The non-Hodgkin lymphomas include a diverse and complex group of malignancies of lymphoreticular histogenesis and differentiation.
In most instances, they initially arise within lymph nodes and tend to grow as solid masses.
The non-Hodgkin lymphomas most commonly originate from cells of the B-lymphocyte series, with an estimated 85% of European and American lymphoid neoplasms having this derivation.
Tumors with a T-lymphocyte derivation are less common, whereas true histiocyte-derived lymphomas are even rarer.
Genetic abnormalities like nonrandom chromosomal and molecular rearrangements play an important role in the pathogenesis of many lymphomas and correlate with histology and immunophenotype.
Most lymphomas do not have a familial pattern; however, coexistence of multiple breast cancers, ovarian cancer, sarcomas, and lymphomas in a family may suggest an inherited abnormality in tumor suppressor genes.
Environmental factors also seem to play a role in the development of NHL. Certain chemicals have been linked to the development of NHL include a variety of pesticides and herbicides (e.g. organophosphates, chlorophenols), solvents and organic chemicals (e.g. benzene, carbon tetrachloride), and wood preservatives.
Thus certain workers like pesticide applicators, workers in the petroleum, rubber, plastics, and synthetic industries have a slightly increased risk of NHL.
Patients who receive cancer chemotherapy and/or radiation therapy are at increased risk of developing NHL.
Several viruses have been implicated in the pathogenesis of NHL, including the Epstein-Barr virus in Burkitt’s lymphoma (especially in endemic areas of Africa), sinonasal lymphoma in Asia and South America, and lymphomas in immunocompromised patients; HTLV-1 Human T-lymphotropic Virus in adult T-cell lymphoma/leukemia; and human herpesvirus 8 (HHV 8) in body cavity-based lymphomas in patients with HIV infection.
Immunodeficiency states that seem to predispose to NHL include congenital immunodeficiency states (e.g. ataxia telangiectasia, Wiskott–Aldrich syndrome, common variable hypogammaglobulinemia, severe combined immunodeficiency (SCID) as well as acquired immunodeficiency states (e.g. HIV infection, iatrogenic immunosuppression for solid organ or bone marrow transplant recipients).
Connective-tissue disorders, including Sjögren syndrome, rheumatoid arthritis, chronic lymphocytic thyroiditis, and systemic lupus erythematosus (SLE) are also associated with increased risk of NHL.
The microscopic appearance of the lesional cells was used in the past to classify the tumors as either lymphocytic or histiocytic.
With the development of modern immunologic techniques, however, it is now known that many of the lesions that had been classified as histiocytic were in fact neoplasms composed of transformed B lymphocytes. In the early 1980s, a group of American pathologists devised a classification scheme, known as the Working Formulation for Clinical Use.
REFERENCES
cancer.org | 1.800.227.2345
Advances in the diagnosis and management
of lymphoma
Zachary H Word1
Matthew J Matasar1,2
1
Lymphoma Service, Department of
Medicine, Memorial Sloan–Kettering
Cancer Center, 2
Department of
Medicine, New York Presbyterian
Hospital, New York, NY, USA
Correspondence: Matthew J Matasar
Memorial Sloan–Kettering Cancer Center,
1275 York Avenue, New York,
NY 10065, USA
Tel +1 212 639 8889
Fax +1 646 422 2291
Email matasarm@mskcc.org
Lymphoma and CLL Forms
Parameswaran Hari, MD, MS
CLymphoma 101: The Basics
Neha Mehta-Shah, MD, MSCI
Assistant Professor
Department of Medicine
Division of Oncology
IBMTR , Milwaukee
Lymphoma is a cancer of the lymphatic system, which is part of the body's germ-fighting network.
The lymphatic system includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphoma can affect all those areas as well as other organs throughout the body.Being older, male, or Caucasian
Having any of the following conditions:
An inherited immune system disorder
An autoimmune disease, Use of immunosuppressant drugs following an organ transplant
High levels of exposure to certain pesticides have been found in some observational studies to slightly increase the risk of NHL in agricultural workers. The risk from low-level and/or periodic exposure to these substances is not certain.
Exposure to radiation THESEare the cause.symptoms. These can include:
night sweats
unintentional weight loss
a high temperature (fever)
a persistent cough or feeling of breathlessness
persistent itching of the skin all over the body, treat meant include like chemotherapy, radiation therapy, bone marrow transplantation, etc
This is a lecture on Lymphoma, exploring the different types and subtypes of Lymphomas. It also discusses the epidemiology, stages, clinical features, diagnosis, treatment and prognosis.
This was presented to undergraduate medical students at University Teaching Hospital (UTH), department of Cancer Disease Hospital by Nghitukuhamba Tangi Elikana Kalipi (6th year medical student) at Cavendish University Zambia, School of Medicine.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. outline
• Definition and introduction
• Classification
• Risk factors and epidemiology
• Pathogenesis
• Clinical features
• Investigations
• Treatment and complications
3. Non-Hodgkin’s lymphomas-definition
and epidemiology
1. Definition: malignant disease of the
lymphoid system, highly heterogeneous,
both histologically and clinically.
2. Epidemiology:
- annual incidence: 5-10 new cases per 100 000 persons,
- age distribution: middle-age patients and the elderly,
- males are affected more often than females (1.5:1.0).
8. Non-Hodgkin’s Lymphoma
Working Classification
• Low Grade
– Small Lymphocytic
– Follicular small-cleaved cell
– Follicular mixed small-cleaved and large cell
• Intermediate Grade
– Follicular large cell
– Diffuse small cleaved cell
– Diffuse mixed small and large cell
– Diffuse large cell
• High Grade
– Large cell immunoblastic
– Lymphoblastic
– Small non-cleaved cell (Burkitt's and non-Burkitt's type)
9.
10. REAL/ WHO 2001/ WHO 2008 CLASSIFICATION OF B
– CELL LYMPHOMAS
10
11. REAL/ WHO 2001/ WHO 2008 CLASSIFICATION OF
THE T/NK CELL LYMPHOMAS .
11
13. High risk aggressive non-Hodgkin’s
lymphomas
1. Age abowe 60 years.
2. Disease stage III and IV.
3. Extranodal involvement of more than 1
site.
4. Serum LDH concentration >1 x normal.
5. Performance status < 80%.
17. EPIDIOMOLOGY
• Incidence is increasing with age
• NHL>HD
• Median age of presentation is 65-70 yrs
• M>F
• More often clinically disseminated at
diagnosis
• B-cell-70% ; T-cell-30%
19. INDOLENT”GOOD” AGGRESSIVE”BAD” HIGHLY
AGGRESSIVE”UGLY”
AGE Older adults Any age Children/young
adults
RATE OF GROWTH Slow waxing and
waning
fast Very fast
STAGE AT
PRESENTATION
High stage 1-1V High stage
PERIPHERAL
BLOOD AND
BONEMARROW
INVOLVEMENT
common UNCOMMON common
20. INDOLENT”GOOD” AGGRESSIVE”BAD” HIGHLY
AGGRESSIVE
CNS INVOLVEMENT rare rare common
NATURAL HISTORY
IF UNTREATED
Indolent
In a proportion
transform to high
grade lymphoma
Survival 1-2 years Survival only weeks
to months
RESPONSE TO
TREATMENT
Not curable by
RT/chemo
Potentially curable Highly responsive;
”escape” b/n
chemotherapy
cycles
CLINICAL OUTCOME Repeated relapse
Asymptomatic
patients may be
observed
70-80%per
complete remission
with treatment.
2/3rd cured of
disease
Cure with early
stage.CNS
prophylaxis
required
24. Malignant transformation of either the
T or B cells
Differentiation in the peripheral lymphoid
tissues
Predisposing
•Gender
•Race
•Family History
•Infections
•Immune System Deficiency
Disorders
•Autoimmune Disorders
•Chemical Exposure
•Radiation Exposure
•Lifestyle Factors
Precipitating
•Unknown
(idiopathic)
25. T lumphocytes proliferate on antigenic stimulation
and migrate into follicles, where they intact in B
lymphocytes
These activated follicles becme germinal
centers, containing macrophages, follicular
dendrite cells and maturing T and B cells
Develops in any lymphoid
tissues (lymph nodes
26. Spreads to various lymphoid tissues
throughout the body, especially the liver,
spleen and bone marrow
Non-hodgkin’s lymphoma
Group of tumors will
develop
27. Most common:
•painless enlargement
of one or more lymph
node, usually in the
neck, armpits, or groin.
(painless, superficial
lymphadenopathy)
•Usually asymptomatic
Systemic B Sx:
•Drenching night sweats
•Unexplained weight loss
•Fever
•Severe itching
28.
29.
30. Clinical features
• Widely disseminated at presentation
• Nodal involvement:
Painless lymphadenopathy, often cervical region is
the most common presentation
• Hepatospleenomegaly
• Extranodal Intestinal lymphoma ( abdominal pain,
anemia, dysphagia);
CNS ( headache, cranial nerve palsies, spinal cord
compression) ;
Skin, Testis; Thyroid; Lung
Bone marrow (low grade): Pancytopenia
32. Oncologic emergencies
• — Potentially emergent complications of NHL
may be present at the time of diagnosis and need
to be considered during the initial workup and
evaluation of a patient with suspected pediatric
NHL..
These can include:
●Superior or inferior vena cava obstruction
●Acute airway obstruction
●Intestinal obstruction, intussusception
●Spinal cord compression
33. ●Pericardial tamponade
●Lymphomatous meningitis and/or CNS mass
lesions
●Hyperuricemia and tumor lysis syndrome
●Ureteral obstruction, unilateral or bilateral
hydronephrosis
●Venous thromboembolic disease
36. Diffuse Large B-Cell Lymphoma
(DLBLC). DLBCL is the most common type of non-
Hodgkins lymphoma, accounting for about 30% of
all NHL cases. It is an aggressive, fast-growing
lymphoma that usually affects adults but can also
occur in children. DLBCL can occur in lymph nodes
or in organs outside of the lymphatic system.
DLBCL includes several subtypes such as
mediastinal large B-cell lymphoma, intravascular
large B-cell lymphoma, and primary effusion
lymphoma.
37. Gross appearance of lymphnodes involved by non-Hodgkin lymphoma of the diffuse
large cell type. The nodes are large and show a homogenous tan cut surface. 37
39. Follicular Lymphoma (FLs).
Follicular lymphoma is the
second most common type
lymphoma, accounting for
about 20% of all NHL cases. It is
usually indolent (slow growing)
but about half of follicular
lymphomas transform over
time into the aggressive diffuse
large B-cell lymphoma.
40. Mantle Cell Lymphoma.
Mantle cell lymphoma is an aggressive type of
lymphoma that represent about 7% of NHL
cases. It is a difficult type of lymphoma to treat
and often does not respond to chemotherapy. It
is found in lymph nodes, the spleen, bone
marrow, and gastrointestinal system. Mantle cell
lymphoma usually develops in men over age 60.
41. Small Lymphocytic
Lymphoma (SLL). SLL is
an indolent type of
lymphoma that is
closely related to B-cell
chronic lymphocytic
leukemia (CLL). It
accounts for about 5%
of NHL cases.
42. Marginal Zone
Lymphomas (MZL). MZLs
are categorized
depending on where the
lymphoma is located.
Mucosa-associated
lymphoid tissue
lymphomas (MALT)
usually involve the
gastrointestinal tract,
thyroid, lungs, saliva
glands, or skin. MALT is
often associated with a
history of an
autoimmune disorder
(such as Sjogren
syndrome in the salivary
glands or Hashimoto's
thyroiditis in the thyroid
gland).
43. Primary Central Nervous System Lymphoma.
This lymphoma involves the brain and
spinal cord. Although it is generally rare, it is
common in people who have AIDS.
44. Burkitt's Lymphoma.
This is one of the most
common types of
childhood NHL,
accounting for about
40% of NHL pediatric
cases in the United
States. It usually starts
in the abdomen and
spreads to other
organs, including the
brain. In African
children, it often
involves facial bones
and is associated with
Epstein-Barr infection.
45. BURKITT LYMPHOMA
TYPES:
1. African (endemic) BL,
2. Sporadic (nonendemic) BL,
3. Subset of aggressive lymphomas in
HIV+ individuals;
(histologically identical but with
clinical, genotypic and virologic
differences)
47. BURKITTS LYMPHOMA
• IT IS ASSOCIATED WITH RECIPROCAL
TRANSLOCATIONS INVOLVING Cmyc gene on
chromosome 8
• Most comman translocation 70% cases-t[8;14]
• Cmyc gene on chromosome 8 and IgH heavy
chain on chromosome 14
• Less comman-t[8;22],t[2;8]
51. • Most burkitts lymphoma presents at
extranodal sites most commanly mandible and
abdominal viscera
• CNS involvement is frequent
• Most rapidly progrssive human tumour
52. Lymphoblastic Lymphoma.
This lymphoma is also
common in children,
accounting for about 25%
of NHL pediatric cases,
most often boys. It is
associated with a large
mediastinal mass
(occurring in chest cavity
between the lungs) and
carries a high risk for
spreading to bone
marrow, the brain, and
other lymph nodes.
53. • Tumour of CD4+ cells,
• Predilection to involve skin,
• Infiltration of epidermis and upper dermis
by T-cells with cerebriform nucleus,
• Spreads to lymphnodes and bone marrow,
• Indolent tumours – median 8 – 9 yrs;
• May transform to large T-cell lymphoma;
MYCOSIS FUNGOIDES/SEZARY SYNDROME
56. Anaplastic Large Cell Lymphoma
• Rearrangements of ALK gene on 2p23,
• In some - ALK fusion proteins (anaplastic
lymphoma kinase)
– tyrosine kinases,
• Large anaplastic cells (horseshoe-shaped
nuclei & voluminous cytoplasm – Hallmark
cells),
• Children or young adults,
• Involve soft tissues,
• Good prognosis – ALK+
57. T cell lymphoblastic lymphoma
• The most common presentation is
- peripheral lymphadenopathy,
- respiratory distress, wheezing,
-and superior vena cava syndrome from mediastinal
involvement .
• more common in males.
• The incidence is stable across all pediatric age groups with
a median age of diagnosis of 12 years.
• Children diagnosed with lymphoblastic lymphoma whose
bone marrow is more than 25 percent replaced by
lymphoblasts are classified and treated as acute
lymphoblastic leukemia.
60. Laboratory features
• Laboratory tests -
• It is important to remember that the complete
blood count (CBC) may be normal.
● -Unexplained anemia,
- thrombocytopenia, or leukopenia
• These changes in peripheral blood counts can be
due to extensive bone marrow infiltration,
hypersplenism from splenic involvement, or
blood loss from gastrointestinal tract
62. Imaging studies
• — Initial imaging studies
-ultrasound,
-radiographs,
-computed tomography are often performed as
part of the evaluation of presenting symptoms
(eg, abdominal pain).
- These may demonstrate
masses and/or lymphadenopathy in the neck,
chest, or abdomen.
63. Imaging studies
• Integrated positron emissions
tomography (PET)/CT scanning is more sensitive
and specific than CT in certain histologic subtypes
of NHL, including the most common subtypes
seen in children
• Imaging of the bones with plain films,
CT, and/or magnetic resonance imaging (MRI) is
not routinely performed in NHL, but is indicated
in the presence of bone pain and/or suspicion of
a pathologic fracture.
64. Imaging studies
• Bone lesions in NHL are mostly osteolytic on
plain films, in contrast to those in patients with
Hodgkin lymphoma, which are predominantly
osteoblastic
• If there is suspicion of spinal cord compression,
urgent MRI of the entire spinal column is
indicated, since multiple sites may be involved.
MRI (with and without gadolinium) of the head is
also indicated for patients with neurologic
symptoms or signs.
65. DIAGNOSIS
• The diagnosis of NHL is based upon the
pathologic evaluation of involved tissue,
usually an abdominal mass, extranodal site, or
lymph node, interpreted within the clinical
context .
• Subtypes of NHL are identified using
- histology,
- immunophenotype, and genetic studies.
67. NHL is staged according to the
Murphy stage
●Stage I – Stage I disease involves a single tumor
(extranodal) or single anatomic area (nodal), excluding
the abdomen and mediastinum.
●Stage II – Stage II disease is designated by any of the
following:
•Single extranodal area plus regional lymph nodes
•Two single extranodal tumors on the same side of the
diaphragm with or without regional lymph nodes
•Primary gastrointestinal tumor (completely resected)
with or without mesenteric lymph nodes
68. ●Stage III – Stage III disease is designated by any one of the
following:
- Primary intrathoracic (mediastinal, thymic, pleural)
disease
- Two extranodal sites on opposite sides of the diaphragm
- Extensive primary intra-abdominal disease
- Two or more nodal areas on opposite sides of the
diaphragm
- Any paraspinal or epidural tumors
●Stage IV – Any of the above with involvement of the bone
marrow, central nervous system, or both
71. •Radiation therapy
-uses high doses of X-
rays, gamma rays, or
other types of ionizing
(damaging) radiation to
kill cancer cells. It may
be applied to the whole
body or to a specific
zone.
72. •Chemotherapy is the
use of cytotoxic (cell
damaging) medicines to
target and kill tumors.
The drugs work by
interrupting the DNA of
fast-growing cells,
preventing them from
growing or reproducing.
74. •Bone marrow
transplantation
•For patients with very
advanced disease, extremely
high does of chemotherapy
may be needed. This type of
chemotherapy wipes out the
body’s entire immune system,
including the bone marrow
that produces blood cells. So,
patients need a bone marrow
transplant in order to recover.
75. Approach Considerations
The treatment of non-Hodgkin lymphoma (NHL)
varies greatly, depending on the following factors:
• Tumor stage
• Phenotype (B-cell, T-cell or natural killer [NK]
cell/null-cell)
• Histology (ie, low-, intermediate-, or high-grade)
• Symptoms
• Performance status
• Patient age
• Comorbidities
76. Management of Indolent NHL
• Follicular lymphoma (grade I-IIIa) comprises
70% of this group. Other entities in this group
include small lymphocytic lymphoma (SLL),
lymphoplasmacytoid lymphoma, and marginal
zone lymphomas (MZL, nodal or extranodal).
77. Management of Indolent NHL
• Indolent stage I and contiguous stage II NHL
• Standard management consists of radiotherapy
alone.
• Indolent noncontiguous stage II, III, and IV NHL
• Frequently used combination regimens are
-(R- CHOP) (Rituximab,cyclophosphamide,
hydroxydaunomycin [Adriamycin], vincristine
[Oncovin], and prednisone),
-CVP (cyclophosphamide, vincristine, and
prednisone), and fludarabine alone or in
combination (eg, with cyclophosphamide or
mitoxantrone).
78. Management of Indolent NHL
• Bendamustine plus rituximab has demonstrated
efficacy for the first-line treatment of advanced
follicular, indolent, and mantle cell lymphomas.
• Current National Comprehensive Cancer Network
guidelines give bendamustine plus rituximab,
RCHOP, and RCVP (rituximab,
cyclophosphamide, vincristine, prednisone)
category 1 recommendations for first-line therapy
of follicular lymphoma.
79. Management of Indolent NHL
• combination of lenalidomide plus rituximab
for both rituximab-refractory and non–
rituximab-refractory indolent NHL are used.
• In patients with indolent NHL that is
refractory to rituximab, obinutuzumab plus
bendamustine followed by obinutuzumab
maintenance has improved efficacy over
bendamustine monotherapy,
80.
81. Aggressive NHL
• Diffuse large B-cell lymphoma is the most
common type of NHL. Other distinct entities in
this group include immunoblastic, anaplastic,
lymphoblastic, large-cell, Burkitt, and Burkitt-
like lymphomas (high-grade lymphomas).
• Mantle cell lymphomasalso behave
aggressively
82. Management of Aggressive NHL
• Aggressive stage I and contiguous stage II
(nonbulky or < 10 cm) NHL
• combination chemotherapy (3 cycles of CHOP)
plus involved-field radiation therapy.
83. Aggressive noncontiguous stage II, III,
and IV NHL
• any of the following regimens[35] :
• CHOP
• (ProMACE-CytaBOM) Prednisone,
methotrexate, leucovorin, doxorubicin,
cyclophosphamide, and etoposide—
cyclophosphamide, etoposide, Adriamycin,
cytarabine, bleomycin, Oncovin,
methotrexate, leucovorin, and prednisone
84. Aggressive noncontiguous stage II, III,
and IV NHL
• (m-BACOD) –Methotrexate, bleomycin,
doxorubicin (Adriamycin), cyclophosphamide,
Oncovin, and dexamethasone
• (MACOP-B) –
-Methotrexate-leucovorin, Adriamycin,
cyclophosphamide, Oncovin, prednisone, and
bleomycin
85. Aggressive noncontiguous stage II, III,
and IV NHL
• Hyper-CVAD (cyclophosphamide, vincristine,
doxorubicin, dexamethasone, alternating with
methotrexate and cytarabine) plus rituximab has
been shown high rate of remission in patients
with mantle cell lymphoma.
• Bendamustine and rituximab combination has
been successfully used in patients with mantle
cell lymphoma in the first and second-line
setting.
86. Management of Indolent Recurrent
NHL
• The following are possible treatment options:
• Single alkylating agents (chlorambucil or
bendamustine)
• Novel biological agents and small molecule
inhibitors include ofatumumab,
lenalidomide, and temsirolimus
• Combination chemotherapy - CVP, CHOP, and
others
• Purine analogues - Fludarabine,
• Rituximab
• Radioimmunotherapy
87. Management of Aggressive Recurrent
Adult NHL
• High-dose chemotherapy plus stem-cell
transplantation is the treatment of choice
• Second-line chemotherapy regimens such as
-ICE (ifosfamide, carboplatin, etoposide),
-DHAP (dexamethasone, high-dose cytarabine,
cisplatin), or
-EPOCH (etoposide, vincristine, doxorubicin,
cyclophosphamide, prednisone) are usually used
with rituximab if the tumor is CD20 positive.
88. Management of T-cell Lymphomas
• Treatment options for T-cell lymphoma can
be categorized as follows:
• Combination chemotherapy regimens
- CHOP,
-CHOP plus etoposide, gemcitabine based-
regimens
• Single chemotherapy agents - Pralatrexate
89. Management of T-cell Lymphomas
• Monoclonal antibodies - Alemtuzumab
(effective in prolymphocytic T-cell leukemia
and hepatosplenic gamma-delta T-cell
lymphoma)
• Immunotoxin - Denileukin diftitox
• Novel biological agents and small molecule
inhibitors - Histone deacetylase inhibitors
(vorinostat, panobinostat, romidepsin,
belinostat), lenalidomide, and bortezomib
90. Surgical Care
• The role of surgery in the treatment of
patients with NHL is limited.
• Surgery is useful in selected situations (eg, GI
lymphoma), particularly if the disease is
localized or if risk of perforation, obstruction,
and massive bleeding is present.
• Orchiectomy is part of the initial
management of testicular lymphoma.
91. Complications of Therapy
• Potential chemotherapy and other treatment-
related complications include the following:
• Cytopenias (ie, neutropenia, anemia,
thrombocytopenia)
• Nausea or vomiting
• Infection
• Fatigue
• Neuropathy
92. Complications of Therapy
• Dehydration after diarrhea or vomiting
• Cardiac toxicity from doxorubicin
• Catheter-related sepsis
• Catheter-related thrombosis
• Secondary malignancies
• Tumor lysis syndrome
• Atherosclerosis