Non-Hodgkin’s lymphoma (NHL)

Classification:

The Kiel classification (reflects the rate at which the cells are dividing):

• High-grade
• Low-grade

Ironically, high-grade lymphomas are potentially curable, whereas low-grade lymphomas are generally considered to be incurable with conventional therapy

A further subdivision is made in the basis of B- or T-cell origin:

• Most NHLs are of B-cell phenotype (although T-cell tumours are increasingly being recognised)

Clinical features:

• Peripheral lymph node enlargement
• With or without systemic symptoms

Low-grade High-grade

Middle-aged/older people Any age group

Bone marrow infiltration common Bone marrow infiltration unusual

Incurable with conventional therapy Potentially curable

Investigations:

FBC:

• Pancytopenia (suggests bone marrow infiltration)

U&Es:

• Patients may have renal impairment as a consequence of ureteric obstruction secondary to intra-abdominal or pelvic lymph node enlargement

LFTs

CXR

CT scans

Bone marrow aspirate

Lymph node biopsy

Low-grade lymphomas:

Are 4 subtypes:

• Follicular lymphoma (median survival is 9 years)
• Lymphoplasmacytoid (LPC) lymphoma (median survival is 5 years)
• Mantle cell lymphoma (centrocytic lymphoma) (median survival is 4 years)
• Low-grade T-cell lymphoma

High-grade lymphomas:

• May be of B- or T-cell origin
• Chemotherapy is given with curative intent
• 60-70% of patients respond to treatment
• About 40% are cured
• Recurrent high-grade lymphoma has a grave prognosis