CASE PRESENTATION ON NON

HODGKINS LYMPHOMA

Presented by:
D. Sai Kumar
Y16PHD0805
 PATIENT DEMOGRAPHICS:
Patient name : P. Madhav reddy
Age : 57 yrs
Sex : Male
IP No. 53678
• SUBJECTIVE EVIDENCE:
Patient came with complaints of
 multiple swelling over the body since 8 months
 Fever since 9 months[low grade ,intermittent
@11:00AM since 2 months
 Decreased appetite, tobacco- chewable,alcohol-regular
 Swelling in neck appeared first, progression in
size, not painful
 Abdomen pain since 2 months.
 Vomiting 1 episode in 10 days.
 Constipation.
 Weight loss in pan of 6 months.
 Burning micturition.
K/C/O :
 HTN since 3 years[on regular medication]
Family history :
 Nil particular
OBJECTIVE EVIDENCE:
CBP:
• Heamoglobin - 12.2 g/dl
• RBC - 5.09 10ᶺ6
• WBC - 6,800 10ᶺ3/ul
• Platelets - 1.63 lakhs /cumm
• Serum uric acid - 11.3 mg/ dl
• Esinophils - 7%
• ẞ-2 micro globlulin serum - 6953 ng/ml
• USG abdomen:
Impression:
 Spleenomegaly
 Minimal to mild ascites
 Malignant nodes in para-arotic, peri-
pancreatic, protocaval para gastric and para-
umbillical regions.
 Malignant nodes in bilateral inguinal region
HISTOPATHOLOGY: suggestive of low grade non
Hodgkin lymphoma grade-1
RADILOGY: retroperitoneal Lymphadenopathy.
Provisional diagnosis: NON HODGKINS
LYMPHOMA
ASESSMENT:
Based on the subjective and objective evidence
the patient is diagnosed to have NON HODGKINS
LYMPHOMA.
ETIOLOGY:
• Lymphoma can develop when lymphocytes grow
out of control.
• Age -60 years
• Previous chemotherapy or radiation therapy
• Immune system deficiency and HIV infection.
STANDARD THERAPY:
• RADIATION THERAPY: uses of high doses of X-ray
gamma rays, or other types of ionizing radiation
to kill cancer cells.
• CHEMOTHERAPY : 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.
• IMMUNO THERAPY: uses the body’s own
immune system to attack and remove cancer
cells.
• BONE MARROW TRANSPLANTATION:
For patients with very advanced disease, extremely
High doses 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.
ASSESSMENT OF CURRENT THRAPY
S.NO DRUG DOSE,FREQUENCY INDICATION
1 INJ.PALANOCETRON 0.25mg/IV ANTIEMETIC
+
INJ.DEXAMETHASONE 16mg in 100ml CORTICOSTEROID
0.9%NS
2 INJ.VINCRISTINE 2mg/IV MITOTIC CELL INHIBITION

3 INJ.DOXORUBICIN 70mg/IV ANTINEOPLASTIC AGENT

4 INJ.CYCLOPHOSPHAMI 100mg/IV ANTINEOPLASTIC AGENT

DE
5 INJ.PANTAPRAZOLE 40mg/IV REDUCE STOMACH IRRITATION

6 TAB.PREDNISOLONE 40-40-20mg/PO TO TREAT N/V ASSOCIATED

WITH CHEMPTHERAPY DRUGS
1) INJ. DEXAMETHASONE:
DOSE: 16mg in 100ml NS
CATEGORY: corticosteroid
INDICATION: chemotherapy induced nausea and
vomiting.
MOA: inhibits multiple inflammatory cytokines
resulting in decreased oedema, capillary leakage
and migration of inflammatory cells thereby
suppressing inflammation.
ADRS: cardiomyopathy,hyperglycemia,osteoporosis
2) TAB.PREDNISOLONE:
DOSE:40-40-20mg/PO for 5 days
CATEGORY: corticosteroid
INDICATION: Non-Hodgkin’s lymphoma
MOA: anti inflammatory effects via binding to
cellular glucocorticoid receptors, it acts to
inhibit inflammatory cells and suppresses
expression of inflammatory mediators.
ADRs: congestive heart failure, kaposi’s sarcoma,
Diabetic ketoacidosis, pancreatitis.
3) INJ. VINCRISTINE:
DOSE: 2mg/IV
CATEGORY: oncolytic vinca alkaloid
anti neoplastic agent
INDICATON: mitotic cell inhibition
MOA: it has an unknown mechanism of action
although it is thought to be related to the arrest of
replicating cells at the metaphase stage through
prevention of microtubule formation in the mitotic
spindle.
ADRs: functional visual loss, Ototoxicity,
Nuerotoxicity.
4)INJ. DOXORUBICIN:
DOSE: 70mg /IV
CATEGORY: Anti-Neoplastic agent.
INDICATION: Non-Hodgkins lymphoma.
MOA: It is an anthracyclin topo-isomerase ll inhibitor
It blocks nucleotide replication and action of DNA
and RNA polymerase thus helps in cytocidal activity.
ADRs: CHF,MI, pancreatitis, nuetropenia,TCP.
5)INJ.CYCLOPHOSPHAMIDE:
DOSE:100mg/IV
CATEGORY: Alkylating agent, Anti-Neoplastic agent
INDICATION: Non Hodgkin’s lymphoma
MOA: It’s cytotoxic action is primarily due to cross
linking of strands of DNA and RNA, as well as to
inhibit of protein synthesis. It is a potent immuno
suppressant.
ADRs: cardiotoxicity, angiosarcoma of liver.
PLAN:
GOALS OF THERAPY:
DISEASE SPECIFIC GOALS:
• To destroy as many lymphoma cells as possible
and to induce a complete remission[all evidence
of disease is eliminated]
PATIENT SPECIFIC GOALS:
• Given the curable nature of disease and patient
long term survival.
• Maximize cure for all stages.
• Minimize the complications [aching muscles, a
painful blistering rash]
MONITORING PARAMETERS:
THERAPUETIC MONITORING PARAMETERS:
• CT scan, PET scan [positron emission
tomography] ,WBC,ẞ-2 micro globulin serum
TOXICITY MONITORING PARAMETERS:
• Monitor hypercalcemia, urinary sediment , CBC
during therapy, symptoms of pulmonary toxicity
with cyclophosphamide.
• Monitor hepatic function test , blood uric acid,
potassium ,calcium phosphate with doxorubicin.
• Monitor neurotoxicity, uric acid levels with
vincristine.
PATIENT COUNSELLING:
ABOUT DISEASE:
• A condition occurs when the body produces to
many abnormal lymphocytes, a type of WBC.
ABOUT MEDICATION:
• VINCRISTEIN:
Advice patient to avoid vaccines during therapy due
to drug induced immuno suppression.
This drug may cause alopecia ,constipation, N/V,and
report signs and symptoms of myelosupression
DOXORUBICIN:
• Drug may cause fatal harm or chromosomal
damage in sperm, loss of fertility in males,
premature menopause in females.
CYCLOPHOSPHAMIDE:
• Warn patient to report symptoms of delayed
wound healing and renal toxicity.
LYFE STYLE MODIFICATIONS:
• Avoiding behaviors that increase chance of getting
AIDS and hepatitis C infections, both of which
weaken the immune system.
• Avoiding unnecessary exposure to radiation.
• Maintaining a normal weight and eating a healthy
diet.
• Take complex carbohydrates, including whole grains
such as oats or whole wheat.
• Take lean proteins and dairy products.
• Plenty of fruits and vegetables.
• Healthy fats, such as those found in nuts, and olive
oil.