Non-Hodgkins Lymphoma (NHL)

By- Arshad Khan

Group 13
Non-Hodgkin’s lymphomas (NHL) are a heterogeneous
group of malignant lymphomas. There are many different
subtypes, every few years the classification is updated. Today,
morphology, immunophenotype, molecular, cytogenetics, and
other techniques are used for diagnosis.
Treatment generally depends on the aggressiveness of the
disease (indolent, aggressive, or very aggressive)

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NON- Hodgkin’s Lymphoma

 Absence of Reed-Sternberg Cells

 May result from damage to DNA that controls
growth of cells in immune system
 Increased incidence in immunodeficiency

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Associated with Non-H lymphoma

 SLE
 Celiac Disease
 AIDS
 Organ transplant patients
 Rheumatoid Arthritis

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Causes and Risk Factors

 The Exact causes are still unknown

– Higher risk for individuals who:
 Exposed to chemicals such as pesticides or solvents
 Infected w/ Epstein-Barr Virus
 Family history of NHL (although no hereditary pattern
has been established)
 Infected w/ Human Immunodeficiency Virus (HIV)

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Classifications

 Based on cell type and location(s)

 Non symptomatic ->
 Aggressive
– Worst prognosis < 1 year

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 Non-Hodgkin’s Lymphoma (NHL)

 A diverse group of primary malignancies of

lymphoreticular tissue
 The clinical course and natural history is more
variable than Hodgkin’s disease
 The pattern of spread is irregular and more patients
have leukemic features
 Current histologic classifications utilize electron
microscopic morphology, histochemical studies and
selected cell surface antigens.
– For our purposes NHL is classified according to nodular
(favorable) and diffuse (unfavorable) types

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NHL

 In contrast to Hodgkin’s disease, about two-thirds of

patients initially have asymptomatic
lymphadenopathy
 In addition to peripheral and mediastinal
lymphadenopathy NHL is commonly found initially as
an abdominal mass or as hepatic or splenic
enlargement
 Fever, weight loss and night sweats are frequently
present
 The median age at diagnosis is 50
 No sex preference is noted
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NHL

 Patients below 35 or over 65 are more likely to have

diffuse histology
 As with Hodgkin’s, chemotherapy and / or radiation
therapy are the primary forms of treatment
 Staging laparotomy is seldom required
 Significant therapeutic benefit can be achieved by
splenectomy in 80-90 % of patients with advanced
lymphomas (including Hodgkin’s disease)

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Classification

 Usually classified by how the cells look under

a microscope and how quickly they grow and
spread
– Aggressive lymphomas (high-grade lymphomas)

– Indolent Lymphomas (low-grade lymphomas)

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 Classification of Malignant
Lymphomas
 Low Grade: small lymphoid cells, nodular
growth
 Intermediate Grade: large cells, follicular and
diffuse patterns
 High Grade: immunoblastic, lymphoblastic,
Burkitt’s disease
 T-cell lymphomas: peripheral, cutaneous

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 Non-Hodgkin’s Lymphoma
Staging

 Stage is the term used to describe the extent of

tumor that has spread through the body( I and II are
localized where as III and IV are advanced.
 Each stage is then divided into categories A, B, and E
– A: No systemic symptoms
– B: Systemic Symptoms such as fever, night sweats and
weight loss
– E: Spreading of disease from lymph node to another organ

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Staging

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 Non-Hodgkin’s Lymphoma

 Two main types of Non-Hodgkin’s Lymphoma:

 B-Cell and T-Cell Lymphomas

– B-Cell lymphomas (80%)
– T-Cell lymphomas (15%)

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NHL – Classification:

 According to cell type

– T cell, B cell, Histiocytic & Misc. NHL
 According to Clinical grade
– Low grade, Intermediate & High grade NHL.
 Histopathological
– Diffuse/Follicular NHL,
– Small, Intermediate & Large cell NHL
Ex: Lennert’s lymphoma is a low grade Tcell NHL.
Burkitt’s lymphoma is a high grade B cell NHL
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Kiel Classification of NHL

 B Cell NHL:
– Low Grade: lymphocytic, plasmacytic, centrocytic,
mixed centrocytic centroblastic.
– High Grade: Centroblastic, Immunoblastic, Burkitts,
lymphoblastic.
 T Cell NHL:
– Low Grade: lymphocytic, mycosis, Lennerts
– High Grade: immunoblastic, lymphoblastic etc.
 Rare types:
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NHL- Histologic types

Diffuse - & - Follicular

 NHL- Histologic types

Small – Intermed. – Large

Staging of Lymphoma
Lymphoma spread to Spleen
Lymphoma spread to Spleen
Laboratory Diagnosis:
Laboratory Diagnosis:

 Haematological:
– Normocytic normochromic anemia, High ESR*
– Leucocytosis, Eosinophilia, lymphopenia
– Leukoerythroblastic picture - BM infiltration*
 Bone marrow:
– Normal, or late involvement.
– Trephine biopsy- diffuse or follicular infiltration
 Biochemical:
– High serum LDH – poor prognosis
– Hypercalcemia, Alkaline phosphatase, Uric acid.
– Serum transaminases & Bilirubin – Liver 23
Laboratory Diagnosis:

 Immunological:
– Monoclonal gammopathy –B cell NHL, Myeloma
– Low normal gammaglobulins
– Autoimmune hemolytic anemia – auto ab.
 Karyotypic/Genetic:
– t(14;18) – B cell follicular (14* heavy chain)
– t(11;14) – diffuse NHL

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Diagnosis

 X-Rays
 CT scans
 Magnetic Resonance Imaging (MRI)
 Biopsy
 Lymphangiogram
– Pictures of the lymphatic system taken w/ x-ray
after a special dye is injected to illuminate lymph
nodes and vessels

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Treatment

 Non-Hodgkin’s Lymphoma is usually treated by a

team of physicians including hematologists, medical
oncologists and a radiation oncologist.

 In some cases such as for Indolent lymphomas, the

Doctor may wait to start treatment until the patient
starts showing symptoms, known as “watchful
waiting”

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Treatment Options

 Chemotherapy
 Radiation
 Bone Marrow Transplantation
 Surgery
 Bortezomib (Velcade)
 Immunotherapy
 Using the bodies own immune system combined with
material made in a lab.

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Treatment:

 Staging & grading

 Chemotherapy – CHOP, MCHOP..

 Radiotherapy – Local/regional/TBI
 Combination –
 Intensive Chemo/Radio-TBI
 with Autologous bone marrow rescue.

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Survival Rates

 Survival Rates vary widely by cell type and

staging.

– 1 Year Survival Rate: 77%

– 5 Year Survival Rate: 56%

– 10 Year Survival Rate: 42%

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Thank you

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