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What is Non Hodgkins lymphoma PowerPoint Presentation

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Slide 1 - Non Hodgkin’s lymphoma Rakesh Biswas MD, Professor, Department of Medicine, People's College of Medical Sciences, Bhanpur, Bhopal, India
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Slide 5 - Staging Stage I : Involvement of single LN region (I) or extra lymphatic site (IAE ) Stage II : Two or more LN regions involved (II) or an extra lymphatic site and lymph node regions on the same side of diaphragm Stage III : Involvement of lymph node regions on both sides of diaphragm, with (IIIE) or without (III) localized extra lymphatic involvement or involvement of the spleen (IIS) or both (IISE) Stage IV : Involvement outside LN areas (Liver, bone marrow) A : Absence of ‘B’ symptoms B : B symptoms present
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Slide 7 - Non Hodgkin’s lymphoma Incidence is increasing NHL>HD Median age of presentation is 65-70 yrs M>F More often clinically disseminated at diagnosis B-cell-70% ; T-cell-30%
Slide 8 - 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
Slide 9 - Clinical features contd Systemic symptoms Sweating, weight loss, itching Metabolic complications: hyperuricemia, hypercalcemia, renal failure Compression syndrome: Gut obstruction Ascites SVC obstruction S/C Compression
Slide 10 - Classification REAL Clinical / Working Formulation Low grade Intermediate grade High grade
Slide 11 - Classification Low grade Proliferation: Low Course: Indolent Symptoms: -ve Treatment: Not curable High grade High Rapid, fatal(un-Rx) +ve Potentially Curable
Slide 12 - Etiology Cannot be attributed a single cause Chromosomal translocations: t (14, 18) Infection: Virus:EBV, HTLV,HHV-8, HIV Bacteria: H.Pylori - Gastric lymphoma Immunology: Congenital immunodeficiency, Immunocompromised patients - HIV, organ transplantation
Slide 13 - Management Low grade: Asymptomatic : No treatment ; Radiotherapy for localised disease (Stage 1); Chemotherapy: mainstay is Chlorambucil; Initial response good , but repeated relapses, median survival 6-10 yrs; Newer: Fludarabine, 2-CdA (Chlorodeoxyadenosine) Monoclonal antibody: Rituximab SCT/BMT
Slide 14 - Aggressive ( high / intermediate grade): Chemotherapy: mainstay CHOP -every 3 weeks, at least 6 cycles Cyclophosphamide, Doxorubicin Hydrochloride, Vincristine, Prednisolone
Slide 15 - High risk cases with poor prognostic factors or relapse : High dose chemotherapy combined with autologous BMT / SCT Monoclonal antibody With CNS involvement / leukemic relapse : Similar to ALL
Slide 16 - Prognosis Low grade : Median survival –10 yrs High Grade: Increasing age, advanced stage, concomitant disease, raised LDH,T- cell phenotype : Poor prognosis
 

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