Lymphoma

Classification

• Hodgkin lymphoma (15%)
• Non-hodgkin lymphoma
  • B-cell lymphoma
    • Aggressive
      • Diffuse large B-cell lymphoma (DLBCL) (30%)
      • Burkitt lymphoma (1-2%)
    • Indolent
      • Mantle cell lymphoma (5%)
      • Follicular lymphoma (25%)
      • Marginal cell lymphoma (5-10%)
      • Small lymphocytic (5-10%)
      • Lymphoplasmacytic/Waldenstrom macroglobulinemia (1-2%)
  • T-cell lymphoma
    • Angioimmunoblastic (3%)
    • Anaplastic large cell (2%)
    • Peripheral T-cell lymphoma NOS (5%)
    • Mycosis fungoides / Sezary syndrome (5%)

Stages

• I: 1 node
• II: nearby mets (on same side of diaphragm)
• III: distant mets (on other side of diaphragm)
• IV: liver/spleen
• -B: constitutional symptoms, such as weight loss >10% in 6 mo, fevers, night sweats

Risk Factors

• Autoimmune disorders
  • Celiac disease
  • Sjogren syndrome
  • Crohn disease
• Chronic viral infections
  • HIV HCV HTLV1 EBV
• Chronic bacterial infections
  • H pylori
• Immunocompromised
  • Post-transplant lymphoproliferative disorders

Investigations

• Labs
  • Lymph node or tisue biopsy, ideally excisional
  • Bone marrow aspiration and biopsy
  • CBC + blood film
  • Liver panel, creatinine, SPEP, hemolytic workup, LDH
  • Hep B, Hep C in preparation for chemo
  • HIV, as a secondary cause of lymphoma
  • HTLV-1, as a secondary cause of ATLL in Caribbean patients
• Imaging
  • CT H&N C/A/P for staging
  • PET-CT
  • At diagnosis, for DLBCL and HL
  • After treatment, for DLBCL and HL

Management

• Establish diagnosis with tissue biopsy
• Staging with CT C/A/P + neck +/- PET scan

Complications

• Tumour lysis syndrome
  • Increased risk with Burkitt's, DLBCL, and bulky disease
  • Prophylaxis with allopurinol 300mg po daily
  • Treat with allopurinol or rasburicase
• Mass effect
  • Treat with prednisone