Lymphoma

Definition: Lymphoma is a malignancy of lymphocytes arising from lymphoid tissues. It is broadly classified into:

• Hodgkin Lymphoma (HL)
• Non-Hodgkin Lymphoma (NHL)

Major Types

Hodgkin Lymphoma (HL)

• Characterized by Reed–Sternberg cells (CD30+, CD15+)
• Typically affects young adults
• Spread is orderly and predictable

Non-Hodgkin Lymphoma (NHL)

• Heterogeneous group (B-cell > T-cell)
• More variable clinical behavior
• Includes:
  • Diffuse Large B-Cell Lymphoma (DLBCL) – aggressive, most common
  • Follicular Lymphoma – indolent
  • Mantle Cell Lymphoma, Burkitt Lymphoma, T-cell Lymphomas

Clinical Features

• Painless lymphadenopathy (commonly cervical or supraclavicular)
• B symptoms: fever, night sweats, weight loss
• Fatigue, hepatosplenomegaly
• Extranodal involvement (GI, CNS, marrow)

Diagnosis

• Excisional lymph node biopsy (gold standard)
• Immunophenotyping (flow cytometry, IHC)
• PET-CT for staging
• Bone marrow biopsy if indicated
• Cytogenetics/molecular studies (e.g., t(14;18) in follicular lymphoma, MYC in Burkitt)

Staging (Ann Arbor System)

• Stage I–IV based on extent of nodal/extranodal involvement
• “A” = no B symptoms, “B” = presence of B symptoms
• Bulky disease = large mass (>10 cm or >1/3 mediastinum)

Treatment Overview

Hodgkin Lymphoma

• ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine
• Consider Brentuximab vedotin (CD30+) or nivolumab (PD-1) in relapse
• Cure rate high, even in advanced stages

Non-Hodgkin Lymphoma

• DLBCL: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
• Follicular lymphoma: rituximab ± chemo or observation
• Burkitt lymphoma: aggressive multi-agent chemo (e.g., hyper-CVAD)
• Mantle cell lymphoma: rituximab + bendamustine or R-HyperCVAD; often transplant
• CNS prophylaxis if high risk (e.g., testicular, breast, high LDH)

Key Pharmacologic Considerations

• Rituximab: anti-CD20 monoclonal antibody; watch for infusion reactions, HBV reactivation
• Chemotherapy toxicity: neutropenia, mucositis, cardiac toxicity (doxorubicin), neuropathy (vincristine)
• Growth factor support (e.g., G-CSF) often needed
• TLS prophylaxis in high-grade NHLs (hydration, allopurinol, rasburicase)

Monitoring

• CBC, renal/hepatic function
• LDH (prognostic marker)
• Interim PET scan for response assessment
• Cardiac monitoring with anthracyclines
• Long-term: secondary malignancy risk, fertility, cardiac function

Prognosis

 

• HL: >85% cure rate
• NHL: depends on type and stage (e.g., indolent vs aggressive subtypes)
• Use IPI (International Prognostic Index) for NHL risk stratification

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