Non-hodgkin Lymphomas – Lymphoma

00:01 Now let us move to the other major subtype of lymphomas, non-Hodgkin's lymphomas. Not a very imaginative title I am sure you would agree for this very broad group of diseases. Now there are many many different types of malignant disease within this group of non-Hodgkin's lymphoma. Around 85 percent of these are derived from B lymphocytes whereas the remainder are derived from T lymphocytes. These disorders are actually increasing in incidence. We aren't exactly sure why, but certainly infection is . . . and trigger in some of these cases. Now clinically this is quite an important consideration in that we can divide this disorder into a high-grade and low-grade disease.

00:56 What do I mean by that? Well, as you will see on that list there. The high-grade disease is more aggressive, but paradoxically quite curable. Other lymphomas or low grade, they progress slowly, but they are more difficult to cure. It may recognize that is a similar phenotype to leukemia where you have acute leukemias, which are quite aggressive, but curable than chronic leukemias, which are more slowly progressive, but more difficult to cure.

01:34 The diagnosis of non-Hodgkin's lymphoma is very similar to Hodgkin lymphoma needing history.

01:42 Examination and investigations and critical biopsy of the lymph node. Again the immunohistochemistry is important in defining the distribution of T cells and B cells and the expression of characteristic markers, which define the subset of the disease. As we shall see, cytogenetic and gene mutation analysis are becoming increasingly important in lymphoma and I have showed two examples there, the t(14:18) translocation in follicular lymphoma and the MYD88 mutation in the lymphoblastic lymphoma. CT and PET scanning are very important to determine the stage of disease and the response to therapy. You will recognize on the right CT scan of a patient with lymphoma and you will see on the left side of that image, the lymphoid mass just adjacent to the liver sitting above the kidney.

02:47 Let us now look at some of the individual subtypes of non-Hodgkin's lymphoma.

02:55 Let us start with high-grade aggressive non-Hodgkin lymphoma. The most important subtype here is Diffuse large B-cell Lymphoma DLBCL. Now as with all non-Hodgkin lymphoma, this disease may be present in lymph node tissue or sometimes in other tissues in which case it goes under the term of extranodal disease and that is a common feature of non-Hodgkin's lymphomas and not always so restricted to lymphoid tissue as is Hodgkin lymphoma. The treatment for Diffuse Large B-cell Lymphoma is with the use of an anti-CD20 antibody together with combination chemotherapy and that is a classic regimen that is used R- or CHOP given in 1-3 cycles and indeed this is curative in the majority of patients these days.