NON-

HODGKIN’S
LYMPHOMA

Oliveros francis!!!!!!!!!!!!!!!!!
 NON-HODGKIN’S LYMPHOMA
(NHL):

 A heterogeneousgroup of B- and T-cell

malignancies that are diverse in cellular origin,
morphology, cytogenetic abnormalities, response
to treatment, and prognosis

 Anyof a large group of cancers of lymphocytes

(white blood cells).
HAEMATOPOIETIC MALIGNANCIES

Myeloproliferative Malignant
diseases Leukaemias lymphomas

chronic myeloid Acute myeloid Hodgkin’s

leukaemia leukaemia lymphoma
(CML) (AML)

Polycythemia Chronic myeloid Non-hodgkin’s

vera leukaemia lymphoma
(PV) (CML) (NHL)

Idiopathic Acute lymphatic

myelofibrosis leukaemia Burkitt's lymphoma
(MF) (ALL)
cutaneous T-cell
Essential Chronic lymphatic lymphoma (CTCL)
thrombocythemia leukaemia
(ET) (CLL)

hairy cell
leukaemia
(HCL)
HAEMATOPOIETIC MALIGNANCIES

Myeloproliferative Malignant
Leukaemia
diseases lymphomas
 Family of chronic  Neoplastic  Neoplastic
neoplastic disease of a disease of
diseases haematopoietic lymphatic tissue
precursor cell
 Due to a clonal  Originates in
disorder arising  Characterised by lymph node or
at the level of the replacement of spleen
pluripotent stem normal bone
 Hodgkin’s (15%)
cell marrow
 non-Hodgkin’s
 Characterised by  Often infiltration
abnormal into other organs (85%)
proliferation of 1
 Malignant clones
or more blood cell
lines suppress normal
cell formation
 THE
LYMPHAT
IC
SYSTEM
 Lymphatic Tissue
 Lymph nodes, spleen, liver, skin and the
respiratory, GI and GUT tract
 Lymphocytes undergo further
proliferation and differentiation in
lymphoid tissue
◦ B-lymphocytes
 tend to reside in lymph nodes & spleen

◦ T-lymphocytes
 tend to circulate throughout the
lymphatic system
LYMPH NODE - NORMAL HISTOLOGY
afferent lymphatic vessel capsule

te x
cor
x follicle (mainly B-
c or te cells)
a
par - germinal centre
dulla - mantle zone
me

artery

efferent lymphatic vessel

vein
 NHL INCIDENCE
 Incidence of 13.3/100,000 per year
 Predominates in the 40-70 years age group
 most common neoplasm in the 20-40
age group
 Incidence is rising
 150% growth over the past 30 years
 increasing by 4% annually since
1970’s
 Mortality rate is also rising
 2% rise per year
 third highest rise, exceeded only by
lung cancer in women and malignant
melanoma
STAGING OF NHL
MODIFIED ANN ARBOR STAGING OF NHL

Stage I Involvement of a single lymph node region

Stage II Involvement of 2 lymph node regions on the same side of

the diaphragm

Stage III Involvement of lymph node regions on both sides

of the diaphragm

Stage IV Multifocal involvement of 1 extralymphatic sites

± associated lymph nodes or isolated extralymphatic
organ involvement with distant nodal involvement

The Non-Hodgkin’s Lymphoma Pathologic Classification Project. Cancer. 1982;49:2112.

 CATEGORIES OF
NON-HODGKIN’S
LYMPHOMA
FOLLICULAR NON-
HODGKIN’S LYMPHOMA

AGGRESSIVE NON-
HODGKIN’S LYMPHOMA

INDOLENT NON-
HODGKIN’S LYMPHOMA
 A S
P H OM
L LYM
CE L
B-
 Diffuse Large B-Cell Lymphoma
(DLBLC). DLBCL is the most common type
of non-Hodgkins lymphoma, accounting for
about 30% of all NHL cases. It is an
aggressive, fast-growing lymphoma that
usually affects adults but can also occur in
children. DLBCL can occur in lymph nodes
or in organs outside of the lymphatic
system. DLBCL includes several subtypes
such as mediastinal large B-cell lymphoma,
intravascular large B-cell lymphoma, and
primary effusion lymphoma.
 Follicular Lymphoma
(FLs). Follicular lymphoma
is the second most
common type lymphoma,
accounting for about 20%
of all NHL cases. It is
usually indolent (slow
growing) but about half of
follicular lymphomas
transform over time into
the aggressive diffuse
large B-cell lymphoma.
 Mantle Cell Lymphoma.
Mantle cell lymphoma is an aggressive
type of lymphoma that represent about 7%
of NHL cases. It is a difficult type of
lymphoma to treat and often does not
respond to chemotherapy. It is found in
lymph nodes, the spleen, bone marrow,
and gastrointestinal system. Mantle cell
lymphoma usually develops in men over
age 60.
 Small Lymphocytic
Lymphoma (SLL).
SLL is an indolent
type of lymphoma
that is closely
related to B-cell
chronic lymphocytic
leukemia (CLL). It
accounts for about
5% of NHL cases.
 Marginal Zone Lymphomas
(MZL). MZLs are
categorized depending on
where the lymphoma is
located. Mucosa-associated
lymphoid tissue lymphomas
(MALT) usually involve the
gastrointestinal tract,
thyroid, lungs, saliva
glands, or skin. MALT is
often associated with a
history of an autoimmune
disorder (such as Sjogren
syndrome in the salivary
glands or Hashimoto's
thyroiditis in the thyroid
gland).
 Lymphoplasmacytic
Lymphoma.
Lymphoplasmacytic
lymphoma, also called
Waldenstrom's
macroglobulinemia or
immunocytoma, is a rare
type of lymphoma
accounting for about 1% of
NHL cases. It usually affects
older adults and most often
involves bone marrow,
lymph nodes, and spleen.
• Primary Central Nervous System
Lymphoma.
This lymphoma involves the brain and
spinal cord. Although it is generally rare, it
is common in people who have AIDS.
 Burkitt's Lymphoma. This
is one of the most
common types of
childhood NHL,
accounting for about 40%
of NHL pediatric cases in
the United States. It
usually starts in the
abdomen and spreads to
other organs, including
the brain. In African
children, it often involves
facial bones and is
associated with Epstein-
Barr infection.
 Lymphoblastic Lymphoma.
This lymphoma is also
common in children,
accounting for about 25%
of NHL pediatric cases,
most often boys. It is
associated with a large
mediastinal mass
(occurring in chest cavity
between the lungs) and
carries a high risk for
spreading to bone
marrow, the brain, and
other lymph nodes.
PATHOGENESIS
 Predisposing
• Gender
• Race
• Family History Precipitating
• Infections • Unknown
• Immune System Deficiency (idiopathic)
Disorders
• Autoimmune Disorders
• Chemical Exposure
• Radiation Exposure
• Lifestyle Factors

Differentiation in the peripheral lymphoid

tissues

Malignant transformation of either

the T or B cells
 T lumphocytes proliferate on antigenic
stimulation and migrate into follicles, where they
intact in B lymphocytes

These activated follicles becme germinal

centers, containing macrophages, follicular
dendrite cells and maturing T and B cells

Develops in any lymphoid

tissues (lymph nodes
Spreads to various lymphoid tissues
throughout the body, especially the
liver, spleen and bone marrow

Group of tumors will

develop

Non-hodgkin’s
lymphoma
 Most common:
Systemic B Sx:
• painless enlargement
• Drenching night sweats
of one or more lymph
node, usually in the • Unexplained weight
neck, armpits, or loss
groin. (painless, • Fever
superficial • Severe itching
lymphadenopathy)
• Usually asymptomatic
 I ON
N T
E
V d
R E n n t
P a e
g em
an a
M
• Resting your stomach and being alert for signs of
dehydration
• Gentle exercise along with adequate intake of fluids
and a diet that is high in fruits, vegetables, and fiber.
• Get extra rest while you are receiving chemotherapy
or radiation therapy.
• Change your diet, rinsing your mouth with liquid
medicines, and putting a baking soda paste or
nonprescription medicine on mouth sores.
• If you find you have trouble sleeping, having a
regular bedtime, getting some exercise during the
day, avoiding naps, and using other tips to relieve
sleep problems may help you sleep more easily.
You may be able to reduce your stress by expressing
your feelings to others. Learning relaxation techniques
may also help you reduce your stress.
Adapting to your body image changes may involve
talking openly about your concerns with your partner
and discussing your feelings with your doctor. Your
doctor may also be able to refer you to organizations
that can offer additional support and information.
To prevent weight loss and conserve your strength, it is
important to eat well during treatment for cancer.
If pain occurs, many treatments are available to relieve
it. If your doctor has given you instructions or
medicines to treat pain, be sure to follow them. You may
use home treatment for pain to improve your physical
and mental well-being. Be sure to discuss any home
treatment you use for pain with your doctor.
T
R
E
A
T
M
E
N
T
• Radiation therapy
-uses high doses of X-
rays, gamma rays, or
other types of ionizing
(damaging) radiation
to kill cancer cells. It
may be applied to the
whole body or to a
specific zone.
• Chemotherapy is the
use of cytotoxic (cell
damaging)
medicines to target
and kill tumors. The
drugs work by
interrupting the DNA
of fast-growing cells,
preventing them
from growing or
reproducing.
• Immunotherapy uses
the body’s own
immune system to
attack and remove
cancer cells. Doctors
inject a patient with a
special type of
antibody, or cell
marker, that binds to
antigens on a cell’s
surface.
• Bone marrow
transplantation
• For patients with very
advanced disease,
extremely high does of
chemotherapy may be
needed. This type of
chemotherapy wipes out
the body’s entire immune
system, including the
bone marrow that
produces blood cells. So,
patients need a
bone marrow transplant in
order to recover.
 ReCeNt STUDIES….
A selective high affinity ligand (SHAL) designed to
bid to an over-expressed human antigen on non-
Hodgkin's lymphoma also binds to canine B-cell
lymphomas.
Balhorn RL, Skorupski KA, Hok S, Balhorn MC,
Guerrero T, Rebhun RB.
(Department of Applied Science, University of
California, Davis, Davis, CA 95616, United States.)
(JUNE 2,2010)
Therapies using antibodies directed against cell
surface proteins have improved survival for
human patients with non-Hodgkin's lymphoma
(NHL). It is possible that similar immuno-
therapeutic approaches may also benefit canine
NHL patients.
Unfortunately, variability between human and
canine epitopes often limits the usefulness of
such therapies in pet dogs. The Lym-1 antibody
recognizes a unique epitope on HLA-DR10 that
is expressed on the majority of human B-cell
malignancies.
The Lym-1 antibody has now been observed to
bind to dog lymphocytes and B-cell NHL.
Sequence comparisons and computer modeling
of a human and three canine DRB1 proteins
identified several orthologs of human HLA-
DR10 expressed by dog lymphocytes.
Immuno-staining confirmed the presence of
proteins containing the Lym-1 epitope on dog
lymphocytes and B-cell NHL. In addition, a
selective high affinity ligand (SHAL) SH-7139
designed to bind within the Lym-1 epitope of
HLA-DR10 was also observed to bind to canine
B-cell NHL tissue.
This SHAL, which is selectively cytotoxic to
cells expressing HLA-DR10 and has been shown
to cure mice bearing human B-cell lymphoma
xenografts, may prove useful in treating B-cell
malignancies in pet dogs.