Non- Hodgkin’s L ymphoma - PowerPoint Presentation

Slide1

Non-Hodgkin’sLymphoma

Klinika Hematologii, Nowotworów Krwi i Transplantacji Szpiku

We Wrocławiu

Aleksandra Bogucka-Fedorczuk

Definition Non-Hodgkin lymphoma (NHL)

is

a

heterogenous

group

of

neoplasm

charecterised

by

clonal

proliferation

of

lymphoid

cells

.

Different

subtypes

of NHL

develop

at

different

stages

of

lymphocytes

B, T

or

NK

differentation

How does it start?

How does it start?

Dysregulation

of

oncogens

expression

,

Example

:

oncogene

c-MYC

oncogene

BCL2nncogene BCL6

Supressor gens mutationsExample:gene P53

Uncontrolled

clonal proliferation

B-Cells help make antibodies, which are proteins that attach to and help destroy antigensLymphomas are caused when a mutation arises during the B-cell life cycleVarious different lymphomas can occur during several different stages of the cycle

Follicular lymphoma, which is a type of B-cell lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2, which blocks apoptosis.

B-Cell Lymphoma (80%)

T-Cell Lymphoma (15%)

The T-cells are born from stem cells, similar to that of B-cells, but mature in the thymus.

They help the immune system work in a coordinated fashion.

These types of lymphomas are categorized by how the cell is affected

Anaplastic Large cell Lymphoma, t-cell lymphoma caused by a gene translocation in chromosome 5

Usually classified by how the cells look under a microscope and how quickly they grow and spread

Indolent

Lymphomas (low-grade lymphomas)

-

Indolent – these lymphomas grow slowly.

G

enerally

considered incurable with chemotherapy and/or radiation therapy (FOLLICULAR LYMPHOMA)

Aggressive

– these lymphomas have a rapid growth pattern. This is the second most common form of NHL and are curable with chemotherapy (Diffuse large B-cell lymphoma – DLBCL

)

Very

agressive – Burkitt Lymphoma

Classification

Most

common

?

Risk factors

Infectious

factors

(EBV, HIV, HCV,

H.pylori

)

Autoimmune

diseases

Sex: Male

AgeExposure to herbicides, solvent etc,

When to think about it

?

Symptoms

:

Enlarged

lymph

nodes

! (

peripheral

but not always)Usually painless, without skin changes, speed of the growth depends on NHL subtype. Sometimes

causes other symptoms by pressing against a vein (swelling of an arm or leg), or against a nerve

Sometimes

involvement

of

nonlymphatic

structures

When to think about it

?

Reccuren

fevers

Weight

loss

Night

sweats

FatigueHepatospleenomegalyBonepainReccurent infectionsExtranodal: intestinal (

abdominal pain, dysfagia) CNS (headache, cranial nerve palsies Skin, Thyroid,

Lungs- Pancytopenia (not always: onlywhen

bone marrow involvement)

B

symptoms

(

systemic

symptoms

)

Biopsy

-

diagnosis

!

Blood tests (complete blood count, LDH, liver and kidney function

)

Staging

procedures

:

CT scans

or

PET-

scan

(necessary to perform the staging and to

control

response

to the

treatment

)

Sometimes

X-

ray

or

Magnetic Resonance Imaging (MRI)

B

one

marrow

biopsy

and

aspirate

Diagnosis

FL

DLBCL

Diagnosis

Ghielmini

M.,

Montoto

S.

Lymphomas

Essential

for

Clinicians

. ESMO Press, 2016

Diagnosis - staging

Ann

Arbor

staging

:

stage

I, II, III, IV

divided

into

category

A (no B

symptoms

), B (B symptoms)

or

E (

nonlymphatic

organ

involved

).

IPI (International

Prognostic

Index), MIPI

staging

(

Mantle

Cell Lymphoma

Prognostic

Index), FLIPI (

Folicular

Lymphoma International

Prognostic

Index)

based

mostly

on

age

, Ann

Arbor

stage

, LDH

evaluation

,

extranodal

involvement

and performance status

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)

Diagnosis

-

staging

Chemotherapy

Radiation

Bone Marrow Transplantation

Immunotherapy

Using the

anty

bodies

against

antigens

of a

cells

(

Rituximab

–

anti CD20 antibody) combined with material made in a lab.

Treatment

options

www.pharmacodia.com

THANK YOU!