Introduction to Lymphomas
Lymphomas are solid neoplasms that originate in lymph nodes or other lymphatic tissues of the body.
They’re a heterogeneous group of disorders which can arise at virtually any site.
They more often occur in regions with large concentrations of lymphoid tissues, e.g. lymph nodes, tonsils, spleen and bone marrow.
Two main groups of Lymphomas
- Hodgkin’s disease
- Non-Hodgkin’s lymphomas
Hodgkin’s disease
This is characterized by Reed-Sternberg cells (large binucleate cells with vesicular nuclei and prominent eosinophilic nucleoli).
Reed-Sternberg cells are occasionally found in other clinical conditions e.g. hyperplastic or inflammatory lesions of lymph nodes.
Non-Hodgkin’s lymphomas:
Non-Hodgkin’s lymphomas is a heterogeneous collection of lymph proliferative malignancies.
Vary widely according to histological subtype, stage and bulk of disease
Investigations
Mandatory
- Full Blood Count (i.e. haemoglobin, haematocrit leucocyte and differential counts; red cell indices, reticulocyte count)
- Erythrocyte sedimentation rate
- Coombs test
- Bone marrow aspiration and needle biopsy
- Serum Urea, Electrolytes,
- Serum Uric acid
- Liver Function Tests: transaminases-ALT, AST, ALP; bilirubin; serum proteins
- HIV screening Immunoglobulins,
- Chest X-ray
Optional
- Examination of post-nasal space
- Serum copper level
- Neutrophil alkaline phosphatase
- Tomograms of lung or mediastinum
- Skeletal X-ray
- Abdominal ultrasound scans
- Intravenous pyelography
- CT scans of chest and abdomen
- Supplementary node biopsy
Treatment objectives
- Induce remission
- Restore patient to disease-free state
- Maintain state of well-being
Non-drug treatment
- Appropriate nutrition
- Adequate hydration
- Red cell and platelet concentrate transfusions as required
Drug treatment for Lymphomas
- Malaria prophylaxis: proguanil 200 mg orally daily
- Antibiotics as indicated
- Allopurinol 300 mg orally daily (when uric acid is high)
Non-Hodgkin’s lymphomas
CHOP (3 weekly):
- Prednisolone 100 mg orally on days 1 – 5
- Cyclophosphamide 750 mg/m2 intravenously on day 1 Doxorubicin 50 mg/m² intravenously on day 1, 2
- Vincristine 1.4 mg/m² (maximum of 2 mg) intravenously on day 1
CHOP (4 weekly):
- Cyclophosphamide 750 mg/m² intravenously on days 1 and 8
- Doxorubicin 25 mg/m’intravenously on days 1 and 8
- Vincristine 1.4 mg/m (maximum 2 mg) on days 1 and 8
- Prednisolone 100 mg orally on days 1-8
Hodgkin’s lymphoma
MOPP
- Mechlorethamine 6 mg/m² intravenously on days 1 and 8
- Vincristine 1.4 mg/m² (maximum 2 mg) intravenously on days 1 and 8.
- Procarbazine 100 mg/m’orally on days 1 and 4
- Prednisolone 40 mg orally on days 1-14.
ChIVPP
- Chlorambucil 6 mg/m’orally on days 1 and 14
- Vinblastine 6 mg/m² (maximum 10 mg) intravenously on days 1 and 18.
- Procarbazine 100 mg/m’orally on days 1 and 14.
- Prednisolone 40 mg orally on days 1-14
Supportive measures
- Appropriate nutrition
- Adequate hydration
Notable adverse drug reactions, caution
- All the drugs are contraindicated in patients with hypersensitivity reactions to the respective medicines
- Profound nausea, vomiting, diarrhoea and abdominal discomfort
- Secondary malignancies
- Myelosuppression (except the steroids)
- Steroids (prednisolone) may cause Cushing’s syndrome, hypertension, diabetes mellitus, suppression of immunity, infections
- Vincristine: neurotoxic
- Cyclophosphamide: alopecia and
- Doxorubicin: cardiotoxic haemorrhagic cystitis
Prevention
Avoid unnecessary exposure to irradiation and chemicals