Case Study

Non-Hodgkin Lymphoma
David Lloyd

After Ruths Rad Bio Class?

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Multiple subdivisions of
Lymphoma

John Leonard, MD, director of the Cornell Center for Lymphoma and Myeloma at Weill Cornell Medical
Center

"You could be in a room with 100 people with

lymphoma and at most only 30 people would have
the same thing you're dealing with,"

This is a Bouncing Ball

Lymphatic Cancer3
Lymphoma

Hodgkin
Lymphoma

Non-Hodgkin
Lymphoma
(NHL)

Lymphatic Cancer3
Lymphoma

Hodgkin
Lymphoma

Lymphomas are classified

based on the type of cells
involved.NonHodgkinLymphomas are
marked by mutations ofBcellsorT-cells. Hodgkins
lymphomais marked by
the presence of R-S cell.

Non-Hodgkin
Lymphoma
(NHL)

Hodgkins Lymphoma3
Defined
by the
presence
of a large,
Abnormal
B-lymphocyte
cell.
Called a
Reed-Sternberg
Cell.

Large double
Nuclei needed
for Dx.

Epidemiology 4

**Leukemia & Lymphoma Society

2014, expect 70,800

new NHL cases.
of
s
e
t
e r a la t io n
c
n
ide popu
c
n
I
0
NHL 100,00
/
19.6

About 731,277 people living with or in

remission from lymphoma in the US

Five-Year Relative Survival

Rate4

Non-Hodgkin Lymphoma 3
NHL

B-Cell
B cells normally
help protect the
body against germs
(bacteria or viruses)
by making proteins
called antibodies

T-Cell
Several types of T
cells:
-Directly destroy
cells
-Attract other
typesof WBC
- Regulate the

B-cell Lymphomas 3
Diffuse large B-cell
lymphoma
Primary Mediastinal Large B-Cell
Lymphoma
Follicular lymphoma

Burkitt lymphoma

Chronic lymphocytic
leukemia

Lymphoplasmacytic
lymphoma

Marginal zone B-cell

lymphomas

Hairy cell leukemia

Mantle cell
lymphoma

Primary central
nervous system
(CNS) lymphoma

Primary Mediastinal Large BCell Lymphoma7

Thought to arise
from thymic
(medullary) B cells,
is a rapidly growing
dominant mediastinal
mass
Mostly affects young
adults in 3rd and 4th
decade of life
2.4 percent of
all non-Hodgkin
lymphomas

Presentation1

Enlarged lymph nodes

Fever- B
Night sweats - B
Fatigue
Itching
Weight Loss - B

Presentation of Chest Lymphoma 3

Enlarged lymph nodes can press on trachea causing
coughing or difficulty breathing
Chest pain/pressure
Superior Vena Cava
Syndrome swelling
bluish-red
appearance
in head neck
and upper chest.

Risk Factors5

GENERAL

BODY

-Autoimmune
-Age 60 and older
disease
-Men
-Viruses, infection
- Caucasian
-Epstein-Barr virus

GENETICS

-Inherited
immune
disorders

LIFESTYLE

PREVIOUS
TREATMENT

-Exposure to
certain chemicals Immunosuppressa
nt drugs after
organ transplant

Detection and Diagnosis for

PMLBCL7

Mediastinal Lymph Nodes

Diseased cells can
travel anywhere that
lymph fluid travels and
in extra nodal tissue
More likely to spread
randomly rather than in
an orderly pattern

Relapse is
common to
Liver, Kidney
and CNS

Spleen
Thymus
Tonsils
Bone
Marrow

Staging Ann Arbor Classification 3

Involvement of
a single
lymphatic site

Involvement of
2 or more
lymphatic sites
on same side
of the diaphragm

Staging Ann Arbor Classification 3

Involvement of
2 or more
lymphatic sites
on both sides
of the diaphragm

Diffuse or
disseminated
involvement of
one or more
extra lymphatic
organs

Staging Ann Arbor Classification 3

A
B
E

Grading3
NHL

Indolent

Aggressive

(Low-Grade)

(High-Grade)

Slow growing

Faster growing
Poorer Prognosis

Primary Mediastinal large B-cell lymphoma is an aggressive lymphoma.

This means it is fast-growing and usually needs treatment right away.

Ways to treat Lymphoma 1

Chemoimmunotherapy 6
Study by Memorial Sloan Kettering Cancer Center
Retrospective analysis of 54 PMLBCL pts
3 Years
PFS (Progression Survival) 78%
OS (Overall Survival) 88%

No
Radiation
Therapy
Suggestive that with
compelling data non-radiating
regimens may be possible

Stem Cell Transplantation 8

Meta-analysis of clinical trials by Greb et al 2008, Rev 2010
Meta analysis drew from 15 RCTs

Compared

nalysis concluded that there was no clear OS (overall survival)

r EFS (event free survival) benefit to frontline ASCT compared with chemotherap

Chemoimmunotherapy Wins!!!
RCHOP 14 ICE

Combined with IFRT (involved field radiation therapy)

as needed

Questions??

References
1. Reviews CT. e-Study Guide for: Principles and Practice of Radiation Therapy by
Charles Washington, ISBN 9780323053624. Cram101; 2012.
2. Vann AM, Dasher B, Wiggers N. Portal Design in Radiation Therapy, 3rd Edition.
2013.
3. Available at: http://
www.cancer.org/cancer/non-hodgkinlymphoma/detailedguide/non-hodgkin-lymp
homa-types-of-non-hodgkin-lymphoma
. Accessed October 28, 2014.
4. Availableat:www.lls.org/content/nationalcontent/resourcecenter/freeeducationma
terials/generalcancer/pdf/facts.pdf. Accessed October 28, 2014.
5. Available at: http://www.cancercenter.com/non-hodgkin-lymphoma/risk-factors.
Accessed October 28, 2014.
6. Available at: DOI: 10.1200/JCO.2014.55.2810. Accessed October 28, 2014.
7. Available at: http://emedicine.medscape.com/article/203681-overview. Accessed
October 28, 2014.
8. Available at: DOI: 10.1177/2040620714547327. Accessed October 28, 2014.