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The Link Between Non Hodgkin’s Lymphoma With Other Hematological Disorders In Clinical Features
Lymphadenopathy In Non Hodgkins Lymphoma
Diffuse well differentiated lymphoma may merge imperceptibly with chronic lymphatic leukemia and Waldernstrom’s macroglobulinemia. Histological picture of the lymph nodes is similar in these condition. Acute lymphatic leukemia, especially in children, present with lymph node involvement, indistinguishable from diffuse poorly differentiated lymphoma. Histiocytic lymphomas are relatively uncommon, but when they occur, the histiocytes may phagocytose erythrocytes causing hemolytic anemia.
Majority of non hogdkin’s lymphomas are monoclonal B cell tumours and paraproteins of IgM or IgG classes may be demonstrable in many cases. T cell NHL presents especially with mediastinal lymph node enlargement in children.
Enlarged Tonsils In Lymphoma
The Clinical Picture
Majority of cases occur in the second to fifth decades. The duration of illness ranges from weeks to months. More than 70% of the cases are in advanced stages on presentation.
The disease begins as asymmetric painless progressive lymphadenopathy, involving one or several lymph node regions. The cervical axillary, inguinal, mediastinal, abdominal andotehr groups of nodes may be affected. The nodes are firm, variable in size from a few to several centimeters and are matted in the later stages. Pressure on neighbouring structures may lead to mediastinal syndrome, Horner’s syndrome and lymphedema.
Enlargement of the tonsils and Waldeyer’s ring leads to obstruction in breathing and swallowing. Liver and spleen are moderately enlarged in the majority of cases. Mesenteric and retroperitoneal lymph nodes may be enlarged.
Systemic manifestations include early onset of fever, weight loss and night sweats in about 30% of cases. Anemia and infections are also more common.
Involvement of other organs
Though, several organs are affected in the advanced stages of NHL, sometimes extranodal involvement may be the presenting symptom. Involvement of the skin leads to nodular or diffused lesions. Intense pruritis is an early and intractable symptom in a few. Brain, spinal cord and meninges are affected in 20% of cases. Gastrointestinal tract, liver, lungs, respiratory tract, pleura and bone may be the seat of primary lymphoma. Hemorrhagic pleural effusion may occur.
Drug Therapy To Treat Lymphoma
Stages I and II respond to radiotherapy as for HL. In the other stages, chemotherapy Is advocated.
Single drug regimen: Continuous or intermittent therapy with chlorambucil or cyclophosphamide has been reported to give good results in patients with localized nodular and diffuse well- differentiated lymphomas. Since in the vast majority of cases, the disease is widespread on presentation. Single-drug therapy is unsuitable. Single-drug therapy with cyclophosphamide is unsatisfactory due to the great tendency for early relapse.
Combination thereapy with cyclophosphamide, Vincristine and prednisolone (COP), as in the case of stages III and IV Hodgkin’s disease, has been tried with remission rates up to 55- 60%. A remission rate of 60% is obtained with MOPP regimen. In more advanced cases, Adriamucin and bleomycin have been included (BACOP regimen) with remission rate up to 80%. Local irradiation with 4000 to 5000 rads to control massive local disease and systemic chemotherapy tend to give better remission rates in diffuse poorly differentiated lymphoma.
In cases resistant to the usual combination, chemotherapy, the following regimen has been found to be effective and well tolerated. Cyclophosphamide 1g/m2 intravenous weekly, mitomycin 10 mg/m2 intravenous weekly and prednisolone, 60 mg oral daily.
Total body irradiation of 15 rads twice a week for 5 weeks (total 150 rads) has been used as an alternative.
Neuroprophylaxis as for acute leukemia has been advocated in stages III and IV NHL with neurological symptoms.
© 2014 Funom Theophilus Makama