Non-Hodgkin Lymphoma

 11 September 2011, Hollywood actor Andy Whitfield was died at 39 years old. He played the part of Spartacus, a soldier condemned to fight as a gladiator and who ultimately leads a rebellion against the Romans (the Third Servile War). He was diagnosed with Non-Hodgkin Lymphoma by a doctor, March 2010.


Definition

Lymphoma malignum non-Hodgkin's or non-Hodgkin's lymphoma is a primary malignancy of lymphoid tissue wich solid.

Non-Hodgkin Lymphoma

Histological Classification of non-Hodgkin's Lymphoma

The first assumption is that the differentiation status of lymphocytes can be seen from the size and configuration of the core, lymphoid cells are small and round cells are considered as well-differentiated, and small lymphoid cells of irregular shape is considered as a poorly differentiated lymphocytes. The second assumption is the large lymphoid cells with vesicular nuclei and cytoplasm that usually has a lot of pale ascribed to the class of monocyte macrophages (histiocytes).

Signs of immunological non-Hodgkin's Lymphoma

B lymphocytes contain surface immunoglobulin which can be colored and shows the receptors for complement and Fc fraction of immunoglobulins. T lymphocytes have no surface immunoglobulin that can be colored, but have the ability to form bonds with red blood cells of sheep. Thus B and T lymphocytes can be known and specified amount in both peripheral blood and in suspensions of cells derived from lymphoid tissues. This approach has been proven that most of the HNL derived from B cells and that the proliferating cells are usually monoclonal.

Etiology and Pathogenesis

Cytogenic  abnormalities, such as chromosomal translocations. Lymphoma malignum undifferentiated cell subtypes (DU) is another high degree of malignancy HNL, rare in adults but is often found in children. Histological subtypes include Burkitt lymphoma, which is a B-cell lymphoma and has a characteristic chromosomal abnormality, which is translocated long arm of chromosome number 8 (8q) is usually to the long arm of chromosome 14 (14q +).

Viral infections, one of which is suspected of Epstein-Barr virus associated with Burkitt's lymphoma, a disease commonly found in Africa. Infection of HTLV-1 (Human T Lymphoytopic virus type 1).

Clinical Overview

Majority for asymptomatic patients as much as 2% of patients may experience fever, night sweats and weight loss.

Patients with indolent lymphoma can occur adenopathy over several months before diagnosis, although there is usually a persistent enlargement of lymph nodes nodules. For extranodule, the disease most often occurs in the stomach, lungs and bone, resulting in disease symptoms in the character which usually affect these organs.

By applying the criteria used by Rosenberg and Kaplan to determine the chains lymph nodes that are interconnected. Jones found that in 81% among 97 patients with HNL types of follicular and 90% among 93 patients with LNH type of diffuse, spread of disease also occurs by way of travel from one place to the adjacent. Nevertheless the relationship between regional lymph nodes and left neck region of the aorta in LNH follicular type is not as clear as what is seen in diffuse type HNL.

Burkitt Non-Hodgkin Lymphoma

Disease Stages

Staging is based on the type of pathology and level of involvement. Type of pathology (level of low, medium or high) based on the formulation of a new job. Level of involvement is determined according to the Ann Arbor classification.

a. New Form

Low level:

1. Small lymphocytic

2. Folicel cell mytosis

3. Folicel cells with characterized  mixture of large and small cell and mytosis

 Moderate level

4. Large Folicel cells

5. Small follicles mytosis, Diffuse

6. Large and small mixed cell, diffuse

7. Large cell, diffuse

High level: Type of an unfavorable

8. Large cell immunoblast

9. Lymphoblastic

10. Unsplit cell

b. Level of involvement is determined according to the Ann Arbor classification

Stage I:Involvement of one lymph node region (I) or the involvement of one organ or one place extralymphatic (IIE)

Stage II:

The involvement of two regions or more lymph nodes on the same side of the diaphragm (II) or local involvement in the organ or site extralymphatic and one or more regional lymph nodes on the same side of the diaphragm (IIE). Another recommendation: the number of nodal areas involved are indicated by subscript (subscript)

Stage III:

The involvement of regional lymph nodes in the second did the diaphragm (III), which can also be accompanied by a local involvement in the organ or site extralymphatic (IIIE) or both (IIIE + S) Stage IV:

Diffuse involvement or without enlarged lymph nodes. Reasons to classify patients into stage IV should be explained further by showing the place with the symbol.

Systemic symptoms

Each stage is subdivided into categories A and B. B for patients with certain symptoms and A for

those without such symptoms. Classification B will be given to patients with:

1. weight loss that can not be explained where the magnitude of more than 10% of body weight in 6 months prior to discharge from hospitalization

2.  fever that can not be explained by temperatures above 38  C.

3. night sweats.

Determination Criteria Stadium

Clinics (CS) when based solely on the results of physical examination and laboratory pathology (PS) when based on biopsy and laparotomy.

Treatment and Therapy

Therapy is usually done through a multidisciplinary approach. Therapies that can be done is:

1. Low malignancy Level / indolent:

In principle Symptomatic

- Chemotherapy: single or double medication (by mouth), if deemed necessary: COP (cyclophosphamide, Oncovin, and Prednisone)

- Radiotherapy: LNH highly radiosensitive.

Radiotherapy can be done for local and palliative. Radiotherapy: Low Dose Involved Field Radiotherapy TOI + course

2.Moderate malignancy Level / aggressive lymphoma

- Stage I: Chemotherapy (CHOP / CHVMP / BU) + radiotherapy, CHOP (cyclophosphamide, Hydroxydouhomycin, Oncovin, Prednisone)

- Stage II - IV: parenteral combination chemotherapy, radiotherapy plays for the purpose of palliation.

3. High malignancy Level  Lymphoblastic (NHL-lymphoblastic)

- Always be given treatments such as Acute lymphoblastic Leukemia (ALL)

- Re-evaluation of the treatment carried out on:

1. after the fourth cycle of chemotherapy

2. after the complete treatment cycle