Non-Hodgkin - PowerPoint PPT Presentation

About This Presentation
Title:

Non-Hodgkin

Description:

Non-Hodgkin s lymphomas-definition and epidemiology 1. Definition: malignant disease of the lymphoid system, highly heterogeneous, both histologically and clinically. – PowerPoint PPT presentation

Number of Views:381
Avg rating:3.0/5.0
Slides: 34
Provided by: poznanmed
Category:
Tags: hodgkin | non

less

Transcript and Presenter's Notes

Title: Non-Hodgkin


1
Non-Hodgkins lymphomas-definition and
epidemiology
  • 1. Definition malignant disease of the lymphoid
    system, highly heterogeneous, both histologically
    and clinically.
  • 2. Epidemiology
  • - annual incidence 5-10 new cases per 100 000
    persons,
  • - age distribution middle-age patients and the
    elderly,
  • - males are affected more often than females
    (1.51.0).

2
Non-Hodgkins lymphomas-Clinical features
  • 1. Constitutional symptoms (fever, night sweats,
    weight loss)
  • 2. Lymphadenopathy
  • (cervical, supraclavicular, axillary, inguinal,
    mediastinal, retroperitoneal, mesenteric,
    pelvic).
  • 3. Mediastinal adenopathy (T cell lymphoma)
  • 4. Extralymphatic involvement (gastrointestinal,
    testicular masses, solitary bone lesions, CNS).
  • 5. Unexplained anemia and thrombocytopenia ( bone
    marrow infiltration).

3
Histologic classification of non-Hodgkins
lymphomas
  • 1. Rappaport - 1966
  • 2. Lukes and Collins - 1974
  • 3. Dorfman - 1974
  • 4. Bennet et al., - 1974
  • 5. Lennert - 1974
  • 6. WHO - 1976
  • 7. Working Formulation - 1982
  • 8. REAL - 1994
  • 9. WHO - 1999

4
Histologic classification of non-Hodgkins
lymphomas - Working Formulation (WF)
  • 1. Low grade
  • 2. Intermediate grade
  • 3. High grade

5
Histologic classification of non-Hodgkins
lymphomas - Working Formulation (WF)
  • Low grade
  • A. - Small lymphocytic cell.
  • B. - Follicular, predominantly small cleaved
    cell
  • C. - Follicular mixed, small cleaved and large
    cell.

6
Histologic classification of non-Hodgkins
lymphomas - Working Formulation (WF)
  • Intermediate grade
  • D. - Follicular, predominantly large cell.
  • E. - Diffuse small cleaved cell.
  • F. - Diffuse mixed, small and large cell.
  • G. - Diffuse large cell.

7
Histologic classification of non-Hodgkins
lymphomas - Working Formulation (WF)
  • High grade
  • H. - Large cell immunoblastic.
  • I. - Lymphoblastic.
  • J. - Small noncleaved cell Burkitts

8
Non-Hodgkins lymphomas /NHL/
  • - clinical features

9
For the diagnosis of non-Hodgkins lymphomas the
histological examination of a lymph node is
necessary!
10
Non-Hodgkins lymphomas - histological
classification
11
REAL /Revised European-American Lymphoma/-WHO
classification of non-Hodgkins lymphomas
  • Precursor B- or T-cell lymphomas
  • Peripheral B- or T-cell lymphomas

12
REAL /Revised European-American Lymphoma/-WHO
classification of non-Hodgkins lymphomas
  • Precursor B cell lymphomas
  • - acute lymphoblastic leukemia
  • - lymphoblastic lymphoma

13
REAL /Revised European-American Lymphoma/-WHO
classification of non-Hodgkins lymphomas
  • Peripheral B cell lymphomas
  • - Chronic lymphocytic leukemia/lymphocytic
    lymphoma
  • - Chronic prolymphocytic leukemia
  • - Immunocytoma/lymphoplasmocytic lymphoma
  • - Mantle cell lumphoma
  • - Marginal zone lymphoma /MALT-type/
  • - Hairy cell leukemia

14
REAL /Revised European-American Lymphoma/-WHO
classification of non-Hodgkins lymphomas
  • Peripheral B cell lymphomas /continued/
  • - Follicle center cell lymphoma
  • - Plasma cell myeloma/plasmocytoma
  • - Diffuse large B cell lymphoma
  • - Burkitts lymphoma
  • - Splenic marginal zone B cell lymphoma

15
REAL /Revised European-American Lymphoma/-WHO
classification of non-Hodgkins lymphomas
  • Precursor T cell lymphomas
  • - Acute lymphoblastic leukemia
  • -Lymphoblastic lymphoma

16
REAL /Revised European-American Lymphoma/-WHO
classification of non-Hodgkins lymphomas
  • Peripheral T cell lymphomas
  • T cell chronic lymphocytic leukemia
  • T cell chronic prolymphocytic leukemia
  • Large granular lymphocyte leukemia /LGL/
  • Mycosis fungoides /Sézary syndrome
  • Peripheral T cell lymphomas, unspecified

17
REAL /Revised European-American Lymphoma/-WHO
classification of non-Hodgkins lymphomas
  • Peripheral T cell lymphomas/continued/
  • Angioimmunoblastic T cell lymphoma
  • Angiocentric lymphoma
  • Intestinal T cell lymphoma
  • Adult T cell lymphoma/leukemia
  • Anaplastic large cell lymphoma

18
Very aggressive non-Hodgkins lymphomas
  • B-, T-cell acute lymphoblastic leukemia
  • B-, T-cell lymphoblastic lymphomas
  • Burkitts lymphoma
  • Adult T cell lymphoma/leukemia

19
High risk aggressive non-Hodgkins lymphomas
  • 1. Age abowe 60 years.
  • 2. Disease stage III and IV.
  • 3. Extranodal involvement of more than 1 site.
  • 4. Serum LDH concentration gt1 x normal.
  • 5. Performance status lt 80.

20
Treatment results of aggressive non-Hodgkins
lymphomas according to the risk group
  • Risk group No of risk CR 5-year
    survival
  • __________________factors ______________________
    ______
  • Low 0,1 87 73
  • Low intermediate 2 67 50
  • High intermediate 3 55 43
  • High 4,5 44 26


21
Treatment results of patients under age 60 with
aggressive non-Hodgkins lymphomas according to
the risk group
  • Risk group No of risk CR 5-year survival

  • factors________________________________
  • Low 0 92 87
  • Low intermediate 1 78 69
  • High intermediate 2 57 46
  • High 3 46 32

22
Treatment results of aggressive advanced
non-Hodgkins lymphomas using different
chemotherapy programs
  • 1. First-generation CHOP
  • - CR 50-55. Long-term survival 35-50 .
  • 2. Second-generation mBACOD, ProMACO-MOPP
  • - CR 70-80. Long-term survival 50-60.
  • 3. Third-generation MACOP-B
  • - CR 84. Long-term survival 75
  • - CR 52-57. Long-term survival 47-56

23
Comparative evaluation of treatment results in
aggressive advanced non-Hodgkins lymphomas
  • 3-year survival Mortality
  • _______________________
  • CHOP 41 1
  • mBACOD 46 5
  • ProMACE-CytoBOM 46 3
  • MACOP-B 41 6
  • Southwest Oncology Group

24
Treatment results in patients over 60 years with
aggressive advanced non-Hodgkins lymphomas
  • ______Program_____________________5-year survival
  • CHOP 45
  • mBACOD 39
  • ProMACE-CytoBOM 41
  • MACOP-B 23

25
Therapy of aggressive non-Hodgkins lymphomas
  • 1. Chemotherapy CHOP
  • complete remission 60-80
  • permanent cure 40-60
  • refractory/recurrent disease 30-50

26
Recommended treatment of aggressive non-Hodgkins
lymphomas
  • 1. Low risk patients -CHOP
  • 2. High risk patients
  • - CHOP
  • - ablative therapy and hematopoietuc stem cell
  • transplantation

27
Treatment results of refractory/ recurrent
aggressive non-Hodgkins lymphomas
  • Chemotherapy programs ESHAP, DHAP, IMVP16, MINE
  • Complete remission 20 - 30
  • 3. 2-3-year survival 10

28
Hematopoietic stem cell transplantation in
aggressive non-Hodgkins lymphomas - Indications
  • 1. Refractory disease
  • 2. Relapse
  • 3. High risk in CR
  • 4. Lymphoblastic and Burkitts lymphomas

29
Treatment results of aggressive non-Hodgkins
lymphomas with high risk
  • 1. Ablative therapy and hematopoietic stem cell
  • transplantation - 5 year survival (DFS) 70-90
  • 2. Consolidation chemotherapy (DHAP)
  • - 5-year survival (DFS) 25-50

30
Radiotherapy of aggressive non-Hodgkins lymphomas
  • 1. Exclusively in pathologic stage I and IE.
  • 2. No indications for combined therapy.

31
Results of radiotherapy in pathologic stage I/IE
aggressive non-Hodgkins lymphomas
  • 1. Complete remission - 90
  • 2. 10-year survival - 54
  • - patients under 60 years - 75
  • 3. Chemotherapy - if one of the
  • following symptoms are present
  • - bulk of disease (lymph node gt 7 cm),
  • - high serum LDH concentration,
  • - localization in gastrointestinal track,
    testicles

32
Therapy of very aggressive non-Hodgkins
lymphomas
  • 1. Previous results 2-3 year survival 15
  • 2. At present
  • - remission induction treatment as in ALL (High
    risk),
  • - consolidation
  • a/ ablative therapy and hematopoietic stem cell
    transplantation (allogeneic or
    autologous)
  • - CR 80-100
  • - 3-5 year survival (DFS) 50-70
  • b/ high - dose cytarabine

33
Age-adjasted prognostic index in aggressive
non-Hodgkins lymphomas
  • 1. Disease stage (I, II vs. III, IV).
  • 2. Serum LDH concentration (lt 1x normal vs gt1 x
    normal).
  • 3. Performance status (?80 vs lt 80).
  • Age-adjasted International Prognostic Index
Write a Comment
User Comments (0)
About PowerShow.com