Page 275 - Essential Haematology

Chapter 20 Non-Hodgkin lymphoma / 261

include chest X - ray and computed tomography
(CT) scanning (Fig. 20.9 ). Positron - emission tom-
ography (PET) may detect disease not seen on CT
scan and is used to follow treatment response (Fig.
20.10 ). Bone marrow aspiration and trephine are
also performed for diagnosis and staging and HIV
testing is needed.

Specifi c s ubtypes of n on - Hodgkin
l ymphoma

Low - g rade n on - Hodgkin l ymphoma
Small l ymphocytic l ymphoma

This term is used for cases with the same morphol-
ogy, immunophenotype and cytogenetics as chronic
9
lymphocytic lymphoma (CLL), less than 5 × 10 /L
peripheral blood B cells and no cytopenias due to
bone marrow involvement. Most of the patients are
‘
elderly and often no treatment is required ( watch
and wait ’ ).

Lymphoplasmacytoid l ymphoma
(Waldenstr ö m ’ s m acroglobulinaemia)
Figure 20.7 Iliac crest trephine biopsy in lymphocytic

This is an uncommon condition, seen most fre-

lymphoma. Prominent nodules of lymphoid tissue are
quently in men over 50 years of age. When, as
seen in the intertrabecular space and paratrabecular
areas. usually is the case, the disease produces a mono-
clonal IgM paraprotein, lymphoplasmacytoid lym-
phoma (LPL) may be termed Waldenstr ö m ’ s

macroglobulinaemia. The cell of origin appears to
be a post - germinal centre B cell with the character-
istics of an IgM - bearing memory B cell. Th e disease
Table 20.4 International prognostic index for

usually presents with an insidious onset, often with
high - grade lymphoma.
fatigue and weight loss. Hyperviscosity syndrome
(see Fig. 21.13) is a common complication as IgM

Good Bad
paraprotein (a pentameter) increases blood viscosity
Age < 60 years > 60 years more than equivalent concentrations of IgG or IgA.
Performance status 0 or 1 > 2 Visual upset is frequent and the retina may show a
variety of changes such as engorged veins, haemor-
Stage (see p. 247) I or II III or IV
rhages, exudates and a blurred disc (see Fig. 21.13) .
Number of 0 or 1 > 2 If the macroglobulin is a cryoglobulin, features of
extranodal sites cryoprecipitation, such as Raynaud s phenomenon,
’
may be present. LPL may also be diagnosed by
Serum LDH Normal Raised
chance in symptomless patients.
Anaemia, at least partly caused by an increased
LDH, lactate dehydrogenase.
plasma volume, is usually a significant problem and