Prognostic Factors and Characteristics

Prognostic Factors

Non-Hodgkins' Lymphoma

INTERNATIONAL PROGNOSTIC INDEX FOR NHL (NCCN 2007)

ALL PATIENTS

  • age >60
  • stage CS III-IV
  • serum LDH > normal
  • ECOG 2-4
  • 2 or more extra-nodal sites

PATIENTS w/ age > 60

  • III or IV
  • serum LDH > 1 x normal
  • ECOG 2-4
Risk Groups ALL PATIENTS PATIENTS 60 YEARS 5-OS
Low 0 or 1 0 73%
Low intermediate 2 1 51%
High intermediate 3 2 43%
High 4 or 5 3 26%

Hodgkins' Disease

UNFAVORABLE FACTORS FOR HODGKIN'S DISEASE (NCCN 2007)
localized presentations

  • Bulky disease:
  • Mediastinal mass (chest x-ray) with maximal-tumor-width/intrathroacic-diameter > 1/3:
  • Mediastinal mass greater than 35% of
  • the thoracic diameter at T5-6
  • Erythrocyte sedimentation rate 50, if asymptomatic
  • > 3 sites of disease
  • B symptoms
  • Extranodal invovlement
Groups 10-OS
Favorable 96%
Unfavorable, Age <= 50 95%
Unfavorable, Age > 50 71.4%

Advanced HD

  • Albumin < 4 g/dL
  • Hemoglobin < 10.5 g/dL
  • Male
  • Age 45 years
  • Stage IV disease
  • Leukocytosis (white blood cell count at least 15,000/mm
  • Lymphocytopenia (lymphocyte count less than 8% of white blood cell count, and/or lymphocyte count less than 600/mm )
Prognostic Score 5-FFP 5-OS
0 84% 89%
1 77% 90%
2 67% 81%
3 60% 78%
4 51% 61%
> 5 42% 56%

Working Formulation for NHL

Low Grade Median survival of 5-7 years
Intermediate Grade Median survival is 8mo-3yrs
High Grade Median survival is 8mo-3yrs

Low Grade

  • small lymphocytic
  • follicular small cleaved
  • follicular mixed small cleaved & large cell
  • mantle cell

Intermediate Grade:

  • follicular large cell
  • diffuse small cleaved
  • diffuse mixed small cleaved & large cell
  • diffuse large cell

High Grade:

  • immunoblastic large cell
  • lymphoblastic
  • small noncleaved

Indolent (Low-grade) B-cell Lymphoma Antigen & Genetic Profile

Histology CD5 CD 10 CD 23 B-Cell
Small Lymphocytic + - + +
Folicular - + +/- +
Mantle Cell + - - +
MALT - - - +

Antigens Commonly Expressed by Lymphoid Neoplasms

B-Cell Antigens CD19, CD20, CD22
NK Cell Antigens CD16, CD56, CD57
T-Cell Markers CD2, CD7, CD8
R-S CD15+, CD30+
Myeloid/ monocytes CD33
  • peroxidase-positive granules called Auer rods are found in AML.
  • CD5: expressed on all T-cells and small subset of B-cells
  • CD 10: marrow, pre-B cells, follicular center B-cells; also called CALLA
  • CD 23: Activated mature B-cells
  • CD 45 (known as leukocyte common antigen)

Genotypes Express by Lymphoid Neoplasms

Lymphoid Neoplasm Genotype
MALT H. pylori
Follicular Bcl-2, t(14,18)
Burkitt's c-MYC, EBV(Africa), t(8,14)
Mantle Cell Bcl-1(also known as Cyclin D1), t(11,14)
CNS Lymphoma HIV
Adult T-Cell HTLV-1
Kaposi's sarcoma HHV-8
Extra-nodal B-Cell HCV
Cutaneous B-cell Lymphoma Borrelia burgdorferi

Translocations

Follicular t(14,18) Low-grade
Marginal Zone t(11,18) Low-grade
Mantle Cell t(11,14) High-grade
Burkitt's t(8,14) High-grade
CML t(9,22) Philadelphia (Ph) chromosome
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