Fast Five Quiz: Test Your Knowledge on Key Aspects of Non-Hodgkin Lymphoma

Emmanuel C. Besa, MD

Disclosures

August 20, 2018

Whole-body FDG PET can be used for the initial evaluation of patients with NHL; however, this scan is more useful for posttreatment evaluation to differentiate early recurrences or residual disease from fibrosis or necrosis. This type of PET has a higher predictive value for relapse than classic CT. A study by Zinzani and colleagues determined that midtreatment scanning using PET allowed physicians to better make crucial decisions on further treatment. A study by Terezakis and colleagues found that incorporating FDG PET into CT-based treatment planning in patients with lymphoma resulted in beneficial changes in management, volume definition, and normal tissue dosimetry for a significant amount of patients.

In the early stage of disease, patients with NHL may have blood counts within the reference range. As the disease progresses, a complete blood cell count with differential and platelet count in patients with NHL may reveal the following:

  • Anemia secondary to bone marrow infiltration, autoimmune hemolysis (particularly associated with small lymphocytic lymphoma/chronic lymphocytic leukemia), bleeding, anemia of chronic disease

  • Thrombocytopenia, leukopenia, or pancytopenia secondary to bone marrow infiltration or autoimmune cytopenias

  • Lymphocytosis with circulating malignant cells (common in patients with low-grade lymphomas)

  • Thrombocytosis (paraneoplastic syndrome associated with lymphomas or reactive secondary to blood loss)

CT of the neck, chest, abdomen, and pelvis is used to detect enlarged lymph nodes, hepatosplenomegaly, or filling defects in the liver and spleen. It is the most widely used test for initial staging, assessing treatment response, and conducting follow-up care.

Serum chemistry studies in patients with NHL may show the following:

  • Elevated LDH level indicates poor prognosis and correlates with increased tumor burden.

  • Abnormal liver function test results are secondary to hepatic involvement, hypermetabolic tumor growth, and/or chronic inflammation.

  • Hypercalcemia may be observed in patients with acute form of adult T-cell lymphoma-leukemia.

For more on the workup of NHL, read here.

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