Guidelines on Diagnosis and Treatment of Malignant Lymphomas

Introduction
In Ireland and Northern Ireland approximately 800 new cases of
malignant lymphoma, Hodgkin lymphoma (HL) and non-Hodgkin
lymphoma (NHL), are registered each year. In line with the rest
of the western world, the incidence of NHLs appears to be
increasing, probably by 3-5% per year and, being largely a
disease of the elderly, these tumours represent an increasing
cause of cancer-related death. The reasons for increasing
incidence are multiple, ranging from the increasing elderly
population, greater accuracy of diagnosis and unknown
environmental factors. The increase has not been noted in
HL and in all subtypes of NHL and cannot solely be explained
on the basis of the HIV epidemic.
NHLs are a heterogeneous group of diseases which are
mainly linked by their origin within the lymphoid system and
its different cellular components. Over 60% of NHLs are
accounted for by two diseases, diffuse large B-cell lymphoma
(DLBCL) which is an aggressive disease and follicular lymphoma
(FL) which is an indolent or non-aggressive entity. Many other
less- common and often rare sub-types of NHL exist. All display
distinct natural histories and require complex diagnostic
approaches and management.
The Lymphoma Forum of Ireland (LFI) first met in October 2002
and outlined its aims as: the promotion of a high standard of
care and the development of all aspects of lymphoma diagnosis
and treatment in Ireland and Northern Ireland, development and
fostering of research initiatives relating to malignant lymphomas
and interaction with other relevant bodies towards achieving
these aims. Members of the LFI include medical oncologists,
haematologists, pathologists and radiation oncologists involved
in the diagnosis and management of malignant lymphomas.
After a number of exploratory meetings, it was agreed that the
initial step required was the development of management
guidelines for these diseases in line with the WHO classification
and best international treatment practices. As an initial effort,
guidelines for the diagnosis and management of 22 diseases
have been developed as well as guidelines for the management
of some generic issues. This is the first update of the guidelines
issued in parallel with the updated WHO guidelines published in
2008 and these will be made available on the Haematology
Association of Ireland website.
Over the last forty years there have been numerous efforts to
classify lymphoid malignancies culminating in the WHO
classification introduced after much international effort in 2001.
It is clear that malignant lymphomas require a sophisticated
diagnostic approach based on clinical features, morphology,
immunophenotyping and genetic analysis. It is essential that
such an approach underpins the clinical management of these
diseases, many of which are amenable to cure. Clinical care
should be delivered by those with expertise and experience
in the area, within a multidisciplinary setting.
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