📋 Key Information Summary
- Non-Hodgkin lymphoma (NHL) encompasses a heterogeneous group of mature B-cell, T-cell, and NK-cell neoplasms — aggressive subtypes (especially DLBCL) are far more common than indolent subtypes in Australia.
- Australia has one of the highest NHL incidence rates globally (~18 per 100 000 person-years); DLBCL and follicular lymphoma together account for >60 % of cases.
- The WHO Classification (5th edition, 2022) is the diagnostic standard; accurate subclassification by an expert haematopathologist is essential for treatment selection.
- Excisional lymph-node biopsy with immunophenotyping (flow cytometry, immunohistochemistry) and molecular studies (FISH for MYC, BCL2, BCL6) is the gold standard — fine-needle aspiration alone is insufficient.
- PET-CT is the preferred staging modality for FDG-avid aggressive lymphomas (DLBCL, Hodgkin); CT chest/abdomen/pelvis remains acceptable for indolent subtypes.
- The Lugano Classification (modified Ann Arbor) stages NHL I–IV with PET-CT; bone-marrow biopsy is no longer routinely required in FDG-avid lymphomas staged by PET-CT.
- R-CHOP-21 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) × 6 cycles is the first-line standard for DLBCL; CNS-IPI score guides CNS prophylaxis decisions.
- High-grade (double-/triple-hit) lymphomas harbouring MYC plus BCL2 and/or BCL6 rearrangements require intensified regimens such as dose-adjusted R-EPOCH.
- Indolent follicular lymphoma (Grade 1–2) is managed with watch-and-writ for low-tumour-burden disease; immunochemotherapy (BR or R-CHOP) is first-line for symptomatic or high-burden disease.
- Relapsed/refractory aggressive NHL may benefit from CAR T-cell therapy (tisagenlecleucel, axicabtagene ciloleucel) — available at designated Australian centres via the Life Saving Drugs Programme.
- Consolidation radiotherapy is indicated for early-stage DLBCL (limited-field after R-CHOP) and for residual bulky disease post-chemotherapy.
- Survival surveillance includes clinical review, LDH, and CT at 3–6-month intervals for 2 years, then 6–12-monthly to 5 years; PET-CT for routine surveillance is not recommended outside clinical concern.
- Aboriginal and Torres Strait Islander peoples have a higher proportion of aggressive NHL subtypes and later-stage presentation; culturally safe pathways and remote-access specialist consultation are essential.
Introduction & Australian Epidemiology
Non-Hodgkin lymphoma (NHL) is a heterogeneous group of mature B-cell, T-cell, and natural-killer (NK)-cell malignancies arising from lymphoid tissue. The spectrum ranges from indolent entities such as follicular lymphoma and marginal-zone lymphoma, which may be managed with observation alone for years, to highly aggressive forms including diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma, which require urgent systemic therapy.
Australia has one of the highest age-standardised incidence rates of NHL worldwide, estimated at approximately 18 per 100 000 person-years. In 2024, an estimated 7 000 new cases of NHL were diagnosed nationally, with a median age at diagnosis of ~67 years and a male-to-female ratio of approximately 1.4 : 1. NHL represents approximately 4 % of all new cancer diagnoses in Australia and is the sixth most common cancer overall.
DLBCL is the single most common subtype, accounting for 30–40 % of all NHL cases in Australian registries, followed by follicular lymphoma (~25 %), marginal-zone lymphoma (~8 %), mantle-cell lymphoma (~6 %), and peripheral T-cell lymphoma (~5 %). The relative 5-year survival for all NHL subtypes combined is approximately 74 %, although this varies markedly by histology — approaching 90 % for localised follicular lymphoma but falling below 50 % for advanced-stage peripheral T-cell lymphoma not otherwise specified (PTCL-NOS).
Recognised risk factors in the Australian context include immunosuppression (HIV, post-transplant, iatrogenic), autoimmune disease (Sjögren syndrome, coeliac disease, rheumatoid arthritis), chronic hepatitis C (particularly splenic marginal-zone lymphoma), Helicobacter pylori (gastric MALT lymphoma), and increasing age. Epstein–Barr virus (EBV) is associated with specific entities including post-transplant lymphoproliferative disorder (PTLD) and EBV-positive DLBCL not otherwise specified.
Classification (B vs T Cell, Grade)
Accurate subclassification of NHL is critical because prognosis and treatment differ substantially between entities. The WHO Classification of Haematolymphoid Tumours (5th edition, 2022) is the international diagnostic standard and is used by all Australian haematopathology laboratories.
Mature B-Cell Neoplasms (>85 % of NHL in Australia)
| Subtype | Behaviour | Key Features | Approximate % of NHL |
|---|---|---|---|
| Diffuse large B-cell lymphoma (DLBCL), NOS | Aggressive | Most common NHL; curable with R-CHOP; cell-of-origin (GCB vs ABC) prognostically relevant | 30–40 % |
| Follicular lymphoma (FL) | Indolent | Grade 1–2 indolent, Grade 3B treated as DLBCL; t(14;18) BCL2 rearrangement; CD10+, BCL2+ | ~25 % |
| Marginal-zone lymphoma (MZL) | Indolent | Extranodal (MALT), nodal, splenic; H. pylori eradication cures gastric MALT in ~80 % | ~8 % |
| Mantle-cell lymphoma (MCL) | Aggressive (rarely indolent) | t(11;14) CCND1-IGH; SOX11+; typically older males; intensive vs de-escalated approaches | ~6 % |
| Burkitt lymphoma | Highly aggressive | MYC translocation t(8;14); "starry sky" histology; very high proliferation; dose-intensive chemo | ~2 % |
| High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements ("double-hit" / "triple-hit") | Highly aggressive | Treated with dose-adjusted R-EPOCH rather than R-CHOP; poor prognosis if MYC + BCL2 only | ~3–5 % of DLBCL |
Mature T-Cell and NK-Cell Neoplasms (~10–15 % of NHL)
| Subtype | Behaviour | Key Features | Approximate % of NHL |
|---|---|---|---|
| Peripheral T-cell lymphoma, NOS | Aggressive | Heterogeneous; CHOP-based therapy; poor 5-year OS (~30 %); no single standard regimen | ~3 % |
| Angioimmunoblastic T-cell lymphoma | Aggressive | Systemic symptoms, polyclonal hypergammaglobulinaemia; EBV+; CHOP or CHOEP-based | ~1–2 % |
| Anaplastic large-cell lymphoma (ALCL) | Aggressive | ALK+ (better prognosis) vs ALK−; CD30+; brentuximab vedotin active | ~2 % |
| Extranodal NK/T-cell lymphoma, nasal type | Highly aggressive | EBV-driven; midline destructive lesions; SMILE protocol; no anthracycline (P-glycoprotein) | ~1 % |
| Cutaneous T-cell lymphoma (mycosis fungoides / Sézary syndrome) | Indolent → aggressive | Skin-directed therapy early; systemic for advanced; novel agents (mogamulizumab) | ~3 % |
Grading — Indolent vs Aggressive
Indolent
Grade 1–2 FL, MZL, Small lymphocytic lymphoma / CLL
Low proliferation index (Ki-67 <30 %); long natural history; watch-and-writ appropriate in many cases; median survival measured in decades for early-stage disease.
Setting: Outpatient haematology
Aggressive
DLBCL, MCL, PTCL, ALCL, Grade 3A FL
Rapid growth; curable in a significant proportion with immunochemotherapy; urgent treatment often required; Ki-67 typically 40–90 %.
Setting: Oncology unit — urgent initiation
Highly aggressive
Burkitt, Double/Triple-hit, Lymphoblastic lymphoma, ENKTL
Doubling time days to weeks; Ki-67 approaching 100 %; tumour lysis syndrome risk; intensive regimens; CNS prophylaxis mandatory; oncological emergency in many cases.
Setting: Inpatient — immediate intervention
Clinical Features & Staging
Presenting Features
NHL may present with painless peripheral lymphadenopathy, extranodal disease, or constitutional ("B") symptoms. The mode of presentation varies by subtype.
- Lymphadenopathy: Painless, rubbery, non-tender lymph node enlargement — cervical, axillary, inguinal, or mediastinal. Rapidly growing nodes suggest aggressive histology.
- B symptoms: Unexplained fever >38 °C, drenching night sweats, unintentional weight loss >10 % of body weight within 6 months. Present in ~30–40 % of aggressive NHL and confer adverse prognostic significance.
- Extranodal disease: Occurs in ~40 % of NHL at presentation — most commonly GI tract, bone marrow, skin, Waldeyer ring, CNS, bone, and testis.
- Mediastinal mass: May cause SVC obstruction (dyspnoea, facial swelling, plethora) — requires urgent investigation and treatment.
- Bone marrow infiltration: Cytopenias, fatigue, or incidental finding on staging biopsy.
- Gastric NHL: Epigastric pain, dyspepsia, or GI bleeding — H. pylori-associated MALT lymphoma may be cured with antibiotics alone.
- CNS involvement: Headache, cranial nerve palsies, altered mental status — consider in testicular, breast, kidney, or epidural lymphoma; high LDH; IPI ≥3.
Staging — Lugano Classification (Modified Ann Arbor)
| Stage | Definition | 5-Year OS (DLBCL, approximate) |
|---|---|---|
| I | Single lymph-node region or single extranodal site (IE) | ~90 % |
| II | ≥2 nodal regions on same side of diaphragm | ~80 % |
| III | Nodes on both sides of diaphragm | ~65 % |
| IV | Diffuse extranodal involvement (e.g. bone marrow, liver, lung) | ~50–55 % |
Suffixes: A = no B symptoms; B = B symptoms present; E = contiguous extranodal extension; Bulky = mass ≥10 cm (or ≥⅓ thoracic diameter for mediastinal).
International Prognostic Index (IPI) — Aggressive NHL
The IPI remains the standard prognostic tool for DLBCL. Each factor scores 1 point: age >60 years, LDH >upper limit of normal, ECOG performance status ≥2, Ann Arbor stage III–IV, >1 extranodal site.
Low risk
IPI 0–1
5-year OS ~75–80 %.
Standard R-CHOP
Low-intermediate
IPI 2
5-year OS ~55–65 %.
Standard R-CHOP ± clinical trial
High-intermediate / High
IPI 3–5
5-year OS ~30–50 %.
R-CHOP; consider CNS prophylaxis; intensification per subtype
Investigations (Biopsy, Immunophenotype)
Critical: Fine-needle aspiration (FNA) alone is insufficient for NHL diagnosis. Excisional or incisional lymph-node biopsy with adequate tissue for histology, immunophenotyping, and molecular studies is required. Core biopsy may be acceptable if excision is not feasible, provided adequate tissue is obtained.
Essential Investigations
Essential
Excisional lymph-node biopsy
Histological architecture assessment; WHO subtyping; Ki-67 proliferation index. Referred to haematopathologist with expertise in lymphoma.
Essential
Immunohistochemistry (IHC) panel
CD20, CD3, CD10, BCL2, BCL6, MUM1, Ki-67, MYC, CD5, CD23, Cyclin D1, SOX11, CD30, ALK. Hans algorithm for cell-of-origin (GCB vs non-GCB).
Essential
Flow cytometry
Rapid immunophenotyping; light-chain restriction confirms clonality; distinguishes reactive from neoplastic process.
Available
FISH for MYC, BCL2, BCL6 rearrangements
Critical to identify double/triple-hit lymphomas (high-grade B-cell lymphoma with MYC and BCL2/BCL6 rearrangements). All DLBCL and Grade 3 FL should be tested. Available at major Australian centres.
Available
PET-CT (FDG)
Preferred staging modality for FDG-avid aggressive NHL; replaces bone-marrow biopsy in DLBCL if PET is negative for marrow involvement. Interim PET (Deauville score) guides treatment in some protocols. MBS item 61446 (PET scan for lymphoma).
Available
CT chest / abdomen / pelvis with IV contrast
Alternative to PET-CT for indolent subtypes; baseline for monitoring; accessible across all Australian centres.
Essential
Bone-marrow biopsy
May be omitted if PET-CT clearly negative for marrow in FDG-avid subtypes; remains necessary for indolent lymphomas and when PET unavailable.
Available
LDH, FBC, renal function, LFTs, Uric acid
LDH is a component of IPI; elevated uric acid may indicate tumour lysis risk; baseline renal and hepatic function guide chemotherapy dosing. Bulk-billed standard pathology.
Available
Hepatitis B (HBsAg, anti-HBc, anti-HBs) and Hepatitis C serology
Mandatory before rituximab — HBV reactivation risk requires antiviral prophylaxis (entecavir) if HBsAg+ or anti-HBc+.
Available
HIV serology
HIV-associated NHL requires concurrent ART and modified chemotherapy regimens. Offer to all patients with NHL.
Specialist
Cerebrospinal fluid cytology and flow cytometry
Lumbar puncture indicated when CNS involvement suspected (CNS-IPI ≥4, testicular, breast, kidney, epidural, or high-grade histology with high LDH).
Specialist
Next-generation sequencing (NGS) panel
TP53 mutational status, MYD88 L265P (in suspected PCNSL or testicular lymphoma), EZH2 mutations (follicular lymphoma). Increasingly available at tertiary centres; not yet standard of care for all patients.
Subtype-Specific Diagnostic Considerations
- Gastric MALT lymphoma: EGD with multiple biopsies; H. pylori testing (histology, urease test, stool Ag); t(11;18) if available (predicts antibiotic resistance).
- DLBCL: Cell-of-origin by Hans algorithm (CD10, BCL6, MUM1) — GCB vs non-GCB/ABC; MYC IHC ≥40 % triggers FISH for MYC rearrangement.
- Follicular lymphoma: Grade 1–2 vs 3A vs 3B (3B managed as DLBCL); FLIPI score.
- Mantle-cell lymphoma: Cyclin D1+ or t(11;14); SOX11 for indolent variant identification; TP53 mutation testing guides intensity.
Management (R-CHOP, Radiotherapy, Surveillance)
First-Line Therapy — Aggressive NHL (DLBCL)
R-CHOP-21 remains the standard first-line regimen for DLBCL. Six cycles are recommended for advanced-stage (II–IV) disease; 3–4 cycles plus involved-field radiotherapy (IFRT) is an acceptable alternative for non-bulky stage I–II disease.
Rituximab
MabThera® · Biosimilars available · Anti-CD20 monoclonal antibody
Adult dose
375 mg/m² IV Day 1 of each cycle (R-CHOP-21)
Paediatric dose
375 mg/m² IV per protocol (regimen-dependent)
Renal adjustment
None required
PBS status
✔ PBS General Benefit (IV)
Cyclophosphamide
Endoxan® · Alkylating agent
Adult dose
750 mg/m² IV Day 1 of each cycle
Renal adjustment
Reduce dose by 25 % if CrCl <10 mL/min
PBS status
✔ PBS General Benefit
Doxorubicin (hydroxydaunorubicin)
Adriamycin® · Anthracycline
Adult dose
50 mg/m² IV Day 1 (lifetime cumulative max 450 mg/m²)
Caution
Cardiotoxicity — baseline echocardiogram required; avoid if LVEF <50 %
PBS status
✔ PBS General Benefit
Vincristine
Vinca alkaloid
Adult dose
1.4 mg/m² IV Day 1 (cap 2 mg to reduce neurotoxicity)
Hepatic adjustment
Reduce by 50 % if bilirubin >3 × ULN
PBS status
✔ PBS General Benefit
Prednisolone
Solone® · Corticosteroid
Adult dose
100 mg PO daily Days 1–5 of each cycle
PBS status
✔ PBS General Benefit
HBV reactivation risk: All patients must be screened for hepatitis B before starting rituximab. Patients who are HBsAg+ or anti-HBc+ require antiviral prophylaxis with entecavir (Baraclude®) or tenofovir, commenced before chemotherapy and continued for ≥12 months after the last dose of rituximab. Monitor HBV DNA monthly during treatment.
DA-R-EPOCH — Intensified Alternative
Dose-adjusted R-EPOCH (rituximab, etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin — continuous infusion over 96 h) is preferred for:
- Double-hit or triple-hit lymphomas (MYC + BCL2 and/or BCL6 rearranged)
- MYC-rearranged DLBCL without additional hits
- Primary mediastinal B-cell lymphoma (PMBCL)
- Some CNS lymphoma protocols
DA-R-EPOCH is given for 6 cycles with G-CSF support. It requires inpatient or ambulatory chemotherapy infusion facilities.
Indolent NHL — Follicular Lymphoma
Watch and wait (active surveillance) is standard of care for asymptomatic, low-tumour-burden follicular lymphoma (GELF criteria negative). Median time to first treatment is 2–5 years; outcomes are equivalent to immediate therapy. Reassure patients that observation does not worsen prognosis.
When treatment is indicated (symptomatic, high tumour burden, cytopenias, organ compromise, rapid progression):
- First-line: Bendamustine + rituximab (BR) × 6 cycles or R-CHOP × 6 cycles. BR is generally preferred for its favourable toxicity profile in older adults.
- Rituximab maintenance: 375 mg/m² IV every 2 months for 2 years following immunochemotherapy — improves PFS.
- Rituximab monotherapy: 375 mg/m² IV weekly × 4 for those not fit for combination chemotherapy.
Bendamustine
Ribomustin® · Alkylating agent
Adult dose
90 mg/m² IV Days 1–2 of each 28-day cycle
Renal adjustment
Caution if CrCl <40 mL/min (limited data)
PBS status
✔ PBS Restricted Benefit (follicular lymphoma)
Gastric MALT Lymphoma
- H. pylori eradication therapy (PPI + clarithromycin + amoxicillin [or metronidazole if penicillin-allergic] for 14 days) is first-line for all H. pylori-positive gastric MALT lymphoma, regardless of stage.
- Complete remission is achieved in ~80 % of stage IE cases.
- Confirm eradication with urea breath test at ≥4 weeks post-treatment.
- Refractory disease: involved-field radiotherapy (24–30 Gy) or rituximab-based systemic therapy.
Mantle-Cell Lymphoma
- Fit patients (age ≤65, adequate organ function): R-DHAP or R-CHOP/R-DHAP alternating, followed by autologous stem-cell transplant (ASCT) consolidation.
- Older / less fit patients: BR (bendamustine + rituximab) × 6 cycles; rituximab maintenance thereafter.
- Indolent MCL (SOX11−, low Ki-67, non-nodal): Observation may be appropriate.
- Relapsed/refractory: BTK inhibitors — ibrutinib (Imbruvica®), zanubrutinib (Brukinsa®), acalabrutinib (Calquence®). PBS Authority Required.
Ibrutinib
Imbruvica® · BTK inhibitor
Adult dose
560 mg PO daily until progression
Hepatic adjustment
280 mg daily if moderate hepatic impairment
PBS status
✔ PBS Authority Required (relapsed/refractory MCL)
Radiotherapy
- Early-stage DLBCL (I–II non-bulky): Involved-site radiotherapy (ISRT) 30–36 Gy after abbreviated R-CHOP (3–4 cycles).
- Residual bulky disease: Consolidation ISRT 30–40 Gy after 6 cycles R-CHOP.
- Indolent NHL (localised): ISRT 24–30 Gy as definitive therapy — may provide long-term disease control.
- Palliative: 8 Gy in 1 fraction or 20 Gy in 5–10 fractions for symptomatic localised disease.
Relapsed / Refractory NHL
Relapsed DLBCL: If within 12 months of R-CHOP or primary refractory, CAR T-cell therapy (tisagenlecleucel [Kymriah®] or axicabtagene ciloleucel [Yescarta®]) is the preferred second-line treatment for eligible patients, based on the ZUMA-1 and JULIET trials. Available in Australia at designated centres through the Life Saving Drugs Programme (LSDP).
- Chemosensitive relapse (DLBCL): Salvage chemotherapy (R-ICE, R-DHAP, or R-GDP) followed by ASCT if fit and chemosensitive.
- Indolent NHL relapse: Rituximab re-treatment; PI3K inhibitor (copanlisib — PBS Authority); lenalidomide + rituximab (R²); or radiotherapy for limited sites.
- T-cell lymphoma relapse: Belinostat (Beleodaq®); pralatrexate (Folotyn®); mogamulizumab (for CTCL); or clinical trial.
CNS Prophylaxis
The CNS-IPI score identifies patients at higher risk of CNS relapse (kidney/adrenal involvement, >1 extranodal site, stage III–IV, LDH >ULN, ECOG >1, age >60). Patients with CNS-IPI 4–6 ("high risk") should be considered for CNS-directed prophylaxis:
- Intrathecal methotrexate 12–15 mg (PBS General Benefit) × 4–6 doses during R-CHOP, OR
- Systemic high-dose methotrexate 3 g/m² IV every cycle (preferred for testicular, breast, or kidney lymphoma).
Survival Surveillance
Post-treatment surveillance aims to detect relapse early and manage long-term toxicity. Routine surveillance PET-CT is not recommended outside clinical suspicion due to high false-positive rates.
0–2 years
Clinical review, FBC, LDH, and CT every 3–6 months. PET-CT only if clinical concern. LDH is the most useful single marker for relapse.
2–5 years
Clinical review and bloods every 6–12 months. CT annually or as clinically indicated.
>5 years
Annual review in primary care. Screen for late effects: secondary malignancies (MDS/AML from alkylating agents, breast cancer from mantle radiotherapy), cardiovascular disease (anthracycline cardiotoxicity), hypothyroidism, peripheral neuropathy.
- End-of-treatment PET-CT (Deauville score 1–3 = complete metabolic response; 4–5 = consider biopsy before assuming residual disease).
- Echocardiogram at 1 year post-anthracycline, then as clinically indicated.
- Fertility counselling should be documented prior to treatment initiation in all patients of reproductive age.
Special Populations
Pregnancy
Diagnosis
CT staging avoided; MRI (no contrast) preferred. Biopsy should not be delayed.
Treatment
Rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) may be used in 2nd/3rd trimester with multidisciplinary guidance. Doxorubicin is avoided if possible (cardiotoxicity concern). Full R-CHOP may be given after 13 weeks' gestation if clinically urgent — discuss with maternal-fetal medicine and haematology.
Radiation
Abdominal/pelvic radiotherapy contraindicated. Supradiaphragmatic IFRT possible with foetal shielding in 2nd/3rd trimester if clinically essential.
Paediatrics
Epidemiology
NHL accounts for ~60 % of childhood lymphoma (more common than Hodgkin lymphoma in <15 years). Burkitt lymphoma, lymphoblastic lymphoma, and anaplastic large-cell lymphoma predominate.
Treatment
Paediatric NHL protocols are intensive and differ substantially from adult regimens. Referral to a paediatric oncology centre (Children's Oncology Group protocols) is mandatory. R-CHOP is NOT standard for paediatric DLBCL — FAB/LMB or BFM protocols are used.
Tumour lysis
Burkitt lymphoma in children has extremely high tumour lysis risk — aggressive hydration, rasburicase (Fasturtec®), and close electrolyte monitoring required.
Elderly (≥75 years)
Fitness assessment
Comprehensive geriatric assessment (CGA) to determine fitness for full-dose R-CHOP vs dose-reduced regimens (R-mini-CHOP for patients >80 years — Peyrade et al.).
Cardiotoxicity
Higher anthracycline cardiotoxicity risk; baseline and serial echocardiography essential. Consider liposomal doxorubicin or non-anthracycline regimens if LVEF borderline.
Neuropathy
Vincristine neurotoxicity more common; consider dose capping at 1 mg and early dose reductions for paraesthesia.
Renal Impairment
Cyclophosphamide
Reduce dose by 25 % if CrCl <10 mL/min. No adjustment for mild-moderate impairment.
Methotrexate (CNS prophylaxis)
Contraindicated if CrCl <30 mL/min without dose modification and enhanced monitoring. Leucovorin rescue mandatory. Consider alternative CNS prophylaxis (intrathecal cytarabine).
Rituximab
No renal dose adjustment required.
Hepatic Impairment
Vincristine
Reduce by 50 % if bilirubin >3 × ULN. Avoid if severe hepatic dysfunction.
Doxorubicin
Reduce by 50 % if bilirubin 1.5–3 × ULN; avoid if >3 × ULN.
Hepatitis B co-infection
Antiviral prophylaxis (entecavir 0.5 mg PO daily) mandatory before rituximab. Continue ≥12 months post-last rituximab dose.
Immunocompromised
HIV-associated NHL
Concurrent ART essential; R-CHOP is standard. Outcomes approach those of HIV-negative patients when CD4 count >200 and viral load suppressed. Prophylaxis against PJP and other opportunistic infections.
Post-transplant (PTLD)
Reduction of immunosuppression is first-line. Rituximab monotherapy for CD20+ early PTLD. R-CHOP for polymorphic or monomorphic PTLD not responding. Referral to transplant centre required.
Iatrogenic (methotrexate, TNF inhibitors)
Withdraw offending immunosuppressant — lymphoma may regress spontaneously in ~50 % of methotrexate-associated cases.
Aboriginal and Torres Strait Islander Health Considerations
Aboriginal and Torres Strait Islander Health
Aboriginal and Torres Strait Islander Australians experience disparities in lymphoma outcomes, including later-stage presentation, higher proportion of aggressive subtypes, and barriers to timely specialist access. Culturally safe care and partnership with Aboriginal Community Controlled Health Organisations (ACCHOs) are essential.
📚 References
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