• FBC, plasma viscosity/ESR and blood film.

• U&E, uric acid, LFTs, LDH, serum |32-microglobulin.

• Serum protein electrophoresis

• Bone marrow trephine biopsy.

• CT of chest, abdomen and pelvis to define areas of nodal and extran-odal disease.

• Others as necessary e.g. LP and CT head/spine for patients with overt CNS symptoms: LP also for high grade disease with marrow, testicular or paranasal sinus involvement, lymphoblastic or Burkitt histology; MRI spine, bone scan, gallium scan, PET scan etc

Staging helps to define prognosis and select appropriate therapy. Also helps assess response to therapy. The Ann Arbor staging system developed for Hodgkin's disease is widely used in NHL (fflHodgkin's disease p210).

Prognostic factors

• Histologic grade.

• Performance status.

• Constitutional (B) symptoms unfavourable.

• Disseminated disease (stage III-IV) unfavourable.

• Extranodal disease (poorer >2 extranodal sites).

• Raised serum |32-microglobulin.

• High proliferation rate measured by Ki-67 immunochemistry.

• BCL-2 protein expression.

• High grade transformation from low grade NHL.

The International Prognostic Index (IPI) was developed for aggressive NHL and validated in all clinical grades of NHL as a predictor of response to therapy, relapse and survival. One point is awarded for each of the following characteristics: age >60, stage III or IV, >2 extranodal sites of disease, performance status >2 and raised serum LDH to identify 4 risk groups. An age-adjusted IPI has also been developed.

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