Therapy Aetiology

The rearrangement and mutation of immunoglobulin genes that occur in B-cell differentiation and the response to antigen offers an opportunity for genetic accidents such as translocations or mutations involving immunoglobulin gene loci that have been characterised in many lymphomas. Most translocations involve genes associated with either proliferation (e.g. c-MYC) or apoptosis (e.g. BCL-2). Factors associated with NHL are:

• Congenital immunodeficiency: ataxia telangiectasia, Wiskott-Aldrich syndrome, X-linked combined immunodeficiency (?EBV infection important).

• Acquired immunodeficiency: immunosuppressive drugs, transplantation, HIV infection (typically high grade and often occur in extranodal sites e.g. brain).

• Infection: HTLV-I (ATLL); EBV (Burkitt lymphoma and immunodeficiency related high grade lymphomas); Helicobacter pylori (gastric MALT lymphomas).

• Environmental toxins: association with exposure to agricultural pesticides, herbicides and fertilisers, solvents and hair dyes.

• Familial: risk increased 2-3 fold in close relatives (?genetic or environmental).

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