Objectives
  • To be able to perform specialist assessment, treatment, and counselling of patients with the various subtypes of non-Hodgkin's lymphoma (NHL)

Awareness
  • Awareness of the existence of the enormous heterogeneity of NHL subtypes, including the clinical classification into indolent, aggressive or highly aggressive lymphomas

  • Awareness of the existence of the enormous heterogeneity of clinical presentation, with at least 40% of cases without peripheral lymph nodes and 20% of cases with only extranodal location

  • Awareness of the existence of the WHO pathological classification of the various NHL subtypes and the European Organisation for Research and Treatment of Cancer (EORTC)/WHO classification of cutaneous T-cell lymphoma (CTCL) and its subtypes

  • Awareness of the existence of different prognostic factors

  • Familiarity with prognostic scoring systems in the various subtypes of NHL

  • Recognition of when treatment is indicated and when observation is appropriate

  • Recognition that the goal of treatment may range from cure for more aggressive histologies to palliation or control of disease for more indolent histologies

  • Awareness of the association of NHL with human immunodeficiency virus (HIV), immunosuppression and hepatitis C virus (HCV)

Knowledge
  • Familiarity with the characteristics of the different pathological subtypes of NHL as classified by the WHO classification

  • Knowledge of the diagnostic criteria of the EORTC/WHO classification in diagnosing CTCL and its subtypes

  • Familiarity with the indications for, expectations from and limitations of the different diagnostic approaches available for the identification and staging of NHL

  • Understanding that fine needle aspiration (FNA) is not sufficient for making a diagnosis of NHL; biopsy is mandatory

  • Familiarity with immunohistochemistry (IHC), fluorescence in situ hybridisation (FISH) analysis and genetic abnormalities

  • Familiarity with the Ann Arbor Staging system for NHL, the International Prognostic Index (IPI) or other indexes, and with the staging system for mycosis fungoides (MF), Sézary syndrome (SS) and non-MF/non-SS CTCL

  • Understanding of the role of the prognostic scoring systems in NHL

  • Familiarity with important prognostic parameters such as MYC or BCL-2 rearrangements

  • Understanding of the role and the limitations of positron emission tomography (PET) imaging in the staging and restaging of various types of NHL

  • Familiarity with the indications for and the value of chemotherapy, chemo-immunotherapy, monoclonal antibodies, targeted therapy, radiation therapy, supportive and palliative care, and survivorship care in NHL

  • Understanding that cure may be reached only with the first-line therapy

  • Understanding of the role of high-dose chemotherapy and/or bone marrow/stem cell transplantation in relapsed and refractory NHL

  • Understanding that indolent lymphomas may relapse as aggressive lymphoma (transformation)

  • Familiarity with the treatment approach of NHL during pregnancy, in older or frail patients, and in patients with HIV, hepatitis B virus (HBV) or HCV infection

  • Understanding of the challenges and unique clinical properties of follicular lymphoma, marginal zone lymphomas, mantle cell lymphoma, diffuse large B-cell lymphoma, lymphoblastic lymphoma, Burkitt lymphoma and T-cell lymphomas, and the role for intensive treatment of the most aggressive forms

  • Understanding that skin-directed therapies are the primary treatment for localised or early-stage CTCL, that systemic therapies are used in advanced stage disease and that chemotherapy has a role in only a minority of cases of more aggressive, advanced disease

  • Understanding of the early-stage and advanced stage setting as well as the bulky disease particularities of the various subtypes of NHL

Skills
  • Ability to contribute actively to a variety of NHL clinical scenarios and patient presentations

  • Ability to discuss critically the treatment options/recommendations

  • Ability to perform a history and physical examination in NHL patients

  • Ability to use effectively the prognostic scoring systems in NHL

  • Ability to contribute to discussions on general management strategies in order to understand all the considerations on when to initiate treatment versus when to observe, which treatment to use, and when to incorporate radiation therapy

  • Ability to prescribe various chemotherapeutic regimens, monoclonal antibodies and targeted agents

  • Ability to manage side effects of various chemo-immunotherapeutic agents

  • Ability to discuss survivorship care and the risk for late treatment effects with patients