Current RMA Instruments
| Reasonable Hypothesis SOP | 90 of 2018 as amended |
| Balance of Probabilities SOP | 91 of 2018 as amended |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 202.8
- ICD-10-AM Codes: C82 to C85
Brief description
Non-Hodgkin Lymphoma (NHL) covers a group of malignancies of the T or B lymphocytes within lymphoid tissue or lymph nodes.
Confirming the diagnosis
The diagnosis is complex and generally requires excision biopsy of a lymph node with histologic, immunologic, and molecular biologic assessment.
The relevant medical specialist is a haematologist or oncologist.
Additional diagnoses covered by these SOPs
- Adult T cell lymphoma/leukaemia
- Other named lymphomas that are not Hodgkin’s lymphoma, small lymphocytic lymphoma or lymphoblastic lymphoma and are not excluded by the SOP definition
- Burkitt’s lymphoma
- MALT (mucosal associated lymphoid tissue) Lymphoma
- Mycosis fungoides – T cell lymphoma of the skin
- Richter’s syndrome. This is where chronic lymphocytic leukaemia transforms to non-Hodgkin’s lymphoma. There is a specific factor for this in the SOP
- Splenic marginal zone lymphoma (B cell)
- Sezary’s disease/Sezary’s syndrome – This is a cutaneous T cell lymphoma
Conditions not covered by these SOPs
- Acute lymphoblastic leukaemia/lymphoblastic lymphoma*
- Chronic lymphocytic leukaemia/small lymphocytic lymphoma*
- Hairy cell leukaemia* - Chronic lymphocytic leukaemia/small lymphocytic lymphoma
- Hodgkin's lymphoma*
- Myeloma*
- Plasma cell malignancy* - Myeloma
- Waldenstrom’s macroglobulinaemia#
* another SOP applies
# non-SOP condition
Clinical onset
The clinical presentation is extremely variable. Initial symptoms tend to be non-specific (e.g. weight loss, fever, night sweats). Detection of a mass or enlarged lymph nodes is the most common presentation. Once the diagnosis has been confirmed, onset can be backdated to the first detection of the relevant mass/lump or the first symptoms that can be attributed to the condition.
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. The natural course of the condition depends on the specific type of NHL and a range of other prognostic factors. Inability to obtain appropriate management could lead to a worsening of the condition in the form of faster disease progression. Relapse after an initial treatment-induced remission is common.