4th May 2024

A 55-year-old man presents to the outpatient department with complaints of persistent fatigue, night sweats, and a noticeable enlargement of the lymph nodes in his neck and armpits over the past two months.

A 55-year-old man presents to the outpatient department with complaints of persistent fatigue, night sweats, and a noticeable enlargement of the lymph nodes in his neck and armpits over the past two months. On examination, multiple non-tender, rubbery lymph nodes are palpable in the cervical and axillary regions. He also reports unintentional weight loss of about 5% of his body weight in the last six months. He has no significant past medical history and takes no regular medications.

Investigations:

Complete blood count: Normal range

Lactate dehydrogenase (LDH): Elevated

Excisional biopsy of the lymph node: Histopathology consistent with Non-Hodgkin Lymphoma (NHL)

Which is the next most appropriate management step?