Lymphoma¶
Danielle Fishman
Background¶
- Classically characterized by lymphadenopathy & constitutional “B” symptoms: fevers, drenching night sweats and weight loss
- Hodgkin:
- 10%
- superficial, nodal disease with orderly spread
- Bimodal Distribution: 15-35 years and >50 years; M>F
- CD15+, CD30+ (Reed Sternberg cells “owl eyes”)
- Associated with EBV in immunocompromised patient
- Non-Hodgkin:
- 90%
- diffuse, nodal and extranodal disease with noncontiguous spread
- Average 65 years, M>F, 85-90% B-cell
- Associated with immunodeficiency (HIV, post-transplant), autoimmune disease, infection (EBV, HTLV-1, H pylori, HCV, Borrelia, C psittacosis, Coxiella)
General Evaluation¶
- History
- B symptoms; pruritus (10-15% of pt with HL); history of radiation
- Physical Exam
- Head & neck, tonsils, axilla, testes, liver, spleen
- Lymphadenopathy: painless, firm, fixed, >1cm
- Lab tests:
- CBC, CMP, LDH, Uric Acid, Phosphorus
- Consider HBV, HCV, HIV, EBV, Quant gold, Treponemal Ab, ANA
- Imaging:
- CT chest, abdomen, pelvis
- Most will eventually need PET-CT; MRI brain if neuro symptoms
- Consider LP for NHL with high risk of CNS involvement or presence of
neurological symptoms
- Risk factors: Burkitt, Lymphoblastic, testicular involvement, double/triple hit
- Multiple LPs may be required to diagnose CNS lymphoma
-
Diagnosis requires tissue
- Excisional Lymph node biopsy (Surg Onc Consult)
- Core biopsy (CT guided procedure consult)
- Of note, steroids may impact value of biopsy results
-
Lugano Classification: staging of lymphoma
- I. 1 LN region or single extra lymphatic organ/site without nodal involvement
- II. >2 LN regions, same side of diaphragm
- III. LN regions on both sides of diaphragm
- IV. Disseminated disease w/ 1+ extralymphatic organ
-
Hodgkin:
- IPS negative prognostic calculator: albumin <4, hemoglobin <10.5, male, stage IV disease, age>45, WBC count> 15K, lymphocyte <8% of WBC count
- Non-Hodgkin:
- Good prognosis: Follicular, Marginal Zone, Mycosis Fungoides/Sezary Syndrome
- Poor prognosis: DLBCL – can arise from low grade lymphoma Richter transformation), Double/Triple Hit: bcl-2, bcl-6, or myc aberrations, Mantle Cell, Burkitt, Lymphoblastic Lymphoma, and Anaplastic Large Cell Lymphoma
General Management¶
- ECG and TTE to establish pre-chemotherapy cardiac function – many chemo regimens with anthracyclines
- Daily labs: CBC, TLS, LDH
- TLS prophylaxis: mIVF, allopurinol
Common Chemotherapy Regimens for Lymphoma¶
Regimen | Components | Use |
---|---|---|
R-CHOP | Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone | NHL |
R-EPOCH | Etoposide plus the drugs above (dosing is different) |
NHL (Double/Triple hit) |
Hyper-CVAD | Cyclophosphamide, vincristine, doxorubicin, and dexamethasone | NHL |
HD-MTX + R | High Dose methotrexate + Rituxumab | Primary CNS Lymphoma |
ABVD | Doxorubicin, bleomycin, vinblastine, dacarbazine | HL |
Last update:
2022-06-25 02:05:01