Transcript Treatment of Non- Hodgkin`s Lymphoma

Treatment of Non- Hodgkin’s
Lymphoma
Precursor B cell Lymphoblastic
Leukemia
• Remission induction with combination
therapy
• Consolidation phase:
– High dose systemic therapy
– Treatment to eliminate CNS disease
• Continuing therapy: prevent relapse and
effect cure
Precursor B cell Lymphoblastic
Leukemia
• Combination therapy used:
– Rituximab- fludarabine- cyclophosphamide
• Associated with grade III or IV neutropenia
– Cyclophophamide- vincristine- prednisone
– Cyclophosphamide- doxorubicin- vincristineprednisone
B Cell Chronic Lymphoid Leukemia/ Small
Lymphocytic Leukemia
• Most common:
– Chlorambucil: orally; few immediate side effects
• Chosen in elderly patients who require therapy
– Fludarabine: IV; with significant immune suppression
• more active agent; with significant incidence of complete
remission
• Regimens inclusive of this drug is chosen for young patients
presenting with leukemiarequiring therapy
• Second line agent for patients with tumors unresponsive to
chlorambucin
B Cell Chronic Lymphoid Leukemia/ Small
Lymphocytic Leukemia
• Rai stage O and Binet stage A ( no
manifestations of disease other than BM
involvement and lymphocytosis
– Followed without a specific therapy
• With adequate number of circulating
normal blood cells, asymptomatic
– Require treatment for the first few years of
follow up
B Cell Chronic Lymphoid Leukemia/ Small
Lymphocytic Leukemia
• Rai stage III or IV or Binet stage C (Bone
Marrow failure)
– Require initial therapy
– Immune manifestations should be managed
independently of antileukemic therapy
MALT Lymphoma
• Radiation and Surgery
– Because it is often localized
• Eradication of H. pylori infection
• With more extensive diseases:
Chlorambucil
Mantle Cell Lymphoma
• With disseminated disease: aggressive
combination chemotherapy regimens+
autologous/ allogeneic BM transplantation
• Localized diseases: combination
chemotherapy + radiotherapy
• Asymptomatic, elderly patient: observation
+ single- agent chemotherapy
Follicular Lymphoma
• Asymptomatic patient, older patient:
watchful waiting
• For those who require treatment: singleagent chlorambucil or cyclophosphamide
or combination therapy with CVP or CHOP
• For patients with localized follicular
lymphoma: radiotherapy
Follicular Lymphoma
• Most responsive to chemotherapy and
radiotherapy
• Active therapies:
– Fludarabine
– Interferon α: prolong survival in patients on
doxorubicin- containing combination therapies
– Monoclonal antibodies with or without
radionuclides
– Lymphoma vaccines
Diffuse Large B Cell Lymphoma
• Initial Treatmant: combination
chemotherapy regimen= CHOP +
Rituximab
– Stage I or non bulky stage II: 3-4 cycles + field
radiotherapy
– Bulky stage II, stage III, stage IV: 6-8 cycles or
4 cycles then reevaluate -> complete
remission -> 2 more cycles, then therapy
discontinued
Diffuse Large B Cell Lymphoma
• IPI : predict favorable responses
– Score 0-1: 5 year survival >70 %
– Score 4-5: 5 year survival ~20%
• For refractory cases or relapse
– Salvage therapy
– Alternative combination therapy
– Autologous bone marrow transplantation
Burkitt’s Lymphoma
• Treatment should begin 48 hrs after
diagnosis
• High doses of cyclophosphamide
• Prophylactic therapy to CNS mandatory
• Hairy cell leukemia: Cladribine
• Splenic marginal zone lymphoma:
splenectomy, chlorambucil
• Lymphoplasmacytic lymphoma:
Chlorambucil, fludarabine and cladribine
• Nodal marginal zone lymphoma: treatment
same as follicular lymphoma
Precursor T Cell Lymphoblastic
Leukemia
• Very intensive remission induction and
consolidation regimens
• Leukemia- like regimens: for older children
and young adults
• With high levels of LDH or BM, CNS
involvement: BM transplantation
Anaplastic Large T/ Null Cell
Lymphoma
• Treatment regimens same as for other
aggressive lymphomas (diffuse large B
cell lymphoma)
• Rituximab is omitted
• Mycoises Fungoides
– Localized early stage: radiotherapy- total skin
electron beam irradiation
– More advanced disease: topical
glucocorticoids, topical nitrogen mustard,
phototherapy, psoralen with PUVA, electron
beam radiation, IFN, Antibodies, fusion toxins
and systemic cytotoxic therapy
• Adult T Cell Lymphoma/ Leukemia
– Combination chemotherapy regimens