1 / 17

Lymphoma tx

Lymphoma tx. Lymphoma tx. Management varies with type of lymphoma and pt factors (co-morbidities, age, performance status, pt preferences) Goal of tx can be curative, to prolong life, or palliative

mateja
Download Presentation

Lymphoma tx

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lymphoma tx

  2. Lymphoma tx • Management varies with type of lymphoma and pt factors (co-morbidities, age, performance status, pt preferences) • Goal of tx can be curative, to prolong life, or palliative • Multidisciplinary team (haematologists, medical oncologists, radiation oncologists, anatomical pathologists, surgeons, allied health profs, plus ongoing GP care)

  3. Therapeutic Modalities • Chemotherapy – systemic control • Radiation therapy – local control • Immunotherapy - targeted monoclonals (like that CD20 guy) • Allogeneichaematopoeitic stem cell transplantation • Autologous haematopoietic stem cell transplantation

  4. Non-Hodgkin’s Tx • Tx depends on stage (Ann Arbor) • Indolent • low-grade, aggressive • Intermediate-grade, aggressive • High-grade • Special forms

  5. Indolent • Usually disseminated by time of diagnosis and therefore not curable • Not bulky, not symptomatic  no initial tx necessary • Some tx options available, no consensus • Rituximab (the anti-CD20 guy) can be used (low toxicity, avoid chemotherapy) • Or, common chemotherapy regimens (R-CHOP, R-CVP) • Low grade – aggressive  allogeneichaematopoeitic stem cell transplantation

  6. Intermediate grade, aggressive (diffuse large B-cell lymphoma) • Tx with curative intent • Short course chemo (x3) R-CHOP + localised radiation • or, 6-8 cycles R-CHOP w/o radiation (especially more advanced) • Very high risk lymphoma  autologoushaematopoeitic stem cell transplantation • High grade (Burkitt’s, lymphoblastic) • Intense, cyclic chemo + intrathecal chemo as CNS prophylaxis

  7. Special cases • MALT lymphoma of stomach – kill pylori with combo antibiotics; or, whole stomach radiation • Mantle cell – doesn’t respond to standard chemo; intensive chemo + autologoushaematopoeitic stem cell transplantation • Primary CNS lymphoma – repeated cycles of high-dose methotrexate w/ rituximab

  8. R-CHOP • R – Rituximab (Mabthera) • that monoclonal that binds to CD20 • C - Cyclophosphamide • Nitrogen mustard alkylating agent – adds alkyl group to DNA causing irreversible cross-links • H - Hydroxydaunorubicin (Doxorubicin, Adriamycin) • intercalating agent - damages DNA by inserting itself between DNA bases • O - Oncovin (Vincristine) • prevents cell proliferation by binding to tubulin • P - Prednisone (or prednisolone) • corticosteroid

  9. Side effects of R-CHOP • Nausea/vomiting (antiemetics), • Allopecia • Neutropenia • Tumour-lysis syndrome • caused by the break-down products of dying cancer cells and include hyperkalaemia, hyperphosphataemia, hyperuricaemia and hyperuricosuria, hypocalcaemia, and consequent acute uric acid nephropathy and acute renal failure • Allopurinol - prophylactic to prevent hyperuricaemia

  10. Prognosis – Non-Hodgkin’s • Indolent - med surv 10-15yrs • Intermediate • uses IPI (International Prognostic Index) • Factors – age >60, high serum LDH, stage III/IV dis, poor performance status, more than 1 extranodal site • 0-1 factor  5y surv 73% • 2 factors  5y surv 51% • 3 factors  5y surv 43% • 4-5 factors  5y surv 26% • Relapse after initial chemo  autologoushaematopoeitic stem cell transplantation  50% long term lymphoma-free survival

  11. Not pie charts

  12. Hodgkin’s Tx • All should be treated with curative intent • Stage IA w/ high cervical lymph node and low ESR – radiation • Stage I/II – short course chemo ABVD + involved-field radiation • Stage III/IV – full course ABVD • Stage II w/ lgemediastinal mass – full course ABVD + mediastinal radiotherapy

  13. ABVD • A - Adriamycin (the H in R-CHOP) • B - Bleomycin • antibiotic that also induces DNA strands to break • V - Vincristine (the O in R-CHOP) • D - Dacarbazine • Alkylating agent – adds alkyl groups to DNA

  14. ABVD side effects • Acute • Alopecia, nausea/vomiting (antiemetics can be given), myelosuppression, allergic reactions to bleomycin (test dose often given first), neuropathy (temp or perm) • Delayed • Infertility, pulmtox (again bleomycin), cardiac tox (adriamycin), secondary malignancies

  15. Prognosis - Hodgkin’s • Influenced by 7 features – stage, age, gender, haemoglobin, albumin, WBC, lymphocyte count • 0-2 features  75% cure • 3+ features  55% • Stage IA/IIA  10y surv >90% • Stage III/IV  10y surv 50-60% • Poor outcomes – older folk, bulky disease, lymphocyte depletion, mixed-cellularity on histo • Relapse after intial chemo  autologoushaematopoeitic stem cell transplatation  35-50% cure

  16. Champions of sports day jumping castle races Paul Conway Rob Illingworth

More Related