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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.

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Treatment of Non- Hodgkin’s Lymphoma

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  1. Treatment of Non- Hodgkin’s Lymphoma

  2. 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

  3. Precursor B cell Lymphoblastic Leukemia • Combination therapy used: • Rituximab- fludarabine- cyclophosphamide • Associated with grade III or IV neutropenia • Cyclophophamide- vincristine- prednisone • Cyclophosphamide- doxorubicin- vincristine- prednisone

  4. 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

  5. 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

  6. 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

  7. MALT Lymphoma • Radiation and Surgery • Because it is often localized • Eradication of H. pylori infection • With more extensive diseases: Chlorambucil

  8. 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

  9. Follicular Lymphoma • Asymptomatic patient, older patient: watchful waiting • For those who require treatment: single- agent chlorambucil or cyclophosphamide or combination therapy with CVP or CHOP • For patients with localized follicular lymphoma: radiotherapy

  10. 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

  11. 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

  12. 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

  13. Burkitt’s Lymphoma • Treatment should begin 48 hrs after diagnosis • High doses of cyclophosphamide • Prophylactic therapy to CNS mandatory

  14. 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

  15. 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

  16. Anaplastic Large T/ Null Cell Lymphoma • Treatment regimens same as for other aggressive lymphomas (diffuse large B cell lymphoma) • Rituximab is omitted

  17. 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

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