Post on 12-Jan-2016
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- vincristine-
prednisone
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: single- agent 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