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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 63. Lymphomas.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. With all stages and risk-groups of Hodgkin lymphoma, restaging PET-CT following about 8 to 12 weeks of chemotherapy will further guide the patient-specific treatment plan.

  • Image not available. Patients with early stage Hodgkin lymphoma should be treated with combination chemotherapy with or without involved-site radiation.

  • Image not available. Combination chemotherapy with doxorubicin (Adriamycin®), bleomycin, vinblastine, and dacarbazine (ABVD) is the primary treatment for patients with advanced-stage Hodgkin lymphoma. Patients with advanced unfavorable disease may be treated with more aggressive regimens, but are associated with a higher risk of secondary malignancies.

  • Image not available. Some patients with Hodgkin lymphoma will be refractory to initial therapy or will have a recurrence following a complete remission. Response to salvage therapy depends on the extent and site of recurrence, previous therapy, and duration of initial remission. High-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT) should be considered in patients with refractory or relapsed disease.

  • Image not available. The current classification system for non-Hodgkin lymphoma (NHL) is the World Health Organization (WHO) classification system, which is based on the principle that NHLs can be classified into specific disease entities, defined by a combination of morphology, immunophenotype, genetic features, and clinical features.

  • Image not available. As compared with Hodgkin lymphoma, the clinical presentation of NHL is more variable because of disease heterogeneity and more frequent extranodal involvement.

  • Image not available. The Ann Arbor staging system correlates poorly with prognosis in NHL because the disease does not spread through contiguous lymph nodes and often involves extranodal sites.

  • Image not available. Several prognostic models have been developed to estimate prognosis in patients with NHL. The International Prognostic Index (IPI) score is a well-established model for patients with aggressive NHL. The Follicular Lymphoma International Prognostic Index (FLIPI) is a similar model used for patients with follicular and other indolent lymphomas.

  • Image not available. The clinical behavior and degree of aggressiveness can be used to categorize NHL into indolent and aggressive lymphomas. Patients with an indolent lymphoma usually have a relatively long survival, with or without aggressive chemotherapy. Although these lymphomas respond to a wide range of therapeutic approaches, few if any of these patients are cured of their disease. In contrast, aggressive lymphomas are rapidly growing tumors and patients have a short survival if appropriate therapy is not initiated. Most patients with aggressive lymphomas respond to intensive chemotherapy and many are cured of their disease.

  • Image not available. Patients with localized follicular lymphoma can be cured with radiation therapy alone. Advanced follicular lymphoma is not curable, and many treatment options are available, including watchful waiting, extended-field radiation therapy, single-agent alkylating agents, anthracycline-containing combination chemotherapy, anti-CD20 monoclonal antibodies, fludarabine, lenalidomide, idelalisib, and high-dose chemotherapy with HSCT.

  • Image not available. Patients with localized aggressive lymphomas can be cured with several cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin [hydroxydaunorubicin], vincristine [Oncovin®], prednisone) chemotherapy and involved-field irradiation. Patients with bulky stage II, stage III, or stage IV aggressive lymphomas can be ...

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