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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 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 Patients with early stage Hodgkin lymphoma should be treated with combination chemotherapy with or without involved-site radiation.

  • image 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 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 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 As compared with Hodgkin lymphoma, the clinical presentation of NHL is more variable because of disease heterogeneity and more frequent extranodal involvement.

  • image 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 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 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 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 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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