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Source: Chan A, Yee GC. Lymphomas. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8009338. Accessed August 5, 2012.

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  • Heterogeneous group of lymphoproliferative disorders

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  • Unknown

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  • Derived from monoclonal proliferation of malignant B or, less commonly, T lymphocytes and their precursors.
  • Current classification schemes characterize Non-Hodgkin lymphomas (NHLs) according to cell of origin, clinical features, and morphologic features.
  • World Health Organization (WHO) classification terms:
    • Grade refers to histologic parameters such as:
      • Cell and nuclear size
      • Density of chromatin
      • Proliferation fraction
    • Aggressiveness denotes clinical behavior of a tumor.

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  • Fifth most common cause of newly diagnosed cancer in United States
  • Average age at diagnosis: 67 years

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  • Certain infections associated with development of lymphoma:
    • EBV: Burkitt lymphma
    • Kaposi sarcoma–associated herpes virus (KSHV)
    • Human T-cell lymphotropic virus type 1: adult T-cell leukemia/lymphoma
  • Congenital and acquired immunodeficiency states
  • Exposure to herbicides, chemical solvents, and dyes

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  • Patients present with variety of symptoms, which depend on site of involvement and whether nodal or extranodal.

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Signs and Symptoms

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  • Adenopathy can be localized or generalized.
    • Involved nodes painless, rubbery, and discrete, and usually located in cervical and supraclavicular regions.
  • Constitutional (B symptoms) in ~40% of patients
    • Fever
    • Drenching night sweats
    • Weight loss
  • Extranodal disease in 10–35% of patients at diagnosis
    • Mesenteric or gastrointestinal (GI) involvement:
      • Nausea
      • Vomiting
      • Obstruction
      • Abdominal pain
      • Palpable abdominal mass
      • GI bleeding
    • Bone marrow involvement:
      • Anemia
      • Neutropenia
      • Thrombocytopenia

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Means of Confirmation and Diagnosis

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  • Pathologic review of tissue obtained by excisional biopsy of involved lymph node.

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Laboratory Tests

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  • Metabolic panel
  • Complete blood count (CBC)

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Imaging

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  • Chest radiography
  • Computed tomography (CT) of abdomen and pelvis

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Diagnostic Procedures

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  • Excisional lymph node biopsy
  • Bone marrow aspiration and biopsy

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Staging

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  • Systems for classifying NHLs continue to evolve.
    • Slow-growing or indolent lymphomas have favorable outcomes (untreated survival measured in years)
    • Rapid-growing or aggressive lymphomas have unfavorable outcomes (untreated survival measured in weeks to months)
  • International Prognostic Index (IPI) for aggressive lymphomas

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Differential Diagnosis

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  • Relieve symptoms and, whenever possible, cure patient of disease while minimizing risk of serious toxicity.

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  • Therapy depends on many factors, including:
    • Patient age
    • Histologic type
    • Stage and site of disease
    • Presence of adverse prognostic factors
    • Patient preference

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Nonpharmacologic Therapy

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  • Radiation therapy (RT)
    • Standard treatment for localized (Stages I and II) follicular lymphoma
      • 40–60% cure with RT alone
    • Option following watchful waiting in patient with advanced disease
  • Watchful waiting with advanced disease
    • Delay therapy until systemic symptoms or disease progression
    • Median time to treatment 3–5 years
      • ~20% of patients do not require therapy for up to 10 years

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Pharmacologic Therapy

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  • Chemotherapy
    • Localized disease (Stages I and ...

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