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.
- Heterogeneous group of lymphoproliferative disorders
- 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
- World Health Organization (WHO) classification terms:
- Grade refers to histologic parameters such as:
and nuclear size
- Density of chromatin
- Proliferation fraction
- Aggressiveness denotes clinical behavior of a tumor.
- Fifth most common cause of newly diagnosed cancer in United
- Average age at diagnosis: 67 years
- 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
- Patients present with variety of symptoms, which depend
on site of involvement and whether nodal or extranodal.
- Adenopathy can be localized or generalized.
nodes painless, rubbery, and discrete, and usually located in cervical
and supraclavicular regions.
- Constitutional (B symptoms) in ~40% of patients
- Drenching night sweats
- Weight loss
- Extranodal disease in 10–35% of patients
- Mesenteric or gastrointestinal (GI)
- Abdominal pain
- Palpable abdominal mass
- GI bleeding
- Bone marrow involvement:
Means of Confirmation
- Pathologic review of tissue obtained by excisional biopsy
of involved lymph node.
- Metabolic panel
- Complete blood count (CBC)
- Chest radiography
- Computed tomography (CT) of abdomen and pelvis
- Excisional lymph node biopsy
- Bone marrow aspiration and biopsy
- 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
- Relieve symptoms and, whenever possible, cure patient
of disease while minimizing risk of serious toxicity.
- Therapy depends on many factors, including:
- Patient age
- Histologic type
- Stage and site of disease
- Presence of adverse prognostic factors
- Patient preference
- 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
- Watchful waiting with advanced disease
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
- Localized disease (Stages I and ...