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Non-Hodgkin's Lymphoma

Medical Reference Related to Non-Hodgkin's Lymphoma

  1. Changes to This Summary (03 / 06 / 2013)

    The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.Editorial changes were made to this summary.

  2. Stages of Adult Non-Hodgkin Lymphoma

    After adult non-Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.

  3. Treatment for Aggressive, Noncontiguous Stage II / III / IV Adult NHL

    The treatment of choice for patients with advanced stages of aggressive non-Hodgkin lymphoma (NHL) is combination chemotherapy, either alone or supplemented by local-field radiation therapy.[1]The following drug combinations are referred to in this section:ACVBP: doxorubicin + cyclophosphamide + vindesine + bleomycin + prednisone.CHOP: cyclophosphamide + doxorubicin + vincristine + prednisone.CNOP: cyclophosphamide + mitoxantrone + vincristine + prednisone.m-BACOD: methotrexate + bleomycin + doxorubicin + cyclophosphamide + vincristine + dexamethasone + leucovorin.MACOP-B: methotrexate + doxorubicin + cyclophosphamide + vincristine + prednisone fixed dose + bleomycin + leucovorin.ProMACE CytaBOM: prednisone + doxorubicin + cyclophosphamide + etoposide + cytarabine + bleomycin + vincristine + methotrexate + leucovorin.R-CHOP: rituximab, an anti-CD20 monoclonal antibody, + cyclophosphamide + doxorubicin + vincristine + prednisone.Standard Treatment Options for

  4. Treatment for Diffuse Small Noncleaved-Cell / Burkitt Lymphoma

    Diffuse small noncleaved-cell/Burkitt lymphoma typically involves younger patients and represents the most common type of pediatric NHL.[1]Standard Treatment Options for Diffuse Small Noncleaved-Cell/Burkitt LymphomaStandard treatment options for diffuse small noncleaved-cell/Burkitt lymphoma include the following:Aggressive multidrug regimens.Central nervous system (CNS) prophylaxis.Aggressive multidrug regimensStandard treatment for diffuse small noncleaved-cell/Burkitt lymphoma is usually with aggressive multidrug regimens similar to those used for the advanced-stage aggressive lymphomas (such as diffuse large cell).[2,3,4] In some institutions, treatment includes the use of consolidative bone marrow transplantation.[5,6] Adverse prognostic factors include bulky abdominal disease and high serum lactate dehydrogenase.Evidence (aggressive multidrug regimens):An intensive clinical trial (CLB-9251 [NCT00002494]) used aggressive combination chemotherapy patterned after that used in

  5. Low-Stage Childhood NHL Treatment

    Patients with stage I and II disease have an excellent prognosis, regardless of histology. A Children's Cancer Group study demonstrated that pulsed chemotherapy with cyclophosphamide, vincristine, methotrexate, and prednisone (COMP) administered for 6 months for low-stage (stage I or II) nonlymphoblastic non-Hodgkin lymphoma (NHL) was equivalent to 18 months of therapy with radiation to sites of disease, resulting in more than 85% disease-free survival (DFS) and more than 90% overall survival (OS). However, patients with lymphoblastic lymphoma had a much inferior outcome.[1,2] A Pediatric Oncology Group (POG) study tested 9 weeks of short, pulsed chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), with or without radiation to involved sites and with or without 24 weeks of maintenance chemotherapy.[3] The results showed no benefit of radiation or maintenance chemotherapy, but the DFS for nonlymphoblastic lymphoma was superior to that of

  6. Treatment for Adult Lymphoblastic Lymphoma

    Lymphoblastic lymphoma is a very aggressive form of non-Hodgkin lymphoma (NHL), which often occurs in young patients, but not exclusively. Lymphoblastic lymphoma is commonly associated with large mediastinal masses and has a high predilection for disseminating to bone marrow and the central nervous system (CNS). The treatment paradigms are based on trials for acute lymphoblastic leukemia (ALL) since lymphoblastic lymphoma and ALL are considered different manifestations of the same biologic disease. (Refer to the PDQ summary on Adult Acute Lymphoblastic Leukemia Treatment for more information.) Treatment is usually patterned after ALL. Intensive combination chemotherapy with CNS prophylaxis is the standard treatment of this aggressive histologic type of NHL. Radiation therapy is sometimes given to areas of bulky tumor masses. Since these forms of NHL tend to progress quickly, combination chemotherapy is instituted rapidly once the diagnosis has been confirmed.The most important aspects

  7. Treatment for Indolent, Stage I and Contiguous Stage II Adult NHL

    Although localized presentations are uncommon in non-Hodgkin lymphoma (NHL), the goal of treatment should be to cure the disease in patients who are shown to have truly localized occurrence after undergoing appropriate staging procedures.Standard Treatment Options for Indolent, Stage I and Contiguous Stage II Adult NHLStandard treatment options for indolent, stage I and contiguous stage II adult NHL include the following:Radiation therapy.Rituximab with or without chemotherapy.Watchful waiting.Other therapies as designated for patients with advanced-stage disease.Radiation therapy Long-term disease control within radiation fields can be achieved in a significant number of patients with indolent stage I or stage II NHL by using dosages of radiation that usually range from 25 Gy to 40 Gy to involved sites or to extended fields that cover adjacent nodal sites.[1,2,3,4] Almost half of all patients treated with radiation therapy alone will relapse out-of-field within 10 years.[5]Rituximab

  8. Cellular Classification of Adult NHL

    A pathologist should be consulted prior to a biopsy because some studies require special preparation of tissue (e.g., frozen tissue). Knowledge of cell surface markers and immunoglobulin and T-cell receptor gene rearrangements may help with diagnostic and therapeutic decisions. The clonal excess of light-chain immunoglobulin may differentiate malignant from reactive cells. Since the prognosis and the approach to treatment are influenced by histopathology, outside biopsy specimens should be carefully reviewed by a hematopathologist who is experienced in diagnosing lymphomas. Although lymph node biopsies are recommended whenever possible, sometimes immunophenotypic data are sufficient to allow diagnosis of lymphoma when fine-needle aspiration cytology is preferred.[1,2]Historical Classification SystemsHistorically, uniform treatment of patients with non-Hodgkin lymphoma (NHL) has been hampered by the lack of a uniform classification system. In 1982, results of a consensus

  9. Treatment for Indolent, Recurrent Adult NHL

    In general, treatment with standard agents rarely produces a cure in patients whose disease has relapsed. Sustained remissions after relapse can often be obtained in patients with indolent lymphomas, but relapse will usually ensue. Favorable survival after relapse has been associated with an age younger than 60 years, complete remission rather than partial remission, and duration of response longer than 1 year. Even the most favorable subset, however, has a tenfold greater mortality compared with age-adjusted U.S. population rates.[1] Patients who experience a relapse with indolent lymphoma can often have their disease controlled with single agent or combination chemotherapy, rituximab (an anti-CD20 monoclonal antibody), lenalidomide, radiolabeled anti-CD20 monoclonal antibodies, or palliative radiation therapy.[2,3] Long-term freedom from second relapse, however, is uncommon and multiple relapses will usually occur. Patients with indolent lymphoma may experience a relapse with a

  10. Treatment for Indolent, Noncontiguous Stage II / III / IV Adult NHL

    Optimal treatment of advanced stages of low-grade non-Hodgkin lymphoma is controversial because of low cure rates with the current therapeutic options. Numerous clinical trials are in progress to settle treatment issues, and patients should be urged to participate. The rate of relapse is fairly constant over time, even in patients who have achieved complete response to treatment. Indeed, relapse may occur many years after treatment. Currently, no randomized trials guide clinicians about the initial choice of watchful waiting, rituximab, nucleoside analogs, alkylating agents, combination chemotherapy, radiolabeled monoclonal antibodies, or combinations of these options.[1]; [2][Level of evidence: 1iiDiii]For patients with indolent, noncontiguous stage II and stage III non-Hodgkin lymphoma, central lymphatic radiation therapy has been proposed but is not usually recommended as a form of treatment.[3,4]Numerous prospective clinical trials of interferon-alpha,

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