0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
936 Lymphomas■Subsequent follow-up – Frequency dependent on disease subtype –
usually exam and labs q 3 mos and scans q 6 months×3 years with
increasing/individualized intervals thereaftercomplications and prognosis
■Complications dependent upon specific disease subtype and ther-
apy
➣Most chemotherapeutic regimens associated with reversible
dose-dependent drops in normal blood counts (WBC > platelets
> hematocrit)
➣Increased risk of febrile neutropenia when absolute neutrophil
count <500 – administration of granulocyte colony-stimulating
factor (G-CSF) may decrease neutropenic period
➣Age- and treatment-specific reductions in fertility
➣Increased incidence of secondary leukemia and second solid
tumors in HD treated with combined modality therapy
■Prognosis – disease- and stage-specific
■HD
➣Early-stage classic HD frequently curable in 70–90% with appro-
priate induction therapy
➣Advanced-stage classic HD curable in 50–65% with appropriate
induction therapy
➣Salvage chemotherapy often with autologous stem cell trans-
plantation cures a subset of patients with recurrent disease
■NHL
➣Clinical risk models such as International Prognostic Index used
to predict efficacy of combination chemotherapy in specific NHL
subtypes (most useful in DLBCL)
➣“Indolent” lymphomas (such as CLL/SLL, myeloma, FL)
Currently incurable with current standard therapies
Treatable for years with available alternatives
Many new experimental options aimed at increasing curabil-
ity, response duration
➣“Aggressive and highly aggressive” lymphomas (such as DLBCL,
certain PTCLs, Burkitt’s lymphoma)
Subset curable with standard induction therapy (ranging from
40–90% depending on risk factors)
Additional subset of relapsed DLBCLs and certain PTCLs cur-
able with high-dose therapy and stem cell rescue
➣Mantle cell lymphoma treatable, but majority of patients relapse
with current options