0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
Lymphomas 935General Measures
■adequate hydration prior to systemic chemotherapy, allopurinol to
reduce risk of tumor lysis syndrome in certain aggressive NHL sub-
types
specific therapy
■See disease-specific National Cancer Center Network (NCCN) HD
and NHL Guidelines for details of initial (induction) therapy and
therapy following relapse.
■Optimal induction therapy dependent upon specific disease subtype
➣Classic HD – immediate stage-specific treatment (radiation ther-
apy alone used much less frequently)
combination chemotherapy alone or combined modality ther-
apy
➣NHL
Indolent lymphomas (such as CLL/SLL and FL)
Therapy dictated by symptoms and tumor burden.
Options include no therapy with careful follow-up (“watch
and wait”), radiotherapy alone for stage I disease or
local symptomatic progression in absence of systemic
symptomatic disease, single agent chemotherapy (alky-
lating agents), combination chemotherapy (cyclophos-
phamide, vincristine, prednisone), aggressive combination
chemotherapy (usually only for relapsed and refractory dis-
ease), B-cell-specific monoclonal antibodies, specifically
the anti-CD20 monoclonal antibody rituximab and treat-
ment with newer experimental agents.
Aggressive lymphomas (such as DLBCL, PTCL, most
MCL) require immediate Adriamycin-containing combination
chemotherapy (CHOP: cyclophosphamide, doxorubicin, vin-
cristine, prednisone plus rituximab) with or without radiation
therapy (used for some stage I patients). There is no role for
any maintenance therapy after complete remission.
Highly aggressive lymphomas (such as Burkitt’s lymphoma)
require immediate, very intense acute leukemia-like regimens
with CNS prophylaxis.follow-up
■During therapy – CBC with differential, platelets and routine
chemistries
■Following induction therapy – Complete radiographic and labora-
tory restaging to assess response, repeat BM and any additional spe-
cialized studies (i.e., LP) that were positive at diagnosis