| Hodgkin Lymphoma
| Non Hodgkin Lymphoma
| Diffuse large B-cell lymphoma
| Intravascular large B-cell lymphoma
| Mantle cell lymphoma
| Marginal Zone Lymphoma
| Gastric (MALT) Lymphoma
| Primary CNS Lymphoma (PCNSL)
| Burkitt's lymphoma
| Follicular Lymphoma
Most of the patients remain incurable and, in 10 years, 15% to 28% of cases will transform into an aggressive phenotype, typically diffuse large B-cell lymphoma (DLBCL) which usually requires more intensive types of treatment.
- Most common indolent (slow-growing) form of non-Hodgkin
- Accountings for 1 out of 5 lymphomas in the US.
- Usually aged > 50. Median age of 65 years many > 75 years
- See Non Hodgkin Lymphoma
- Lympahdenopathy in the neck, axilla, inguinal, abdomen
- FBC, U&E, LFTs, ESR, CRP, LDH, B2 microglobulin
- CT and PET scan for staging
- Bone marrow aspirate and biopsy
- HIV, HCV, HBV
The introduction of anti-CD20 monoclonal antibody (Rituximab) has definitely improved the outcome of these patients as shown by many studies
- Sometimes a watch and wait strategy is used. The disease is usually very responsive to radiation and chemotherapy. Radiation alone can provide long-lasting remission in some patients with early disease
- Treatment is started if the patient begins to develop lymphoma-related symptoms
- Monoclonal antibodies obinutuzumab (Gazyva) or rituximab
(Rituxan). Rituximab hyaluronidase human (Rituxan Hycela) can
be administered as a subcutaneous (under the skin) injection.
- Chemotherapy regimens include
- Bendamustine (Treanda) and obinutuzumab (Gazyva)
- R-Bendamustine (rituximab [Rituxan] and bendamustine)
- R-CHOP (rituximab, cyclophosphamide, doxorubicin,
vincristine, and prednisone)
- R-CVP (rituximab, cyclophosphamide, vincristine, and
- R-Lenalidomide (rituximab and lenalidomide [Revlimid]), often
referred to as R2 (R-squared)
- Some monoclonal antibodies such as obinutuzumab (Gazyva),
can also be used as maintenance therapy to prolong remission in
patients with no signs of lymphoma.
- After treatment, many patients can go into a remission that
lasts for years; however, this disease should be considered a
chronic or lifelong condition.