Non-Hodgkin Lymphoma

Watchful waiting is most often utilized for indolent lymphomas such as follicular lymphoma. As such, patients may have enlarged lymph nodes that are not causing symptoms and patients may feel well without significant anemia or other signs of disease. Patients may be monitored monthly of every other month with blood testing, symptom survey and physical exams to determine the need for treatment. Watchful waiting is most often utilized for indolent lymphomas such as follicular lymphoma. As such, patients may have enlarged lymph nodes that are not causing symptoms and patients may feel well without significant anemia or other signs of disease. Patients may be monitored monthly of every other month with blood testing, symptom survey and physical exams to determine the need for treatment.

Similar to a previous answer (http://talkabouthealth.com/for-what-types-of-non-hodgkin-lymphoma-is-rituxan-a-typical-treatment-option), the B cell non-Hodgkin’s lymphomas are usually treated with Rituxan. This is because all but a few of these lymphomas express CD20, the target antigen that Rituxan binds to. Rituxan has been shown the be beneficial a single agent therapy in indolent lymphomas, when combined with chemotherapy (R-CHOP or R-CVP are two examples) and for maintenance after initial treatment in the case of indolent lymphomas. Similar to a previous answer (http://talkabouthealth.com/for-what-types-of-non-hodgkin-lymphoma-is-rituxan-a-typical-treatment-option), the B cell non-Hodgkin’s lymphomas are usually treated with Rituxan. This is because all but a few of these lymphomas express CD20, the target antigen that Rituxan binds to. Rituxan has been shown the be beneficial a single agent therapy in indolent lymphomas, when combined with chemotherapy (R-CHOP or R-CVP are two examples) and for maintenance after initial treatment in the case of indolent lymphomas.

R-CHOP (cycophosphamide, adriamycin, vincristine and prednisone, with rituximab) is the standard front-line therapy for diffuse large cell lymphoma and older patients with mantle cell lymphoma. Hyper-CVAD ( a more intensive regimen of cyclophophamide, vincristine, and doxorubicin, alternating with cytosine arabinoside and methotrexate) is often used for younger patients who have mantle cell lymphoma or Burkitts lymphomas. Patients with follicular lyphomas may receive CVP (a gentler form of cyclophosphamide, vincristine and prednisone) with rituximab or receive single agent rituximab. R-CHOP (cycophosphamide, adriamycin, vincristine and prednisone, with rituximab) is the standard front-line therapy for diffuse large cell lymphoma and older patients with mantle cell lymphoma. Hyper-CVAD ( a more intensive regimen of cyclophophamide, vincristine, and doxorubicin, alternating with cytosine arabinoside and methotrexate) is often used for younger patients who have mantle cell lymphoma or Burkitts lymphomas. Patients with follicular lyphomas may receive CVP (a gentler form of cyclophosphamide, vincristine and prednisone) with rituximab or receive single agent rituximab.

Stem cell transplants can be performed as part of the initial therapy, at the time of first relapse and later in the course of the disease. Following initial induction therapy, autologous transplants are being used in first remission for patients with mantle cell lymphoma and T cell lymphomas; although there is not uniform agreement on this practice. Patients with diffuse large cell lymphoma are generally offered autologous transplant when relapse occurs following a first remission. Patients with follicular lymphoma are not offered transplant until the have relapsed 2 or more times or when their disease has transformed to a more aggressive subtype. Stem cell transplants can be performed as part of the initial therapy, at the time of first relapse and later in the course of the disease. Following initial induction therapy, autologous transplants are being used in first remission for patients with mantle cell lymphoma and T cell lymphomas; although there is not uniform agreement on this practice. Patients with diffuse large cell lymphoma are generally offered autologous transplant when relapse occurs following a first remission. Patients with follicular lymphoma are not offered transplant until the have relapsed 2 or more times or when their disease has transformed to a more aggressive subtype.

Lymphoma subtyping is very important as the often predicts the biology and clinical disease course. For example most follicular lymphomas tend to be very slow growing or “indolent”. This means that patients with enlarged nodes who are asymptomatic may not necessarily need urgent treatment. On the other hand Burkitt’s type lymphoma is fast growing, leading rapidly to symptoms and requires urgent chemotherapy to obtain disease control. The subtype also indicates the type of chemotherapy to be used when treatment is initiated. Lymphoma subtyping is very important as the often predicts the biology and clinical disease course. For example most follicular lymphomas tend to be very slow growing or “indolent”. This means that patients with enlarged nodes who are asymptomatic may not necessarily need urgent treatment. On the other hand Burkitt’s type lymphoma is fast growing, leading rapidly to symptoms and requires urgent chemotherapy to obtain disease control. The subtype also indicates the type of chemotherapy to be used when treatment is initiated.

Rituxan is a useful drug for B-cell lymphomas. Most B-cell lymphomas express the B-cell marker protein CD20. Rituxan is a monoclonal antibody with specificity for B cell lymphomas expressing CD20. These include follicular, diffuse large cell, mantle cell and several other types. Rituxan is a useful drug for B-cell lymphomas. Most B-cell lymphomas express the B-cell marker protein CD20. Rituxan is a monoclonal antibody with specificity for B cell lymphomas expressing CD20. These include follicular, diffuse large cell, mantle cell and several other types.

Patients with newly diagnosed non-Hodgkins lymphoma can have an excellent prognosis, but it depends on a number of factors. The most important piece of information is to obtain an adequate biopsy so that a correct diagnosis can be made. Small needle or fine needle aspiration biopsies are inadequate and it is strongly recommended than a excisional biopsy be obtained. Second, is to complete staging to determine the extent of disease. This includes CT scan of the chest, abdomen and pelvis and more frequently, a PET scan. Bone marrow aspiration, blood and urine tests are require to judge the extent of disease. Once these tests are obtained, it will be possible to develop a treatment plan based on lymphoma type, staging of disease, prognosis and the patients symptoms. The treatment could range from watchful waiting without immediate treatment to aggressive chemotherapy followed by autologous stem cell transplant. Patients with newly diagnosed non-Hodgkins lymphoma can have an excellent prognosis, but it depends on a number of factors. The most important piece of information is to obtain an adequate biopsy so that a correct diagnosis can be made. Small needle or fine needle aspiration biopsies are inadequate and it is strongly recommended than a excisional biopsy be obtained. Second, is to complete staging to determine the extent of disease. This includes CT scan of the chest, abdomen and pelvis and more frequently, a PET scan. Bone marrow aspiration, blood and urine tests are require to judge the extent of disease. Once these tests are obtained, it will be possible to develop a treatment plan based on lymphoma type, staging of disease, prognosis and the patients symptoms. The treatment could range from watchful waiting without immediate treatment to aggressive chemotherapy followed by autologous stem cell transplant.