Guidelines on Diagnosis and Treatment of Malignant Lymphomas

Potential pitfalls
a. Failure to investigate a mediastinal mass urgently,
and failure to start treatment promptly.
b. Failure to assess bone marrow with morphology,
immunophenotyping and molecular analysis.
c. Failure to recognise tumour lysis syndrome risk.
Treatment
Patients are treated on ALL type regimens (eg UKALL XII) for
induction and consolidation (usually 3-4 months of intensive
treatment) with CNS directed prophylaxis followed by stem cell
transplantation. Asparaginase may be particularly useful in
treating patients with TLyL and it is advisable to use regimens
which include this agent. There is no clear survival difference
between autologous and allogeneic transplantation. The relapse
rate is higher after autologous transplantation and therefore
patients with high risk features (such as marrow involvement)
and a matched sibling donor should be offered an allogeneic
transplantation in first remission. Young adults (up to the age of
25) are increasingly being treated on paediatric-type protocols
with intensified chemotherapy and no transplantation, however
long follow up is not available for this treatment approach.
Response Evaluation
CT scan of affected area after initial chemotherapy. Bone marrow
and CSF evaluation (if involved at diagnosis) after initial
chemotherapy. Complete restaging within 2 weeks of stem cell
transplantation (SCT) and at 100 days post SCT.
Follow Up
Two monthly follow up for 1 year, 3 monthly follow up for 1 year,
6 monthly for 1 year and then annual follow up. CXR, FBC
and biochemical profile at each follow up visit up to 2 years
and then as indicated.
Patients who relapse with T-ALL and are transplanted in
CR2 have a poor prognosis and so the initial management
decision is crucial.
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