Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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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. 44
Mature T-Cell and NK-Cell Neoplasms Mature T-Cell and NK-Cell Neoplasms
Page 1 and 2: Guidelines on Diag
Page 3 and 4: Guidelines on Diag
Page 5 and 6: Standards In Diagnosis of Lymphoma
Page 7 and 8: Standards in Staging of Lymphoma An
Page 9 and 10: Pathologic Diagnosis of Lymphoma Ge
Page 11 and 12: Hodgkin lymphoma and its differenti
Page 13 and 14: Potential diagnostic pitfalls for l
Page 15 and 16: Summary of the usual Immunostaining
Page 17 and 18: Mature B-Cell Neoplasms Mature B-Ce
Page 19 and 20: Immunophenotype The tumour cells ex
Page 21 and 22: Lymphoplasmacytic Lymphoma Definiti
Page 23 and 24: Splenic Marginal Zone Lymphoma Defi
Page 25 and 26: Extra-nodal Marginal Zone B-Cell Ly
Page 27 and 28: Persistent / progressive disease or
Page 29 and 30: Follicular Lymphoma Definition and
Page 31 and 32: Potential Pitfalls a. Failure to di
Page 33 and 34: Mantle Cell Lymphoma Definition and
Page 35 and 36: Diffuse Large B-Cell Lymphoma Defin
Page 37 and 38: Stage 1 (bulky) and stages II - IV
Page 39 and 40: Treatment Standard chemotherapy for
Page 41 and 42: Burkitt Lymphoma/Leukaemia Definiti
Page 43 and 44: CODOX-M, (3 cycles) for low risk di
Page 45 and 46: Potential pitfalls Failure to diffe
Page 47: Precursor T Cell Neoplasms PRECURSO
Page 51 and 52: Potential Pitfalls Treatment planni
Page 53 and 54: Recommended Investigations Evaluati
Page 55 and 56: Mycosis Fungoides and Sézary Syndr
Page 57 and 58: ■ ■ Lymph node biopsy if there
Page 59 and 60: Primary Cutaneous CD30-Positive T-C
Page 61 and 62: Angioimmunoblastic T-Cell Lymphoma
Page 63 and 64: Prognostic factors The IPI is of li
Page 65 and 66: Hodgkin Lymphoma (HL) Definition an
Page 67 and 68: Prognostic Factors / Index: i. Earl
Page 69 and 70: Immunodeficiency Associated Lymphop
Page 71 and 72: of cases and EBV in about 50%, but
Page 73 and 74: Common Issues in Lymphoma Managemen
Page 75 and 76: Tumour Lysis Syndrome Tumour Lysis
Page 77 and 78: Haematopoietic Recombinant Growth F
Page 79 and 80: Follow-Up Follow-up for patients wi
Page 81 and 82: Follow-up for patients with concern
Page 83 and 84: 77 Appendix
Page 85: Lower border: The lower of (i) 5 cm
Page 88 and 89: Glossary of Treatment Regimens Chlo
Page 90: 2nd Edition. May 2010. Supported by

Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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