Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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Irradiation Of Blood Products Transfusion-associated graft-versus-host disease (GVHD) has been reported in lymphoma patients. To avoid this complication transfusion of irradiated blood components is recommended in the following situations: ■ ■ ■ ■ Patients with Hodgkin lymphoma. This is a life-long requirement even after successful treatment. All recipients of allogeneic haematological stem cell support from commencement of conditioning therapy. This is a lifelong requirement. Patients during priming for stem cell harvesting. Patients treated with purine analogues (fludarabine, pentostatin, cladribine). This is a life-long requirement. 69
Haematopoietic Recombinant Growth Factor Support Erythropoietin Erythropoietin may be used to reduce transfusion requirements in selected patients with lymphoma undergoing chemotherapy. Granulocyte colony stimulating factors Haematopoietic growth factors currently in use include: Filgrastim - r-met HuG – CSF Neupogen Lenograstim - r-HuG – CSF Granocyte Pegylated Filgrastim Neulasta Indications Haematopoietic growth factors may be indicated in the following circumstances and are particularly important for maintaining dose intenstity when chemotherapy is being given with curative intent: 1. Chemotherapy support 2. Peripheral blood stem cell harvest / progenitor cell mobilisation 3. Post peripheral blood stem cell infusion 4. Neutropenic sepsis 5. Invasive fungal infection Chemotherapy Support Primary prophylaxis May be used in ‘at risk patients’ or those who have had a previous episode of febrile neutropenia receiving curative chemotherapy, as recommended below. At risk patients ■ Patients receiving chemotherapy who are at ‘high risk’ (e.g. ≥ 40% likelihood) of developing febrile neutropenia or infection e.g. ■ ■ ■ ■ ■ Pre-existing neutropenia due to disease Extensive prior chemotherapy Previous irradiation to the pelvis or other areas containing large amounts of bone marrow History of recurrent febrile neutropenia while receiving earlier chemotherapy of similar or lesser dose-intensity Conditions potentially enhancing the risk of serious infection e.g. poor performance status, decreased immune function, open wounds or already active tissue infection Secondary prophylaxis – Previous episode of febrile neutropenia The use of GCSF should be considered in patients receiving curative chemotherapy who have had a previous episode of febrile neutropenia. Peripheral blood stem cell harvest Both Filgrastim and Lenograstim may be used for priming (either alone or in combination with chemotherapy). The choice and dose used depends on the protocol for harvesting. Plerixifor with G-CSF may be used for patients who have failed to achieved successful mobilisation with conventional approaches. 70
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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 and 48: Precursor T Cell Neoplasms PRECURSO
Page 49 and 50: Mature T-Cell and NK-Cell Neoplasms
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: Tumour Lysis Syndrome Tumour Lysis
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
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Guidelines on Diagnosis and Treatment of Malignant Lymphomas

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