Lymphoma aggressive

This pair of granule-associated proteins is also localized to cytotoxic T and NK cells. They are essential for both apoptosis and induced cell death of target cells via induction of perforated cell membranes. However, their expression is assumed to be evidence of an activated state. They mark subcutaneous panniculitis-like T-cell lymphoma, aggressive NK-cell leukemia, and extra-nodal NK/T cell lymphoma, nasal type. 

Macon Williams ME, Greer JP, et al. Namral killer-like T-cell lymphomas aggressive lymphomas of T-large granular lymphocytes. Blood. 1996 87(4) 1474-1483. 

Patients in the more aggressive categories are less likely to exhibit involvement of the skin and have a less favorable prognosis [10]. Those patients may have a definable hematological disorder such as a myelodysplastic syndrome, myeloproliferative disorder, acute leukemia, or a malignant lymphoma. In aggressive mastocytosis and mast cell leukemia, the clinical course is determined by the rapidity of the increase in mast cell numbers. 

DQ is a 57-year-old man who came to the emergency room because of shortness of breath. A radiographic examination demonstrates a large mass pressing on the bifurcation of the main stem bronchus. A biopsy demonstrates an aggressive lymphoma a five-drug chemotherapy regimen with both intravenous and intrathecal chemotherapy will start today. 

Delineate the clinical course of follicular indolent and diffuse aggressive non-Hodgkin s lymphoma and the implications for disease classification schemes and treatment goals. 

The clinical course varies widely among these histologies of HL and NHL. Most lymphoma subtypes are highly proliferating tumor cells that require aggressive therapeutic intervention with chemotherapy, radiation therapy, or both. By contrast, certain subtypes of non-Hodgkin s lymphoma... 

Lymphocytopenia [count less than 600 mm3 (0.6 x 109/L) or less than 8% (0.08) of white blood cell count or both] International Prognostic Index—Diffuse, Aggressive Non-Hodgkin s Lymphoma... 

Nonspecific can range from an asymptomatic patient with a less aggressive lymphoma to a patient that is gravely ill with advanced disease... 

There are certain histologic subtypes of diffuse, aggressive NHL that respond less well to treatment with conventional regimens such as CHOP. Burkitt s lymphoma, lymphoblastic lymphoma, mantel cell lymphoma, and primary CNS lymphoma are examples of disease that benefit from more intensive therapy. Regimens such as hyper-CVAD, which alternate cycles of hyperfractionated cyclophosphamide, doxorubicin, vincristine, and dexamethasone with high-dose cytarabine and methotrexate, often are substituted for CHOP. Intrathecal therapy with methotrexate is indicated with documented CNS infiltration of tumor or involvement of the sinuses. The recent appreciation of the etiology of Helicobacter pylori in the etiology of peptic ulcer disease and the association between colonization and mucosal-associated lymphoma (MALT) has spurred... 

TABLE 90-9. Treatment Regimens for Diffuse, Aggressive Non-Hodgkin s Lymphomas... 

Systems for classifying NHLs continue to evolve. Lymphomas can be classified by degree of aggressiveness. Slow-growing or indolent lympho-... 

Diffuse large B-cell lymphomas are the most common lymphoma in patients of all ages but most commonly seen in the seventh decade. Extranodal disease is present at diagnosis in 30% to 40% of patients. The International Prognostic Index score correlates with prognosis. Diffuse aggressive lymphomas are sensitive to chemotherapy with cure achieved in some patients. 

Although historically, elderly adults have lower complete response and survival rates than younger patients, full dose R-CHOP is recommended as initial treatment for aggressive lymphoma in the elderly. 

Approximately one-third of patients with aggressive lymphoma will require salvage therapy at some point. Salvage therapy is more likely to induce response if the response to initial chemotherapy was complete (chemosensi-tivity) than if it was primarily or partially resistant to chemotherapy. 

KI3. Kossakouska, A. E., Urbanski, S. J., Huchcroft, S. A., and Edwards, R. R., Relationship between clinical aggressiveness of large cell immunoblastic lymphomas and expression of 92 kDa gelatinase (type IV collagenase) and tissue inhibitor of metalloproteinase-1 (TIMP-1). Oncol. Res. 4, 233-240 (1992). 

Coiffier, B., Rituximab in combination with CHOP improves survival in elderly patients with aggressive non-Hodgkin s lymphoma, Semin. Oncol., 29,18-22, 2002. 

Tsavaris N, Kosmas C, Vadiaka M, et al. Pegylated liposomal doxorubicin in the CHOP regimen for older patients with aggressive (stage III/V) non-Hodgkin s lymphoma. Anticancer Res 2002 22 1845. 

Schbder et al. recently showed that [ F]-FDG uptake is lower in indolent than in aggressive NHL [49]. A SUV >10 resulted in a higher likelihood for aggressive disease and excluded indolent lymphomas with a sensitivity of 81%. But nevertheless differentiation between aggressive and indolent lymphomas depending on the SUV leaves around 45% of the patients in a gray area. 

H. W. Yeung,, Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin s lymphoma, J. Clin. Oncol. 23(21) (2005) 4643-4651. 

Changes in the chromosome structure are often observed in tumors of the blood-forming system, the leukemias and lymphomas. They are almost always foimd in the later phases of aggressive solid tumors. These extensive reorganizations have wide-reaching consequences for growth behavior and functional performance. 

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