Lymphoma staging

The clinical presentation is similar to that observed in other immunocompromised states. Most patients with AIDS-related lymphoma present with B (constitutional) symptoms and have advanced stage (III or IV) disease at the time of diagnosis. " Involvement of extranodal sites is common. The clinical course of AIDS-related lymphoma is aggressive median survival is about 6 months and 2-year survival is only 10% to 20%. Factors associated with decreased survival include age greater than 35 years, history of injection drug use, CD4 cell count < 100/mm , a history of AIDS prior to the diagnosis of lymphoma, stage III or IV disease, and elevated LDH levels." The IPI has also been validated for use in patients with AIDS-related lymphoma. 

AIDS (acquired immunodeficiency syndrome) is the final stage of disease caused by infection with HIV. In this stage, the vims infection has severely affected the immune system, causing a depletion of CD4+ T-helper cells. AIDS is characterized by the manifestation of typical diseases caused by opportunistic infections (Pneumocystis carinii pneumonia, CMV retinitis, candidiasis of the esophagus, cerebral toxoplasmosis), neurological manifestations, cachexia, or certain tumors (Kaposi sarcoma of the skin, B-cell lymphoma). 

Hardell L, Eriksson M, Degerman A. 1994. Exposure to phenoyacetic Acids, chlorophenols, or organic solvents in relation to histopathology, stage, and anatomical localization of non-Hodgkin s lymphoma. 

Contrast the treatment for early- and advanced-stage disease for Hodgkin s lymphoma. 

The goal of treatment of Hodgkin s lymphoma is cure for all stages of disease and the first relapse. 

BR is a 62-year-old woman who was recently diagnosed with stage IV large B-cell lymphoma. Her bone marrow is positive for lymphoma, and she has type II diabetes and hypertension. 

Options for stage I and II follicular lymphoma include locoregional radiation therapy, chemotherapy followed by radiation therapy, and extended-field radiation therapy. 

Management of stages III and IV indolent lymphoma is controversial because standard approaches are not curative. Time to relapse is only 18 to 36 months. After relapse, response can be reinduced however, response rates and durations decrease with each retreatment. 

Early-Stage Diffuse Large B-Cell Lymphoma... 

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. 

Phenol was not considered carcinogenic to rats or mice receiving 2 500-5000 ppm in drinking water for 103 weeks, although an increased incidence of leukemia and lymphomas was detected in the low-dose male rats. ° Two-stage carcinogenicity studies showed that phenol, applied repeatedly to mouse skin, has promoting activity. 

Hodgkin s disease accounts for 1% of all new cancers diagnosed in Western countries and for 15% of all malignant lymphomas. In patients with early stage lA-IIA disease without B-symptoms or bulky adenopathy, therapy consists of either extended field radiotherapy or limited duration chemotherapy, e.g. ABVD (anthracycline, bleomycin, vinblastine, dacarbazine) for 3-4 cycles followed by involved field radiotherapy. Radiation alone results in a 10-year relapse free survival of 70-75% and, because of the efficacy of salvage chemotherapy for those who relapse, an overall survival of 80-85%. The combined modality approach results in fewer relapses but overall survival is similar. In order to reduce the long term morbidity of radiation current trials are exploring combined modality treatment with lower radiation doses versus chemotherapy alone. 

Topical and oral bexarotene are approved for early-stage (patch and plaque) cutaneous T-cell lymphoma that is refractory to at least one other therapy. Oral bexarotene is also approved for refractory cases of advanced disease however, the best response has been noted in early disease. 

PUVA is most useful for the treatment of severe psoriasis. Early (patch and plaque) stage cutaneous T-cell lymphoma (CTCL) also responds to PUVA therapy. In addition, patients in advanced stages of CTCL have been treated with a modification of PUVA known as extracorporeal photopheresis. In this therapy, blood from a CTCL patient who has taken psoralen is exposed to UVA light and returned to the patient. Lymphocytes are altered or destroyed by the treatment, and theoretically, the return of these abnormal cells triggers an immune response directed against certain lymphocyte surface antigens. The effectiveness of this modality appears to be variable. 

Mechlorethamine Mustargen) is a cytotoxic alkylating agent. Topical application of freshly prepared aqueous solutions are used in patients with early stages of cutaneous T-cell lymphoma. A major disadvantage to the use of this drug is the rapid induction of allergic contact dermatitis in some patients. 

G. Kuhnel, J. Kropp, M. Hanel, M. Laniado, J. Kotzerke, G. Ehninger, Substantial impact of FDG PET imaging on the therapy decision in patients with early-stage Hodgkin s lymphoma, Br. J. Cancer 90(3) (2004) 620-625. 

C.R. Isasi, P. Lu, M.D. Blaufox, A metaanalysis of F-2-deoxy-2-fluoro-D-glucose positron emission tomography in the staging and restaging of patients with lymphoma, Cancer 104(5) (2005) 1066-1074. 

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