From the Guidelines
Lymphoma can cause death primarily through widespread organ infiltration and failure, particularly affecting vital organs like the liver, lungs, brain, or bone marrow, as well as through histologic transformation, which is generally associated with a poor clinical outcome 1. The mechanisms by which lymphoma leads to death are multifaceted and can involve:
- Widespread organ infiltration and failure, affecting vital organs such as the liver, lungs, brain, or bone marrow
- Disruption of normal blood cell production in the bone marrow, leading to severe anemia, infections, and bleeding
- Obstruction of critical structures, such as airways or blood vessels, by large lymphoma masses
- Metabolic disturbances, including tumor lysis syndrome, which can cause kidney failure
- Severe infections due to compromised immunity from the disease and its treatments
- Cachexia, a wasting syndrome with severe weight loss and muscle deterioration
- Neurological complications when lymphoma spreads to the central nervous system
- Treatment complications, including severe side effects from chemotherapy or radiation. Histologic transformation of follicular lymphoma (FL) to diffuse large B-cell lymphoma (DLBCL) is a significant cause of death, accounting for approximately 77 of 140 deaths in a pooled analysis of French and US cohorts of patients with newly diagnosed FL 1. In the context of real-life clinical medicine, it is crucial to prioritize the management of lymphoma to prevent these fatal outcomes, focusing on early diagnosis, appropriate treatment, and close monitoring for signs of disease progression or transformation 1.
From the Research
Lymphoma and Death
- Lymphoma is a group of malignant neoplasms of lymphocytes with more than 90 subtypes, and it can cause death due to various factors such as tumor progression, treatment toxicity, and secondary cancers 2.
- The addition of rituximab to high-dose chemotherapy has been shown to be effective and safe in diffuse large B-cell lymphoma with a poor prognosis, reducing the risk of failure and death 3.
- In primary mediastinal large B-cell lymphoma, rituximab-CHOP (R-CHOP) with or without radiotherapy has been shown to improve overall survival and lymphoma-specific survival rates, with only a small number of lymphoma-related deaths 4.
Treatment-Related Toxicities
- Chemotherapy treatment plans for lymphoma can differ between subtypes, and subsequent toxicities include neuropathy, cardiotoxicity, and secondary cancers such as lung and breast cancer 2.
- High-dose therapy and autologous stem-cell transplantation (ASCT) have been used in patients with mantle cell lymphoma, with rituximab used as an in vivo purge before stem-cell collection and as post-transplant consolidative immunotherapy 5.
Role of Rituximab
- Rituximab has been shown to improve response rates, overall survival, and progression-free survival in patients with high-risk diffuse large B-cell lymphoma, particularly in older patients 6.
- The addition of rituximab to anthracycline-based chemotherapy has been demonstrated to be beneficial in patients with high-risk DLBCL, with improved overall response rates and survival outcomes 6.