From the Guidelines
Diagnosing lymphoma requires a thorough physical examination, blood tests, imaging studies, and a definitive biopsy of affected tissue, with treatment options varying based on lymphoma type, stage, and patient factors, as recommended by the Lugano classification 1.
Diagnostic Steps
To diagnose lymphoma, the following steps should be taken:
- A thorough physical examination to check for enlarged lymph nodes
- Blood tests to assess overall health and look for markers of lymphoma
- Imaging studies such as CT scans, PET scans, or MRIs to determine the extent of disease
- A biopsy of affected tissue, typically a lymph node, which is examined by a pathologist to identify the specific lymphoma type, with excisional biopsy preferred, although core-needle biopsy may suffice when not feasible 1
Treatment Options
Treatment options for lymphoma vary based on the type of lymphoma (Hodgkin or non-Hodgkin), stage, and patient factors, and may include:
- Chemotherapy regimens like ABVD for Hodgkin lymphoma or R-CHOP for B-cell non-Hodgkin lymphomas
- Radiation therapy alone for early-stage disease or combined with chemotherapy
- Targeted therapies like rituximab (anti-CD20 antibody)
- Stem cell transplantation or newer immunotherapies like CAR T-cell therapy for refractory cases
Staging and Response Evaluation
Staging should be thorough, particularly in patients with early stages I and II, and should include a CT-scan, bone marrow aspirate and biopsy, and complete blood count, with response evaluation done after every 2-3 cycles of therapy and after completion of chemotherapy 1
Follow-up
Regular follow-up with oncologists is essential to monitor response and manage side effects, with history and physical examination every 3 months for 2 years, every 6 months for 3 additional years, and subsequently once a year 1
From the FDA Drug Label
INDICATIONS AND USAGE ADCETRIS is a CD30-directed antibody and microtubule inhibitor conjugate indicated for treatment of: • Adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vinblastine, and dacarbazine (1. 1). • Pediatric patients 2 years and older with previously untreated high risk classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide (1.2). • Adult patients with classical Hodgkin lymphoma (cHL) at high risk of relapse or progression as post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation (1. 3). • Adult patients with classical Hodgkin lymphoma (cHL) after failure of auto-HSCT or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not auto-HSCT candidates (1. 4). • Adult patients with previously untreated systemic anaplastic large cell lymphoma (sALCL) or other CD30-expressing peripheral T-cell lymphomas (PTCL), including angioimmunoblastic T-cell lymphoma and PTCL not otherwise specified (NOS), in combination with cyclophosphamide, doxorubicin, and prednisone (1. 5). • Adult patients with systemic anaplastic large cell lymphoma (sALCL) after failure of at least one prior multi-agent chemotherapy regimen (1.6). • Adult patients with primary cutaneous anaplastic large cell lymphoma (pcALCL) or CD30-expressing mycosis fungoides (MF) who have received prior systemic therapy (1. 7). • Adult patients with relapsed or refractory large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL) NOS, DLBCL arising from indolent lymphoma, or high-grade B-cell lymphoma (HGBL), after two or more lines of systemic therapy who are not eligible for auto-HSCT or CAR T-cell therapy, in combination with lenalidomide and a rituximab product (1. 8).
The diagnostic steps for lymphoma are not explicitly stated in the provided drug label. However, the label does mention various types of lymphoma, such as classical Hodgkin lymphoma (cHL), systemic anaplastic large cell lymphoma (sALCL), and large B-cell lymphoma (LBCL), as indications for the use of brentuximab vedotin.
- The treatment options for these types of lymphoma include brentuximab vedotin in combination with other chemotherapy agents, such as doxorubicin, vinblastine, and dacarbazine.
- The label also mentions the importance of monitoring patients for signs of infection, peripheral neuropathy, and other adverse reactions during treatment with brentuximab vedotin 2.
From the Research
Diagnostic Steps for Lymphoma
- The diagnosis of lymphoma typically involves a combination of physical examinations, medical history, and diagnostic tests 3
- Blood counts, blood films, marrow smears, trephine, and tissue biopsies are commonly used to diagnose lymphoma 4
- The International Lymphoma Study Group (REAL) scheme is utilized for lymphoma subclassification 4
- Diagnostic tests may include:
- Complete blood count (CBC) to check for abnormal blood cell counts
- Blood chemistry tests to check for liver and kidney function
- Imaging tests such as CT scans, MRI scans, or PET scans to check for enlarged lymph nodes or other signs of lymphoma
- Bone marrow biopsy to check for lymphoma cells in the bone marrow
Treatment Options for Lymphoma
- Treatment options for lymphoma depend on the type and stage of the disease, as well as the patient's overall health 3
- Common treatment options include:
- Chemotherapy: uses drugs to kill lymphoma cells
- Radiation therapy: uses high-energy rays to kill lymphoma cells
- Immunotherapy: uses drugs to stimulate the immune system to attack lymphoma cells
- Stem cell transplantation: uses healthy stem cells to replace damaged stem cells in the bone marrow
- Bendamustine-rituximab (BR) has been shown to be a promising treatment option for nodular lymphocyte predominant Hodgkin lymphoma, with a favorable efficacy and safety profile 5
- The choice of treatment will depend on the specific type of lymphoma, as well as the patient's individual needs and preferences 3, 4, 5