From the Guidelines
Lymphoma is a cancer that begins in the lymphatic system, which is part of the body's immune system that fights infection and disease, and the two main types are Hodgkin lymphoma and non-Hodgkin lymphoma, which differ in their cell appearance and behavior. The diagnosis of lymphoma typically involves a lymph node biopsy, blood tests, and imaging studies like CT scans or PET scans to determine the type and stage of lymphoma 1.
Common Symptoms
Some common symptoms of lymphoma include:
- Painless swelling of lymph nodes in the neck, armpits, or groin
- Persistent fatigue
- Fever
- Night sweats
- Unexplained weight loss
- Itchy skin
Treatment Options
Treatment options vary based on the type, stage, and aggressiveness of the lymphoma but commonly include:
- Chemotherapy (such as CHOP regimen: cyclophosphamide, doxorubicin, vincristine, and prednisone)
- Radiation therapy
- Immunotherapy (like rituximab)
- In some cases, stem cell transplantation
Prognosis
The prognosis depends on many factors including the type and stage of lymphoma, with some types being highly curable while others may require ongoing management 1. Regular follow-up care is essential after treatment to monitor for recurrence and manage any long-term side effects of treatment. Early detection and treatment significantly improve outcomes, so it's essential to see a doctor if you experience persistent symptoms.
Diagnosis and Workup
A thorough history and physical examination, standard laboratory tests, PET/CT, and diagnostic contrast-enhanced CT are recommended for the workup of lymphoma 1. A bone marrow biopsy may be performed if cytopenias are present or if the PET scan displays multifocal skeletal lesions. Evaluation of ejection fraction is recommended for most patients undergoing doxorubicin-based chemotherapy.
Fertility Preservation
Fertility preservation (semen cryopreservation in male patients, ovarian tissue or oocyte cryopreservation in female patients) is recommended before the initiation of chemotherapy with alkylating agents or pelvic RT 1. Oophoropexy should be considered to preserve ovarian function in premenopausal women if pelvic RT is contemplated.
Stage I–II Favorable Disease
RT alone or chemotherapy regimens (ABVD or Stanford V) are standard treatment options for patients with early-stage HL 1. The potential long-term toxicity of high-dose, large-field irradiation includes an increased risk for heart disease, pulmonary dysfunction, and secondary cancers.
From the FDA Drug Label
INDICATIONS AND USAGE: Vinblastine Sulfate Injection is indicated in the palliative treatment of the following: I Frequently Responsive Malignancies Generalized Hodgkin’s disease (Stages III and IV, Ann Arbor modification of Rye staging system) Lymphocytic lymphoma (nodular and diffuse, poorly and well differentiated) Histiocytic lymphoma Mycosis fungoides (advanced stages) Advanced carcinoma of the testis Kaposi’s sarcoma Letterer-Siwe disease (histiocytosis X)
The basics to know about lymphoma (lymphatic system cancer) include:
- Types of lymphoma: Generalized Hodgkin’s disease, Lymphocytic lymphoma, Histiocytic lymphoma
- Stages: Stages III and IV, Ann Arbor modification of Rye staging system
- Treatment: Vinblastine sulfate is indicated in the palliative treatment of lymphoma, often administered in combination with other antineoplastic drugs 2
- Key points: Lymphoma can be treated with vinblastine sulfate alone or in combination with other agents, and the choice of treatment depends on the type and stage of the disease.
From the Research
Overview of Lymphoma
- Lymphoma is a group of malignant neoplasms of lymphocytes with more than 90 subtypes, traditionally classified as non-Hodgkin or Hodgkin lymphoma 3.
- Approximately 82,000 new U.S. patients are diagnosed with lymphoma annually, with any tobacco use and obesity being major modifiable risk factors 3.
- Genetic, infectious, and inflammatory etiologies also contribute to the development of lymphoma 3.
Classification and Staging
- The Lugano classification system incorporates symptoms and the extent of the disease as shown on positron emission tomography/computed tomography to stage lymphoma 3.
- Staging of lymphoma is essential for the choice of optimal therapy, with prognostic models used to identify patients at high or low risk for recurrence 4.
- The initial treatment for patients with Hodgkin lymphoma is based on the histologic characteristics of the disease, the stage at presentation, and the presence or absence of prognostic factors associated with poor outcome 4.
Treatment Options
- Non-Hodgkin lymphoma is treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide 3.
- Hodgkin lymphoma is treated with combined chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), Stanford V, or BEACOPP with radiotherapy 3.
- Plasmablastic lymphoma, a newly recognized aggressive subtype of non-Hodgkin lymphoma, may be treated with aggressive chemotherapy, including regimens such as DA-EPOCH (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) 5.
Diagnosis and Management
- Lymphoma typically presents as painless adenopathy, with systemic symptoms of fever, unexplained weight loss, and night sweats occurring in more advanced stages of the disease 3.
- An open lymph node biopsy is preferred for diagnosis, with laboratory studies including complete blood count and peripheral blood flow cytometry also playing a role in diagnosis 6.
- Patients with suspected lymphoma should be accurately and comprehensively diagnosed and managed in the generalist setting prior to referral to a hematologist/oncologist 6.