From the Guidelines
Lymphoma typically presents with painless lymphadenopathy, often in the neck, axilla, or groin, and may be accompanied by B symptoms such as fever, night sweats, and unintentional weight loss. Patients may experience other common presentations including fatigue, pruritus, and splenomegaly 1. Hodgkin lymphoma frequently presents with cervical or mediastinal lymphadenopathy, while non-Hodgkin lymphoma can present with more widespread disease. Extranodal involvement may cause site-specific symptoms such as abdominal pain with gastrointestinal involvement, neurological symptoms with CNS involvement, or skin lesions with cutaneous lymphomas.
Key Presentations
- Painless lymphadenopathy in the neck, axilla, or groin
- B symptoms: fever, night sweats, and unintentional weight loss
- Fatigue, pruritus, and splenomegaly
- Extranodal involvement with site-specific symptoms
Diagnosis and Staging
Diagnosis requires excisional lymph node biopsy for histopathological examination, immunophenotyping, and molecular studies 1. Staging involves PET-CT scans and, in some cases, bone marrow biopsy to determine disease extent 1. Early recognition of these presentations is crucial for prompt diagnosis and treatment initiation, as lymphomas are potentially curable malignancies when identified early. It is essential to note that the diagnostic work-up should include a medical history, physical examination, and laboratory tests such as full blood cell count, erythrocyte sedimentation rate, and blood chemistry 1.
From the FDA Drug Label
Adult patients with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) (1. 1). Adult patients with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) with 17p deletion (1.2). Adult patients with Waldenström’s macroglobulinemia (WM) (1.3).
The typical presentations of lymphoma are not explicitly described in the provided drug label. However, it mentions chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) and Waldenström’s macroglobulinemia (WM) as indications for the use of ibrutinib.
- CLL/SLL is a type of lymphoma that affects the blood and bone marrow.
- WM is a type of lymphoma that affects the blood and bone marrow, characterized by an overproduction of IgM antibody. Since the label does not provide direct information on the typical presentations of lymphoma, a conservative clinical decision would be to consult other reliable sources for this information 2.
From the Research
Typical Presentations of Lymphoma
- 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
- The disease can be classified broadly as non-Hodgkin or Hodgkin lymphoma, with non-Hodgkin lymphomas being a heterogeneous group of malignancies of the lymphoid system 4
- B-cell lymphomas account for approximately 90% of all lymphomas, and the 2 most common histological disease entities are follicular lymphoma and diffuse large B-cell lymphoma 4
Symptoms and Staging
- Systemic symptoms such as fever, unexplained weight loss, and night sweats are common in advanced stages of the disease 3
- The Ann Arbor Staging Classification is used routinely to classify the extent of disease, and the International Prognostic Index has been used to define prognostic subgroups 4
- Precise staging of lymphoma is a prerequisite for the selection of a suitable therapeutic regimen and influences the likelihood of its success 5
Diagnosis and Imaging
- An open lymph node biopsy is preferred for diagnosis 3
- Imaging techniques such as CT, ultrasound, and radionuclides play an important part in helping the clinician to manage patients with lymphoma 6
- The International Workshop Group (IWG) criteria have become the widely accepted standard for response assessment in non-Hodgkin's lymphoma 7