21. Clinical Evaluation and Management of Lymphoma

  1. Alvin H. Schmaier MD and
  2. Hillard M. Lazarus MD, FACP
  1. Makiko Ban-Hoefen MD,
  2. Jonathan W. Friedberg MD, MMSc and
  3. Richard I. Fisher MD

Published Online: 22 SEP 2011

DOI: 10.1002/9781444345254.ch21

Concise Guide to Hematology

Concise Guide to Hematology

How to Cite

Ban-Hoefen, M., Friedberg, J. W. and Fisher, R. I. (2011) Clinical Evaluation and Management of Lymphoma, in Concise Guide to Hematology (eds A. H. Schmaier and H. M. Lazarus), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444345254.ch21

Editor Information

  1. Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA

Author Information

  1. University of Rochester Medical Center, Rochester, NY, USA

Publication History

  1. Published Online: 22 SEP 2011
  2. Published Print: 4 NOV 2011

ISBN Information

Print ISBN: 9781405196666

Online ISBN: 9781444345254

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Keywords:

  • Hodgkin lymphoma;
  • non-Hodgkin lymphoma;
  • chronic lymphocytic leukemia;
  • lymph node;
  • Ann Arbor staging;
  • apoptosis;
  • rituximab;
  • hematopoietic cell transplantation

Summary

Hodgkin and non-Hodgkin lymphoma are two malignant disorders arising from cells that populate the lymph nodes. Hodgkin lymphoma generally spreads contiguously from one anatomic lymph node group to another, whereas non-Hodgkin lymphoma spreads less predictably. The prognosis and treatment of lymphomas are greatly influenced by the stage of the disease at diagnosis, categorized by the Ann Arbor staging system. Hodgkin lymphoma is treated with chemotherapy (often ABVD or doxorubicin, bleomycin, vinblastine, and dacarbazine) with or without involved field radiation. Treatments are quite effective and relatively safe, i.e. death from complications of treatment now approximates, if not exceeds, death from Hodgkin disease in certain stages. Treatment recommendations for non-Hodgkin lymphoma are highly dependent on one of the many histologic sub-types of disease, best divided into indolent (slower growing), aggressive (faster growing), and highly aggressive (extremely fast-growing). Paradoxically, indolent non-Hodgkin lymphomas are usually present in a more widespread stage and are incurable (outside the context of hematopoietic cell transplantation), yet some patients can be observed without treatment until intervention is clinically necessary (i.e., when symptoms or visceral organ compromise emerges). When chemotherapy is utilized, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is a commonly used regimen. For the aggressive non-Hodgkin lymphomas, treatment must be initiated soon after diagnosis, as R-CHOP can be curative. There is growing literature on the use of autologous and allogeneic hematopoietic cell transplantation in the treatment of both Hodgkin and Non-Hodgkin lymphoma.