Lymphomas treatment guideline

Introduction to Lymphomas

Lymphomas are solid neoplasms that originate in lymph nodes or other lymphatic tissues of the body.
They’re a heterogeneous group of disorders.
Can arise at virtually any site
More often occurs in regions with large
concentrations of lymphoid tissues, e.g.
lymph nodes, tonsils, spleen and bone
marrow

Two main groups of Lymphomas

  1. Hodgkin’s disease
  2. Non-Hodgkin’s lymphomas

Hodgkin’s disease

This is characterized by Reed-Sternberg cells (large binucleate cells with vesicular nuclei and prominent eosinophilic nucleoli)
Reed-Sternberg cells are occasionally found in other clinical conditions e.g. hyperplastic or inflammatory lesions of lymph nodes

Non-Hodgkin’s lymphomas:

Non-Hodgkin’s lymphomas is a heterogeneous collection of lymph proliferative malignancies Vary widely according to histological subtype, stage and bulk of disease

Investigations

Mandatory

  • Full Blood Count (i.e. haemoglobin, haematocrit leucocyte and differential counts; red cell indices, reticulocyte count)
  • Erythrocyte sedimentation rate
  • Coombs test
  • Bone marrow aspiration and needle biopsy
  • Serum Urea, Electrolytes,
  • Serum Uric acid
  • Liver Function Tests: transaminases-ALT, AST, ALP; bilirubin; serum proteins
  • HIV screening Immunoglobulins,
  • Chest X-ray

Optional

  • Examination of post-nasal space
  • Serum copper level
  • Neutrophil alkaline phosphatase
  • Tomograms of lung or mediastinum
  • Skeletal X-ray
  • Abdominal ultrasound scans
  • Intravenous pyelography
  • CT scans of chest and abdomen
  • Supplementary node biopsy

Treatment objectives

  • Induce remission
  • Restore patient to disease-free state
  • Maintain state of well-being

Non-drug treatment

  • Appropriate nutrition
  • Adequate hydration
  • Red cell and platelet concentrate transfusions as required

Drug treatment for Lymphomas

  • Malaria prophylaxis: proguanil 200 mg orally daily
  • Antibiotics as indicated
  • Allopurinol 300 mg orally daily (when uric acid is high)

Non-Hodgkin’s lymphomas

CHOP (3 weekly):

  • Prednisolone 100 mg orally on days 1 – 5
  • Cyclophosphamide 750 mg/m2 intravenously on day 1 Doxorubicin 50 mg/m² intravenously on day 1, 2
  • Vincristine 1.4 mg/m² (maximum of 2 mg) intravenously on day 1

CHOP (4 weekly):

  • Cyclophosphamide 750 mg/m² intravenously on days 1 and 8
  • Doxorubicin 25 mg/m’intravenously on days 1 and 8
  • Vincristine 1.4 mg/m (maximum 2 mg) on days 1 and 8
  • Prednisolone 100 mg orally on days 1-8

Hodgkin’s lymphoma

MOPP

  • Mechlorethamine 6 mg/m² intravenously on days 1 and 8
  • Vincristine 1.4 mg/m² (maximum 2 mg) intravenously on days 1 and 8.
  • Procarbazine 100 mg/m’orally on days 1 and 4
  • Prednisolone 40 mg orally on days 1-14.

ChIVPP

  • Chlorambucil 6 mg/m’orally on days 1 and 14
  • Vinblastine 6 mg/m² (maximum 10 mg) intravenously on days 1 and 18.
  • Procarbazine 100 mg/m’orally on days 1 and 14.
  • Prednisolone 40 mg orally on days 1-14

Supportive measures

  • Appropriate nutrition
  • Adequate hydration

Notable adverse drug reactions, caution

  • All the drugs are contraindicated in patients with hypersensitivity reactions to the respective medicines
  • Profound nausea, vomiting, diarrhoea and abdominal discomfort
  • Secondary malignancies
  • Myelosuppression (except the steroids)
  • Steroids (prednisolone) may cause Cushing’s syndrome, hypertension, diabetes mellitus, suppression of immunity, infections
  • Vincristine: neurotoxic
  • Cyclophosphamide: alopecia and
  • Doxorubicin: cardiotoxic haemorrhagic cystitis

Prevention

Avoid unnecessary exposure to irradiation and chemicals