World lymphoma awareness day

Dr. Narender kumar Thota,

MD, DM Consultant Medical oncologist,

Hemato-oncologist &Stem cell / Bone marrow transplant specialist

KIMS Hospitals, Sec-bad.

LYMPHOMA

1. What is lymphoma?

Cancer of lymphocytes, lymphocytes are very important infection fighting cells in the body

2. How these patients present to a doctor

Swollen lymph nodes sometimes painful, commonly neck, axilla, groin

Fever

Weight loss

Loss of appetite

Night sweats that soak your clothes

3. How many type of lymphoma are there

Broadly they are divided into Hodgkin and Non-Hodgkin lymphoma

Hodgkin’s lymphoma

• Classical

Mixed cellularity

Lymphocyte predominant

Lymphocyte depleted

Nodular sclerosis

• Nodular lymphocyte predominant

In NHL many subtype

• DLBCL

• Follicular lymphoma

• Mantle cell lymphoma

• Anaplastic large cell lymphoma

• Burkitts lymphoma

• Lymphoblastic lymphoma Etc

4. How lymphoma is diagnosed

Most important part of lymphoma diagnosis is biopsy and immunohistochemistry

Once the diagnosis is confirmed, staging workup is done with PETCT scan, BMA and BM biopsy,

5. What are the other test done for lymphoma?

Routine tests like Complete blood picture, liver function test and renal function test. Virology, 2 D echo,

6. How they are treated?

Lymphomas are treated based on the type of lymphoma and stage

Early stage lymphomas – e.g. follicular lymphoma stage 1 and 2 without symptoms are observed

Stage 1 and 2 Mantle cell lymphoma are observed

Hodgkin’s lymphoma are with ABVD Protocol

All high grade lymphomas are treated with chemotherapy – RCHOP protocol is used

Symptomatic Low grade lymphomas are treated with BR protocol

7. Is there any role for radiotherapy?

Yes,

a. in early stage tumours radiation can be used, based on site and histology

b. At the end of chemotherapy, if PETCT scan shows disease activity in lymph nodes then radiation can be considered for the PETCT positive lymphomas

8. Can lymphomas be observed without treatment/chemotherapy?

Yes – low grade lymphomas like follicular lymphomas grade I and II and early stage mantle cell lymphoma can be observed

9. Is cure possible for lymphomas?

Stag 1 and 2 Hodgkin’s lymphoma and NHL

Few stage 3 and stage 4 also possible

10. If they relapse how they are treated

Hodgkin’s and non-Hodgkin’s lymphomas are treated with salvage chemotherapy protocols which are same for both the type of lymphomas

a. DHAP,

b. GDP

c. ICE  etc

11. Is there any role of bone marrow transplant in lymphoma?

Yes – when lymphomas relapse, they are treated with chemotherapy and then they are consolidated with bone marrow transplant.

12. What are the new drugs available for lymphoma?

For Hodgkin’s lymphoma

a. Brentuximab

b. Immunotherapy – nivolumab and pembrolizumab

c. CAR – T CELL therapy

For NHL

CART cell therapy

d. Axicabtagene ciloleucel

e. Tisagenlecleucel

f. Lisocabtagene maraleucel