Please enable JavaScript.

Coggle requires JavaScript to display documents.

Lymphoma Treatment note: start reading from the left, then up, then down…

- - - - early
        
        early favorable
        
        for nodular lymphocyte-predominant Hodgkin lymphoma only (NLPHL; non-classical HL) can receive radiation only (extended field) without chemo, but higher relapse rate compared to the combined modality
        NOTE: in case radiation only was used then relapse, use salvage chemo
        
        no any of the following:
        B symptoms, extranodal disease (E), bulky disease (X), three of more sites of nodal involvement, ESR higher than 50
        
        chemo: two cycles of the Stanford V regimen or four cycles of the ABVD
        radiation: consolidative involved-field radiation
        
        stage I, II, and IIE
        E=extranodal
        
        early unfavourable
        
        chemo: ABVD alone, alternating ABVD/MOPP, MOPP alone, or hybridized MBV. ABVD is the standard regimen, two or four cycles.
        radiation: If bulky, use involved field radiation only or give additional two cycles of ABVD (a total of 6). if not bulky, complete 6 ABVD cycles with no radiation
        
        with any of the following
        B symptoms, (E), (X), three of more sites of nodal involvement, ESR > 50
      - advanced
        
        advanced favorable
        
        6–8 cycles of ABVD, no further treatment in complete remission. if partial remission add consolidative radiation to residual disease sites
        
        patients with three or fewer poor prognostic factors
        
        advanced unfavorable
        
        6–8 cycles of escalated-dose BEACOPP, no further treatment in complete remission. if partial remission add consolidative radiation to residual disease sites
        
        patients with more than three poor prognostic factors
        
        stage III and IV
        
        In some studies, stage IIB with a large mediastinal mass or extranodal disease is also considered advanced-stage disease.
      - surgery is limited, combination chemotherapy (chemo) is the primary treatment modality
      - in general,
        -early stage: chemo+radiation
        -late stage: chemo with or without radiation
        -refractory or recurrent disease: salvage therapy consists of multiagent chemotherapy with or without high-dose chemotherapy and
      - radiation, click to see the image
        
        involved field radiation: radiation to a single field that contains HL.
        
        extended field radiation or subtotla nodal irradiation: radiation to the involved field and a second uninvolved area
        
        total nodal irradiation: radiation of all areas
        
        long term effects of radiation: cardiovascular disease and secondary malignancies, which commonly occur in the
        lung, breast, gastrointestinal tract, and connective tissue.
        so use chemo to decrease the need of radiation; this is called combined modality approach which is chemo with involved field radiation.
      - refractory or relapsed disease
        
        relapse after initial complete response
        
        late relapse: use the same regimen as before, a different potentially non–crossresistant regimen, radiation, or high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT) (often preceded by conventional-dose chemotherapy).
        
        salvage chemo can be used in:
        -in case radiation only was used, use salvage chemo
        -local recurrence in a nonirradiated location
        -relapse more than 1 year after completion of initial chemotherapy.
        
        early relapse: High-dose chemotherapy and autologous HSCT
        
        refractory, didn't achieve complete remission
        
        autogogous HSCT, don't use salvage chemo
        
        in case of failure of HSCT or in patients who have failed at least two prior chemotherapy regimens and are not candidates for HSCT
        use brenetuximab vedotin
        Brentuximab vedotin is an antibody-drug conjugate (ADC), anti CD30 antibody + monomethyl auristatin E (MMAE); an antimicrotubule agent. when it binds, it disrupts the microtubule network which leads to apoptotic death of cancer cells.
      - long-term complications:
        
        sterility, from alkylating agents (e.g., nitrogen mustard and chlorambucil), dose related. ABVD doesn't cause sterility
        
        secondary malignancies
        
        cardiopulmonary diseases