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New Treatments for Non-Hodgkin's Lymphomas

The non-Hodgkin's lymphomas are a group of cancers of the lymphocytes. The disorders are variable in clinical presentation and course, varying from indolent disease to rapidly progressive devastating illnesses.

Results of studies using techniques of molecular biology have provided clues to the pathogenesis of these disorders. The best-studied example is Burkitt's lymphoma, in which a characteristic cytogenetic abnormality.

Clinical Findings

A. Symptoms and Signs: Patients with indolent lymphomas usually present with painless lymphadenopathy, which may be isolated or widespread. Involved lymph nodes may be present in the retroperitoneum, mesentery, and pelvis.

Treatment

The indolent lymphomas are usually not curable and are approached with palliative therapy. If patients are asymptomatic, no initial treatment may be necessary. However, in 1B3 years, the disease will usually progress and require treatment. Treatment decisions are individualized depending on the patient's age and performance status and the extent of disease. Initial therapy is based on the alkylating agents. Appropriate regimens include chlorambucil, 0.6B1 mg/kg every 3 weeks, or combination therapy with cyclophosphamide, vincristine, and prednisone (CVP). Patients with more aggressive or resistant disease may require more intensive therapy.

Patients with intermediate and high-grade lymphomas should be treated with curative intent. Irradiation is occasionally used for localized disease (supplemented by brief intensive chemotherapy), but the mainstay of therapy is combination chemotherapy. The traditional treatment regimen has been cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP).

Classification of lymphomas:

Low-grade

Small lymphocytic

Small lymphocytic, plasmacytoid

Follicular small cleaved cell

Follicular mixed cell

Intermediate-grade

Follicular large cell

Diffuse small cleaved cell

Diffuse mixed cell

Diffuse large cell

High-grade

Immunoblastic

Small noncleaved (Burkitt=s)

Small noncleaved (non-Burkitt=s)

Lymphoblastic

True histiocytic

Other

Cutaneous T cell (mycosis fungoides)

Adult T cell leukemia/lymphoma

T g lymphocytosis