Lymphomas and multiple myeloma 12/23/2018 1
|
|
- Stuart Antony Cook
- 5 years ago
- Views:
Transcription
1 60 Lymphomas and multiple myeloma 12/23/2018 1
2 Lymphomas Lymphoma is cancer of the lymphatic system. Lymphomas are subdivided into two main categories: Hodgkin's lymphoma (HL) and non- Hodgkin's lymphoma (NHL). The site of malignancy is usually a lymph node. Extranodal disease, most frequently of the stomach, skin, oral cavity and pharynx, small intestine and CNS, can occur and is more common in NHL than HL. 12/23/2018 2
3 Hodgkin's lymphoma Hodgkin s lymphoma (HL) account for about 30% of lymphomas. It is predominantly a disease of young adults, having a peak incidence between the ages of 15 and 35 years. HL is distinguished from NHL by the presence of the pathognomonic Reed-Sternberg (RS) cell which is a ( large abnormal binucleate lymphocyte ). 12/23/2018 3
4 Etiology The cause of Hodgkin's lymphoma is unknown, but a number of risk factors has been identified. The Epstein-Barr virus which can cause glandular fever, has been shown to play an important role in Hodgkin's lymphoma, accounting for about 50 % of all cases. A Patients who have reduced immunity, for example, AIDS or those taking immunosuppressants, may have an increased risk of developing HL. 12/23/2018 4
5 Pathology The characteristic pathological finding in HL is the identification of a large, abnormal binucleate lymphocyte called a Reed- Sternberg cell. Hodgkin's lymphoma is divided into two distinct categories: 1- Classical Hodgkin's lymphoma. 2- Nodular lymphocyte-predominant Hodgkin's lymphoma ( NLPHL). 12/23/2018 5
6 Classical Hodgkin's lymphoma is divided into four histological sub classifications 1- Nodular sclerosis: is the most common form of HL. It is predominated in young adults and females, and has an excellent prognosis. 2- Mixed cellularity: is the second most common type of classic HL and more common in males. 3- Lymphocyte depleted: this carries a poor prognosis and is more common in HIV-positive individuals. 4- Lymphocyte rich: this is a rare type of classic HL. NLPHL accounts for 5% of HL cases and is more common in men. 12/23/2018 6
7 Clinical Presentation of HL HL usually presents with painless enlargement of lymph nodes, often in the neck. Patients will present with B symptoms which are fever, night sweats and/or weight loss. Others include malaise, itching (25%) or pain at the site of enlarged nodes after drinking alcohol. Bone pain may result from skeletal involvement. 12/23/2018 7
8 Primary involvement of the gut, central nervous system or bone marrow is rare. If lymph nodes in the chest are involved, patients may present with breathlessness. 12/23/2018 8
9 Laboratory findings Laboratory findings include normochromic, normocytic anaemia. A raised erythrocyte sedimentation rate and eosinophilia. One-third of patients have a leucocytosis due to an increase in neutrophils. Advanced disease is associated with lymphopenia (lymphocytes < L 1). Plasma lactate dehydrogenase (LDH) is raised in 30 40% of patients at diagnosis and has been associated with a poor prognosis. 12/23/2018 9
10 Investigations and staging Once the diagnosis has been made on biopsy, further investigations are needed to assess disease activity and the extent of its spread through the lymphoid system or other body sites. The staging of HL is assessed by the Cotswolds modification of the Ann Arbor classification system: 12/23/
11 Cotswald Staging Classification for Hodgkin s Disease: 1- Stage I Involvement of a single lymph node region or lymphoid structure. 2- Stage II Involvement of two or more lymph node regions on the same side of the diaphragm. 3- Stage III Involvement of lymph node regions or structures on both sides of the diaphragm. III1 with or without involvement of splenic, hilar, coeliac or portal nodes. III2 with involvement of para-aortic, iliac or mesenteric nodes. 4- Stage IV Involvement of extranodal site. 12/23/
12 The tests required to establish the stage includes: A complete history, physical examination, FBC, urea and electrolytes (U and Es), chest X-ray and computed tomography (CT). Other useful tests include erythrocyte sedimentation rate (ESR), serum LDH and liver function tests (LFTs). Positron emission tomography (PET) can be used to detect active residual disease. 12/23/
13 Treatment HL is potentially curable and, in general, sensitive to both chemotherapy and radiotherapy. Stage of disease is the biggest factor in treatment choice and outcome. 12/23/
14 Early-stage (favourable) disease The cure rate for patients with stages I and IIA disease is greater than 90%. Patients with stages I and IIA disease may be cured with radiotherapy alone (wide or extended field irradiation). However, due to radiation-related late effects and secondary malignancy and the incidence of relapse (25 30%), most receive combined modality treatment (chemotherapy and radiotherapy). This usually consists of two to four cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by involved field radiation therapy (IFRT) The aim of chemotherapy is to destroy subclinical disease outside the field of radiotherapy. 12/23/
15 Early-stage (unfavourable) disease Patients with stage I or II presenting with bulky disease, B symptoms or with more than two sites of disease are treated with four to six cycles of combination chemotherapy, for example, ABVD, and radiotherapy to sites of bulky disease. 12/23/
16 Advanced disease Patients with advanced disease (stages III and IV) are treated with combination chemotherapy. The first widely used combination chemotherapy regimen was MOPP (mechlorethamine, vincristine (Oncovin), procarbazine and prednisolone). ABVD has replaced MOPP chemotherapy as the regimen of choice as it is as effective but less toxic in terms of fertility, haematological toxicity, and the development of acute leukaemia and myelodysplasia. 12/23/
17 Six to eight cycles of ABVD is considered the current standard treatment for advanced disease. A number of regimens have been investigated for example, BEACOPP (bleomycin, etoposide, Adriamycin (doxorubicin), cyclophosphamide,vincristine, procarbazine, prednisolone)). 12/23/
18 Other options for patients unlikely to tolerate ABVD include ChlVPP (chlorambucil, vinblastine, procarbazine,prednisolone) and CHOP (cyclophosphamide, doxorubicin (hydroxydaonorubicin), vincristine (Oncovin), prednisolone, rituximab. 12/23/
19 Salvage therapy for relapsed disease : Response to salvage therapy depends on previous therapy, and length of remission. Choice of salvage therapy should be guided by response to initial therapy and patient's ability to tolerate therapy. Since the success of salvage treatment has been shown to be influenced by the length of remission after initial chemotherapy." Therefore the disease can be classified as : 1- Primary refractory disease (patients who never achieved a complete remission). 2- Early relapse (within 12 months of complete remission). 3- Late relapse (after more than 12 months of complete remission) 12/23/
20 Patients with primary refractory disease or with early relapse are candidates for high-dose chemotherapy with autologus stem cell transplantation. Patients with late relapse can be treated with their initial chemotherapy, radiation therapy, salvage regimen or considered for high-dose chemotherapy with autologus stem cell transplantation. 12/23/
21 Salvage regimens: In an effort to avoid cross-resistance, most salvage regimens incorporate drugs not used in the initial therapy. Commonly used salvage regimens include. 1- DHAP (dexamethasone, cytarabine, and cisplatin). 2- ESHAP (etoposide, methylprednisolone, cytarabine, and cisplatin). 3- ICE (etoposide, ifosfamide and carboplatin,) 4- IVA ( Epirubicin, Etoposide and Ifosfamide) 12/23/
22 Non-Hodgkin s lymphoma (NHL) Non-Hodgkin s lymphoma (NHL) is a term covering all lymphoproliferative system malignancies except Hodgkin's lymphoma. The disease is rare in subject under 30 years of age and incidence increase with age. NHL is slightly more common in men than in women 12/23/
23 Aetiology Congenital and acquired immunodeficiency is the most clearly defined factor known to increase NHL risk.' Immunosuppressant drugs following transplantation lead to a significantly increased (30-50 times) risk of NHL. The risk of NHL in people infected with HIV is more than 100 times that of the general population. Infectious organisms such as Epstein-Barr virus, Helicobacter pylori and hepatitis C virus have all been thought to play a part in the development of NHL. Exposure to certain chemicals such as pesticides and solvents can increase the risk of developing NHL. There is an increased incidence of gastro-intestinal lymphomas in patients with Crohn s disease. 12/23/
24 Clinical Presentation of NHL The most common presentation of NHL is painless lymphadenopathy, frequently in the neck area in the supraclavicular and cervical regions. Spread of disease is haematogenously (via the blood), and so extranodal sites may be involved. Signs and symptoms of infection, anaemia or thrombocytopenia may be present in patients with bone marrow involvement. Hepatosplenomegaly may also be present. 12/23/
25 Patients may also present with any of the following symptoms: unexplained loss of weight, unexplained fever, drenching night sweats. These symptoms are described as B symptoms and patients without these symptoms are classified as category A. B symptoms are more commonly seen in advanced or aggressive NHL but may be present in all stages and histological subtypes. 12/23/
26 Laboratory findings Laboratory examinations may reveal anaemia, a raised erythrocyte sedimentation rate and a raised serum LDH level. There may be a reduction in circulating immunoglobulins, and a monoclonal paraprotein may be seen in a small number of cases. 12/23/
27 Diagnosis and Staging: The diagnosis of NHL is established by histological examination of lymph node biopsy sample. (or biopsy of involved extranodal tissue ). The staging system for non-hodgkin's lymphoma is the same as that used for Hodgkin's disease and its main use is to distinguish localized stage I and II disease from the disseminated stage III and IV disease. 12/23/
28 Classification The most recent classification of lymphoma is the World Health Organization/revised European- American Lymphoma classification which is 1-Precusor B-cell neoplasm 2-Mature (peripheral) B-cell neoplasms 3-Precursor T-cell neoplasm 4-Mature (peripheral) T-cell and natural-killer neoplasms 12/23/
29 Treatment When designing a treatment plan for an individual patient, various factors must be taken into account, these include the: patient's age general health The extent or stage of the lymphoma The particular histological subtype. 12/23/
30 Indolent (low-grade) lymphoma tends to run a slow course and although it is not curable, patients survive for prolonged periods with minimal symptoms. Aggressive (high-grade) lymphomas result in death within weeks or months if untreated. These lymphomas are very responsive to chemotherapy and up to 50 60% may be cured with combination chemotherapy. 12/23/
31 Indolent non-hodgkin's lymphoma Follicular lymphoma is the most common of the indolent lymphomas. For the minority of patients presenting with limited stage disease (stage I), radiotherapy to the involved field is generally used. the majority (80%) of patients present with advanced disease (stages II IV) where the aim of treatment is to reduce disease bulk and offer symptom relief. Rituximab, cyclophosphamide, vincristine, prednisolone (R-CVP) is used as the first-line treatment for advanced (stage III or IV) follicular lymphoma. 12/23/
32 R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) can also be used as first-line treatment for young patients with aggressive disease and is an option in relapsed disease. Other effective chemotherapy regimens in the treatment non- Hodgkin s lymphoma includes FC (Fludarabine and Cyclophosphamide) and CHOP ( Cyclophosphamide, Doxorubicin (hydroxydaunorubicin),vincristine (Oncovin) and Prednisolone). 12/23/
33 If patients fail to tolerate the standard treatment options, an oral alkylating agent, for example, chlorambucil, with or without a steroid can be used. 12/23/
34 Relapsed indolent non-hodgkin's lymphoma Relapsed patients may be re-treated with rituximab if the time to relapse post-rituximab is greater than 6 months. If the time to relapse is less than 6 months, Yttrium-90 labelled ibritumomab tiuxetan (Zevalin ) with a radioactive moiety attached may be considered. 12/23/
35 Aggressive non-hodgkin's lymphoma The most common presentation is diffuse large B-cell lymphoma (DLBCL). The treatment for advanced-stage aggressive NHL is six cycles of the combination of R-CHOP chemotherapy. 12/23/
36 Relapsed aggressive non-hodgkin's lymphoma over the half of all patients have refractory disease or relapse after first treatment. In younger patients with aggressive NHL, the aim will be to introduce remission with further chemotherapy, using an alternative, salvage regimen, and then to consolidate remission with high-dose therapy (HDT). HDT is usually supported by mobilised peripheral blood stem cells (PBSCs) and an autologous PBSC transplantation (auto-pbsct). 12/23/
37 Commonly used salvage regimens include ICE (ifosfamide, carboplatin, etoposide), ESHAP (etoposide, methylprednisolone, cytarabine, cisplatin) DHAP (cisplatin, cytarabine, dexamethasone) 12/23/
38 Gemcitabine may be of benefit for patients with relapsed or refractory disease after two lines of treatment. Gemcitabine is used in combination with other agents, such as cisplatin and methylprednisolone. Rituximab can also be added to these salvage regimens. 12/23/
39 Multiple myeloma Myeloma is a malignant disease of the plasma cells of bone marrow, accounting for 1% of all malignant disease. There is a clonal expansion of abnormal, proliferating plasma cells producing a monoclonal paraprotein, mainly IgG or IgA and rarely IgM and IgD. The paraproteinaemia may be associated with excretion of light chains in the urine (Bence Jones protein), which are either kappa or lambda. 12/23/
40 Epidemiology and Etiology: The median age of diagnosis is over 60 years and the disease occurs more Frequently in men than in women. The etiology of multiple myeloma is unknown. Pathology Although a small number of malignant plasma cells are present in the circulation, the majority are present in the bone marrow. The malignant plasma cells produce cytokines, which stimulate osteoclasts and result in net bone absorption. The resulting lytic lesions cause bone pain, fractures and hypercalcaemia. Marrow involvement can result in anaemia or pancytopenia. 12/23/
41 Symptoms Bone pain Symptom of anemia Symptoms of Renal failure Symptoms of hypercalcemia Recurrent infections Rarely, symptoms of hyperviscosity and bleeding due to thrombocytopenia. Amyloidosis (develops in 10% ) (Amyloidosis is an extracellular deposition of an insolouble protein called amyloid in various tissues which affect the normal function and structure of the affected tissue). 12/23/
42 Investigations The diagnosis of myeloma requires two of the following criteria: An increase in bone marrow plasma cells Radiological evidence of lytic bone lesions Paraproteinaemia or Bence Jones protein Bone marrow aspiration, plasma and urinary electrophoresis, and a skeletal survey are thus required. 12/23/
43 Treatment Multiple myeloma is an incurable disease; however, advancements in the treatment of myeloma have extended survival significantly. Almost all patients will become refractory to initial treatment. Non-pharmacologic Therapy Autologous stem cell transplantation results in higher response rates and extends overall survival. 12/23/
44 Pharmacologic Therapy Immediate support : High fluid intake to treat renal impairment and hypercalcaemia. Analgesia for bone pain. Bisphosphonates, Pamidronate and zolendronic acid for hypercalcaemia and to delay other skeletal related events. Allopurinol to prevent urate nephropathy. Plasmapheresis, as necessary, for hyperviscosity. Plasmapheresis is an operation to take blood from someone, then to separate the red blood cells from the plasma, and to return the red blood cells suspended in a saline solution to the patient. 12/23/
45 1-Conventional-Dose Chemotherapy Patients who present with symptomatic disease will be started on therapy. Two regimens used are : (VAD )vincristine, doxorubicin & dexamethasone (MP) melphalan and prednisone. VAD like chemotherapy regimens are used most often in transplant candidates because it avoids the alkylating agent melphalan, thus minimizing damage to the stem cell compartment 2-Corticosteroids High-dose dexamethasone (40 mg/day) is an option for patients who cannot tolerate chemotherapy or have few highrisk features. Advantages of this regimen include ease of administration 12/23/ and lack of hematologic adverse effect.
46 3-Thalidomide (Thalomid ) Thalidomide as monotherapy or combination therapy is beneficial in the treatment of multiple myeloma.. Thalidomide may be given in combination with dexamethasone, resulting in greater response rates than when given alone. Common side effects of thalidomide therapy include somnolence, constipation, peripheral neuropathy, deep vein thrombosis. Prophylactic anticoagulation should be considered to prevent deep vein thrombosis associated with thalidomide therapy. There are substantial teratogenic effects of thalidomide if used during pregnancy. 4-Bortezomib It induce myeloma cell death. It Approved for the treatment of relapsed disease. 12/23/
47 5-Lenalidomide: Lenalidomide is an immunomodulating agent related to thalidomide that was recently approved for the treatment of patients with multiple myeloma. Lenalidomide lacks the common side effects of thalidomide, such as constipation and peripheral neuropathy. 12/23/
Lec-14 د.خالد نافع. Medicine. Multiple Myeloma
Fifth stage Lec-14 د.خالد نافع Medicine 24/4/2016 Multiple Myeloma Plasma cell myeloma Variants Non - secretory myeloma Indolent myeloma Smouldering myeloma Plasma cell leukaemia Plasmacytoma - Solitary
More informationHodgkin's Lymphoma. Symptoms. Types
Hodgkin's lymphoma (Hodgkin's disease) usually develops in the lymphatic system, a part of the body's immune system. This system carries disease-fighting white blood cells throughout the body. Lymph tissue
More informationLancashire and South Cumbria Haematology NSSG Guidelines for Follicular Lymphoma:
1 Lancashire and South Cumbria Haematology NSSG Guidelines for Follicular Lymphoma: 2018-19 1.1 Pretreatment evaluation The following tests should be performed: FBC, U&Es, creat, LFTs, calcium, LDH, Igs/serum
More informationLYMPHOMA Joginder Singh, MD Medical Oncologist, Mercy Cancer Center
LYMPHOMA Joginder Singh, MD Medical Oncologist, Mercy Cancer Center Lymphoma is cancer of the lymphatic system. The lymphatic system is made up of organs all over the body that make up and store cells
More informationLymphoma: What You Need to Know. Richard van der Jagt MD, FRCPC
Lymphoma: What You Need to Know Richard van der Jagt MD, FRCPC Overview Concepts, classification, biology Epidemiology Clinical presentation Diagnosis Staging Three important types of lymphoma Conceptualizing
More informationLarge cell immunoblastic Diffuse histiocytic (DHL) Lymphoblastic lymphoma Diffuse lymphoblastic Small non cleaved cell Burkitt s Non- Burkitt s
Non Hodgkin s Lymphoma Introduction 6th most common cause of cancer death in United States. Increasing in incidence and mortality. Since 1970, the incidence of has almost doubled. Overview The types of
More informationAggressive Lymphomas - Current. Dr Kevin Imrie Physician-in-Chief, Sunnybrook Health Sciences Centre
Aggressive Lymphomas - Current Dr Kevin Imrie Physician-in-Chief, Sunnybrook Health Sciences Centre Conflicts of interest I have no conflicts of interest to declare Outline What does aggressive lymphoma
More informationLEUKAEMIA and LYMPHOMA. Dr Mubarak Abdelrahman Assistant Professor Jazan University
LEUKAEMIA and LYMPHOMA Dr Mubarak Abdelrahman Assistant Professor Jazan University OBJECTIVES Identify etiology and epidemiology for leukemia and lymphoma. Discuss common types of leukemia. Distinguish
More informationNon-Hodgkin lymphoma
Non-Hodgkin lymphoma Non-Hodgkin s lymphoma Definition: - clonal tumours of mature and immature B cells, T cells or NK cells - highly heterogeneous, both histologically and clinically Non-Hodgkin lymphoma
More informationIndium-111 Zevalin Imaging
Indium-111 Zevalin Imaging Background: Most B lymphocytes (beyond the stem cell stage) contain a surface antigen called CD20. It is possible to kill these lymphocytes by injecting an antibody to CD20.
More informationWhat is a hematological malignancy? Hematology and Hematologic Malignancies. Etiology of hematological malignancies. Leukemias
Hematology and Hematologic Malignancies Cancer of the formed elements of the blood What is a hematological malignancy? A hematologic malignancy is a malignancy (or cancer) of any of the formed elements
More informationNon-Hodgkin lymphomas (NHLs) Hodgkin lymphoma )HL)
Non-Hodgkin lymphomas (NHLs) Hodgkin lymphoma )HL) Lymphoid Neoplasms: 1- non-hodgkin lymphomas (NHLs) 2- Hodgkin lymphoma 3- plasma cell neoplasms Non-Hodgkin lymphomas (NHLs) Acute Lymphoblastic Leukemia/Lymphoma
More informationHodgkin Lymphoma PROVIDING THE LATEST INFORMATION FOR PATIENTS & CAREGIVERS. Revised 2018
PROVIDING THE LATEST INFORMATION FOR PATIENTS & CAREGIVERS Hodgkin Lymphoma Revised 2018 Supported by an independent educational grant from Merck & Co., Inc. and Seattle Genetics, Inc. A six-word narrative
More informationIndolent Lymphomas: Current. Dr. Laurie Sehn
Indolent Lymphomas: Current Dr. Laurie Sehn Why does indolent mean? Slow growth Often asymptomatic Chronic disease with periods of relapse (long natural history possible) Incurable with current standard
More informationIndolent Lymphomas. Dr. Melissa Toupin The Ottawa Hospital
Indolent Lymphomas Dr. Melissa Toupin The Ottawa Hospital What does indolent mean? Slow growth Often asymptomatic Chronic disease with periods of relapse (long natural history possible) Incurable with
More informationLymphoma 101. Nathalie Johnson, MDPhD. Division of Hematology Jewish General Hospital Associate Professor of Medicine, McGill University
Lymphoma 101 Nathalie Johnson, MDPhD Division of Hematology Jewish General Hospital Associate Professor of Medicine, McGill University Disclosures Consultant and Advisory boards for multiple companies
More informationChange Summary - Form 2018 (R3) 1 of 12
Summary - Form 2018 (R3) 1 of 12 Form Question Number (r3) Type Description New Text Previous Text Today's date was removed 2018 N/A Today's Date Removed from Key Fields 2018 N/A HCT Type 2018 N/A Product
More informationHODGKIN LYMPHOMA Updated February 2016 by Dr. Manna (PGY 5 Hematology Resident, University of Calgary)
HODGKIN LYMPHOMA Updated February 2016 by Dr. Manna (PGY 5 Hematology Resident, University of Calgary) Reviewed by Dr. Michelle Geddes (Staff Hematologist, University of Calgary) and Dr. Matt Cheung (Staff
More informationBlood Cancers. Blood Cells. Blood Cancers: Progress and Promise. Bone Marrow and Blood. Lymph Nodes and Spleen
Blood Cancers: Progress and Promise Mike Barnett & Khaled Ramadan Division of Hematology Department of Medicine Providence Health Care & UBC Blood Cancers Significant health problem Arise from normal cells
More informationPlasma cell myeloma (multiple myeloma)
Plasma cell myeloma (multiple myeloma) Common lymphoid neoplasm, present at old age (70 years average) Remember: plasma cells are terminally differentiated B-lymphocytes that produces antibodies. B-cells
More informationHAEMATOLOGICAL MALIGNANCY
HAEMATOLOGICAL MALIGNANCY Reference Compulsory reading Haematology at Glance 2 nd ed. Atul Mehta & Victor Hoffbrand Chapters: 20 to 31 Pages: 46 to 69 Pathogenesis of Haematological Malignancy Figure (a)
More informationNON HODGKINS LYMPHOMA: INDOLENT Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary)
NON HODGKINS LYMPHOMA: INDOLENT Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary) Reviewed by Dr. Michelle Geddes (Staff Hematologist, University of Calgary) and Dr.
More informationManagement Update: Multiple Myeloma. Presented by Prof. Dr. Khan Abul Kalam Azad Professor of Medicine Dhaka Medical College
Management Update: Multiple Myeloma Presented by Prof. Dr. Khan Abul Kalam Azad Professor of Medicine Dhaka Medical College Introduction Multiple myeloma - clonal plasma cell neoplasm Monoclonal antibody
More informationBurkitt lymphoma. Sporadic Endemic in Africa associated with EBV Translocations involving MYC gene on chromosome 8
Heme 8 Burkitt lymphoma Sporadic Endemic in Africa associated with EBV Translocations involving MYC gene on chromosome 8 Most common is t(8;14) Believed to be the fastest growing tumor in humans!!!! Morphology
More informationHodgkin Lymphoma. Erica, Hodgkin lymphoma survivor
Hodgkin Lymphoma Erica, Hodgkin lymphoma survivor Revised 2016 Publication Update Hodgkin Lymphoma The Leukemia & Lymphoma Society wants you to have the most up-to-date information about blood cancer treatment.
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationLymphoma is a cancer that develops in the white blood cells (lymphocytes) of the lymphatic system, which is part of the body's immune system.
Scan for mobile link. Lymphoma Lymphoma is a cancer that develops in the white blood cells of the lymphatic system. Symptoms may include enlarged lymph nodes, unexplained weight loss, fatigue, night sweats
More informationLymphoma. Multiple myeloma.
Lymphoma. Multiple myeloma. Lymphogranulomatosis (Hodgkin's disease, Hodgkin's lymphoma). Hodgkin's Lymphoma, lymphogranulomatosis (LGM) is tumor disease, initially localized in lymphoid tissue, substratum
More informationWaldenstrom s Macroglobulinemia
Waldenstrom s Macroglobulinemia : Introduction Waldenstrom s macroglobulinemia (WM) is a lymphoma, or cancer of the lymphatic system. It occurs in a type of white blood cell called a B-lymphocyte or B-cell,
More informationUPDATE Autologous Stem Cell Transplantation for Lymphoma and Myeloma
UPDATE Autologous Stem Cell Transplantation for Lymphoma and Myeloma Supported by a grant from Supported by a grant from UPDATE Autologous Stem Cell Transplantation for Lymphoma and Myeloma Jonathan W.
More informationGuidelines for the Management of Chronic Lymphocytic Leukaemia (CLL)
Guidelines for the Management of Chronic Lymphocytic Leukaemia (CLL) Version History Version Date Summary of Change/Process 2.0 08.05.08 Endorsed by the Governance Committee 2.1 16.02.11 Circulated at
More informationHaematological Cancer Suspected (Adults & Children)
Haematological Cancer Suspected (Adults & Children) Link to NICE guidelines: https://www.nice.org.uk/guidance/ng47 Patient of any age presents with symptoms of possible haematological cancer If 60 years
More informationLymphatic System Disorders
Lymphatic System Disorders Lymphomas Malignant neoplasms involving lymphocyte proliferation in lymph nodes Specific causes not identified // Higher risk in adults who received radiation during childhood
More informationAggressive NHL and Hodgkin Lymphoma. Dr. Carolyn Faught November 10, 2017
Aggressive NHL and Hodgkin Lymphoma Dr. Carolyn Faught November 10, 2017 What does aggressive mean? Shorter duration of symptoms Generally need treatment at time of diagnosis Immediate, few days, few weeks
More informationLymphoma/CLL 101: Know your Subtype. Dr. David Macdonald Hematologist, The Ottawa Hospital
Lymphoma/CLL 101: Know your Subtype Dr. David Macdonald Hematologist, The Ottawa Hospital Function of the Lymph System Lymph Node Lymphocytes B-cells develop in the bone marrow and influence the immune
More informationPrinted by Martina Huckova on 10/3/2011 3:04:43 PM. For personal use only. Not approved for distribution. Copyright 2011 National Comprehensive
NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g. randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation
More informationHead and Neck: DLBCL
Head and Neck: DLBCL Nikhil G. Thaker Chelsea C. Pinnix Valerie K. Reed Bouthaina S. Dabaja Department of Radiation Oncology MD Anderson Cancer Center Case 60 yo male Presented with right cervical LAD
More informationNon-Hodgkin s Lymphoma
Non-Hodgkin s Lympoma Non-Hodgkin s Lymphomas Janet H. Van Cleave MSN, ACNP-CS, CS, AOCN Acute Care Nurse Practitioner The Mount Sinai Medical Center of New York City Doctoral Student, Yale University
More informationUpdate: Non-Hodgkin s Lymphoma
2008 Update: Non-Hodgkin s Lymphoma ICML 2008: Update on non-hodgkin s lymphoma Diffuse Large B-cell Lymphoma Improved outcome of elderly patients with poor-prognosis diffuse large B-cell lymphoma (DLBCL)
More informationDisclosures WOJCIECH JURCZAK
Disclosures WOJCIECH JURCZAK ABBVIE (RESEARCH FUNDING), CELGENE (RESEARCH FUNDING); EISAI (RESEARCH FUNDING); GILEAD (RESEARCH FUNDING); JANSEN (RESEARCH FUNDING); MORPHOSYS (RESEARCH FUNDING), MUNDIPHARMA
More informationRelapsed/Refractory Hodgkin Lymphoma
Relapsed/Refractory Hodgkin Lymphoma Anas Younes, MD Chief, Lymphoma Service Memorial Sloan-Kettering Cancer Center New York, New York, United States Case Study 32-year-old woman was diagnosed with stage
More informationTreatment of Waldenström s Macroglobulinemia Mayo Consensus
Treatment of Waldenström s Macroglobulinemia Mayo Consensus Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Mayo Clinic College of Medicine Mayo Clinic Comprehensive Cancer Center Mayo Clinic
More informationLymphoma and Myeloma Kris3ne Kra4s, M.D.
Lymphoma and Myeloma Kris3ne Kra4s, M.D. Hematologic Malignancies Leukemia Malignancy of hematopoie3c cells Starts in bone marrow, can spread to blood, nodes Myeloid or lymphoid Acute or chronic Lymphoma
More informationTreatment results in ALL
Treatment results in ALL Adults Complete remission (CR) 80-85% Leukemia-free survival (LFS) 30-40% Children Complete remission (CR) 95-99% Leukemia-free survival (LFS) 70-80% Combination chemotherapy in
More informationTRANSPARENCY COMMITTEE OPINION. 27 January 2010
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 27 January 2010 TORISEL 25 mg/ml, concentrate for solution and diluent for solution for infusion Box containing 1
More informationLymphatic system component
Introduction Lymphatic system component Statistics Overview Lymphoma Non Hodgkin s Lymphoma Non- Hodgkin's is a type of cancer that originates in the lymphatic system. It is estimated to be the sixth most
More informationCLINICAL MEDICAL POLICY
CLINICAL MEDICAL POLICY Policy Name: Rituxan (rituximab) Policy Number: MP-031-MD-DE Responsible Department(s): Medical Management; Clinical Pharmacy Provider Notice Date: 10/01/2017 Issue Date: 11/01/2017
More informationM-Protien, what to do next? Ismail A Sharif MD, FRCPc Internal Medicine Day 22 nd April 2016
+ M-Protien, what to do next? Ismail A Sharif MD, FRCPc Internal Medicine Day 22 nd April 2016 + Disclosures Advisory Boards: AMGEN, Lundbeck, NOVARTIS + Subtypes of Plasma Cell Disorders Increased Plasma
More informationStandard Regimens for Haematology
Regimens for Haematology ChlVPP Chlorambucil 6mg/m 2 PO D1 to 14 Vinblastine 6mg/m 2 (max 10mg) IV on D1 & 8 Procarbazine 100mg/m 2 PO on D1 to 14 Prednisolone 40mg PO D1 to 14 ABVD Doxorubicin 25mg/m
More informationCase Study Discussions on the Nurse s Role in Caring for Patients With Hematologic Malignancies
Case Study Discussions on the Nurse s Role in Caring for Patients With Hematologic Malignancies Case Study Discussions on the Nurse s Role in Caring for Patients With Hematologic Malignancies Welcome and
More informationWaldenstrom s Macroglobulinemia
Waldenstrom s Macroglobulinemia : Monoclonal Antibodies Introduction Waldenstrom s macroglobulinemia (WM) is a lymphoma, or cancer of the lymphatic system. It occurs in a type of white blood cell called
More informationHodgkin s disease/lymphoma. Dr. Horváth Laura
Hodgkin s disease/lymphoma Dr. Horváth Laura Characteristics of classical Hodgkin lymphoma Type of malignant lymphoma in which Reed- Sternberg cells are present in a characteristic background of reactive
More informationVelcade (bortezomib)
Velcade (bortezomib) Line(s) of Business: HMO; PPO; QUEST Integration Medicare Advantage Original Effective Date: 03/09/2004 Current Effective Date: 03/01/2018 POLICY A. INDICATIONS The indications below
More informationLugano classification: Role of PET-CT in lymphoma follow-up
CAR Educational Exhibit: ID 084 Lugano classification: Role of PET-CT in lymphoma follow-up Charles Nhan 4 Kevin Lian MD Charlotte J. Yong-Hing MD FRCPC Pete Tonseth 3 MD FRCPC Department of Diagnostic
More informationClinical Commissioning Policy Proposition: Bendamustine with rituximab for relapsed indolent non-hodgkin s lymphoma (all ages)
Clinical Commissioning Policy Proposition: Bendamustine with rituximab for relapsed indolent non-hodgkin s lymphoma (all ages) Reference: NHS England 1607 1 First published: TBC Prepared by NHS England
More informationBarbara Barnes Rogers, CRNP, MN, AOCN, ANP-BC Adult Hematology-Oncology Nurse Practitioner Fox Chase Cancer Center Philadelphia, Pennsylvania
Barbara Barnes Rogers, CRNP, MN, AOCN, ANP-BC Adult Hematology-Oncology Nurse Practitioner Fox Chase Cancer Center Philadelphia, Pennsylvania Barbara.rogers@fccc.edu Disclosures Barbara Rogers, CRNP, MN,
More informationNICE guideline Published: 20 July 2016 nice.org.uk/guidance/ng52
Non-Hodgkin s lymphoma: diagnosis and management NICE guideline Published: 20 July 2016 nice.org.uk/guidance/ng52 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationUnderstanding your diagnosis. Dr Graham Collins Consultant Haemtologist Oxford University Hospitals
Understanding your diagnosis Dr Graham Collins Consultant Haemtologist Oxford University Hospitals Common questions I get asked What is lymphoma? What subtype do I have and what does that mean? What are
More informationLymphocyte Predominant Hodgkin s Lymphoma. Case Presentation. How would you treat the patient?
Lymphocyte Predominant Hodgkin s Lymphoma Wei Ai, MD, PhD Assistant Clinical Professor University of California, San Francisco January 2010 Case Presentation 32 yo male, diagnosed with stage IIIA lymphocyte
More informationNON HODGKINS LYMPHOMA: AGGRESSIVE Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary)
NON HODGKINS LYMPHOMA: AGGRESSIVE Updated June 2015 by Dr. Manna (PGY-5 Medical Oncology Resident, University of Calgary) Reviewed by Dr. Michelle Geddes (Staff Hematologist, University of Calgary) and
More informationNew Evidence reports on presentations given at EHA/ICML Bendamustine in the Treatment of Lymphoproliferative Disorders
New Evidence reports on presentations given at EHA/ICML 2011 Bendamustine in the Treatment of Lymphoproliferative Disorders Report on EHA/ICML 2011 presentations Efficacy and safety of bendamustine plus
More informationSURVIVORSHIP WITH LYMPHOMA APRIL SHAMY MD,CM JEWISH GENERAL HOSPITAL MCGILL UNIVERSITY
SURVIVORSHIP WITH LYMPHOMA APRIL SHAMY MD,CM JEWISH GENERAL HOSPITAL MCGILL UNIVERSITY Some Statistics Approximately 1 in 2 Canadians develop cancer 25% of Canadians die of cancer 2009: 810,000 Canadians
More informationBortezomib (Velcade)
Bortezomib (Velcade) Policy Number: Original Effective Date: MM.04.003 03/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 06/01/2015 Section: Prescription Drugs Place(s)
More informationRadiation and Hodgkin s Disease: A Changing Field. Sravana Chennupati Radiation Oncology PGY-2
Radiation and Hodgkin s Disease: A Changing Field Sravana Chennupati Radiation Oncology PGY-2 History of Present Illness 19 yo previously healthy male college student began having pain in his R shoulder
More informationOverview of Cutaneous Lymphomas: Diagnosis and Staging. Lauren C. Pinter-Brown MD, FACP Health Sciences Professor of Medicine and Dermatology
Overview of Cutaneous Lymphomas: Diagnosis and Staging Lauren C. Pinter-Brown MD, FACP Health Sciences Professor of Medicine and Dermatology Definition of Lymphoma A cancer or malignancy that comes from
More informationNHS England. Evidence review: Bendamustine with Rituximab for relapsed low-grade Non- Hodgkin s Lymphoma
NHS England Evidence review: Bendamustine with Rituximab for relapsed low-grade Non- Hodgkin s Lymphoma NHS England Evidence review: Bendamustine with Rituximab for relapsed low-grade Non- Hodgkin s Lymphoma
More informationVelcade (bortezomib)
Velcade (bortezomib) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Original Effective Date: 03/09/2004 Current Effective Date: 05/01/2017 POLICY A. INDICATIONS The indications below
More informationPatterns of Care in Medical Oncology. Follicular Lymphoma
Patterns of Care in Medical Oncology Follicular Lymphoma CASE 1: A 72-year-old man with multiple comorbidities including COPD/asthma presents with slowly progressive cervical adenopathy. Bone marrow biopsy
More informationPathology of Hematopoietic and Lymphoid tissue
CONTENTS Pathology of Hematopoietic and Lymphoid tissue White blood cells and lymph nodes Quantitative disorder of white blood cells Reactive lymphadenopathies Infectious lymphadenitis Tumor metastasis
More informationNodular lymphocyte predominant Hodgkin lymphoma. Lymphoma Tumor Board. January 5, 2018
Nodular lymphocyte predominant Hodgkin lymphoma Lymphoma Tumor Board January 5, 2018 Etiology Subtypes of Classical Hodgkin Lymphoma (chl)* Nodular sclerosing HL Most common subtype Composed of large tumor
More informationStrategies for the Treatment of Elderly DLBCL Patients, New Combination Therapy in NHL, and Maintenance Rituximab Therapy in FL
New Evidence reports on presentations given at ASH 2009 Strategies for the Treatment of Elderly DLBCL Patients, New Combination Therapy in NHL, and Maintenance Rituximab Therapy in FL From ASH 2009: Non-Hodgkin
More informationGerman Hodgkin Study Group
German Hodgkin Study Group Deutsche Hodgkin Studiengruppe Avoiding Relapse of Hodgkin Lymphoma: Have We Moved The Needle? Andreas Engert, MD Chairman, German Hodgkin Study Group University Hospital of
More informationLymphoma: The Basics. Dr. Douglas Stewart
Lymphoma: The Basics Dr. Douglas Stewart Objectives What is lymphoma? How common is it? Why does it occur? How do you diagnose it? How do you manage it? How do you follow patients after treatment? What
More informationPage 1 of 9 Title Authored By Course No Contact Hours 2 ABCs of Lymphoma Anita Rothera RNC, BS, CDE LYM020108 Purpose The goal of this course is to help health care professionals learn about the different
More informationUpdate in Lymphoma Imaging
Update in Lymphoma Imaging Victorine V. Muse, MD Lymphoma Update in Lymphoma Imaging Victorine V Muse, MD Heterogeneous group of lymphoid neoplasms divided into two broad histological categories Hodgkin
More informationCorporate Medical Policy
Corporate Medical Policy Hematopoietic Cell Transplantation for Hodgkin Lymphoma File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_cell_transplantation_for_hodgkin_lymphoma
More informationBlood Cancers in the Community
Over to you, mate Blood Cancers in the Community National Rural Health Conference NZ Rural General Practice Network April 7, 2018 Brian Grainger Haematology Registrar Auckland Acknowledgements Dr James
More informationThis is a controlled document and therefore must not be changed or photocopied L.80 - R-CHOP-21 / CHOP-21
R- / INDICATION Lymphoma Histiocytosis Omit rituximab if CD20-negative. TREATMENT INTENT Disease modification or curative depending on clinical circumstances PRE-ASSESSMENT 1. Ensure histology is confirmed
More informationLONDON CANCER NEWS DRUGS GROUP RAPID REVIEW
LONDON CANCER NEWS DRUGS GROUP RAPID REVIEW Bortezomib as first line induction prior to melphalan and autologous stem cell transplantation (ASCT) in untreated symptomatic multiple myeloma patients suitable
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Hodgkin s Lymphoma in Children Aged 6 Years Or Below- Long Term Follow Up Results Giri G V
More informationHematology 101. Rachid Baz, M.D. 5/16/2014
Hematology 101 Rachid Baz, M.D. 5/16/2014 Florida 101 Epidemiology Estimated prevalence 8,000 individuals in U.S (compare with 80,000 MM patients) Annual age adjusted incidence 3-8/million-year 1 More
More informationHODGKIN DISEASE. What is cancer?
HODGKIN DISEASE What is cancer? Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of
More informationLeukemias. Prof. Mutti Ullah Khan Head of Department Medical Unit-II Holy Family Hospital Rawalpindi Medical College
Leukemias Prof. Mutti Ullah Khan Head of Department Medical Unit-II Holy Family Hospital Rawalpindi Medical College Introduction Leukaemias are malignant disorders of the haematopoietic stem cell compartment,
More informationB-cell lymphoma vaccine (BiovaxID) for follicular non-hodgkin s lymphoma
B-cell lymphoma vaccine (BiovaxID) for follicular non-hodgkin s lymphoma May 2010 This technology summary is based on information available at the time of research and a limited literature search. It is
More informationA Female Van Driver with a Swollen Arm
A Female Van Driver with a Swollen Arm Charles D Forbes,* William F Jackson,** A 28-year-old female van driver presented with a 5 day history of a swollen, painful left arm. The swelling had started shortly
More informationBLOOD AND LYMPH CANCERS
BLOOD AND LYMPH CANCERS 2 Blood and Lymph Cancers Highlights from the 2009 Annual Meeting of the American Society of Clinical Oncology Edited by Kenneth C. Anderson, MD Harvard Medical School and Dana-Farber
More informationLymphoma Read with the experts
Lymphoma Read with the experts Marc Seltzer, MD Associate Professor of Radiology Geisel School of Medicine at Dartmouth Director, PET-CT Course American College of Radiology Learning Objectives Recognize
More informationThe Lymphoma Guide Information for Patients and Caregivers
The Lymphoma Guide Information for Patients and Caregivers Ashton, lymphoma survivor This publication was supported by Revised 2016 Publication Update The Lymphoma Guide: Information for Patients and Caregivers
More informationLymphoma: What You Need to Know
Lymphoma: What You Need to Know www.lymphoma.org.au Lymphoma What You Need to Know Whilst Lymphoma Australia (LA) has made every effort to confirm the accuracy of the information contained herein, it makes
More informationTRANSPARENCY COMMITTEE OPINION. 8 November 2006
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 8 November 2006 MABTHERA 100 mg, concentrate for solution for infusion (CIP 560 600-3) Pack of 2 MABTHERA 500 mg,
More informationDIAGNOSIS AND TREATMENT OF WALDENSTRÖM S MACROGLOBULINAEMIA IN THE NETHERLANDS. Monique Minnema UMC Utrecht
DIAGNOSIS AND TREATMENT OF WALDENSTRÖM S MACROGLOBULINAEMIA IN THE NETHERLANDS Monique Minnema UMC Utrecht Organisation of hematological care in the Netherlands Intensive chemotherapy, including acute
More informationWHAT ARE PAEDIATRIC CANCERS
WHAT ARE PAEDIATRIC CANCERS INTRODUCTION Childhood cancers are RARE 0.5% of all cancers in the West Overall risk that a child will develop cancer during first 15 years of life is 1 in 450 and 1 in 600
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 18 July 2012
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 18 July 2012 MABTHERA 100 mg, concentrate for solution for infusion B/2 (CIP code: 560 600-3) MABTHERA 500 mg, concentrate
More information37 Novel Therapies for
37 Novel Therapies for Multiple Myeloma Abstract: Current standard of management for newly diagnosed multiple myeloma are continuously evolving due to the advent of a number of novel agents with different
More informationDiagnosis and patient pathway in lymphomas
The Royal Marsden Diagnosis and patient pathway in lymphomas Dr Ian Chau Consultant Medical Oncologist The Royal Marsden Hospital London & Surrey Change Presentation title and date in Footer dd.mm.yyyy
More informationPathology of Hematopoietic and Lymphoid tissue
Pathology of Hematopoietic and Lymphoid tissue Peerayut Sitthichaiyakul, M.D. Department of Pathology and Forensic Medicine Faculty of Medicine, Naresuan University CONTENTS White blood cells and lymph
More informationYESCARTA (axicabtagene ciloleucel)
YESCARTA (axicabtagene ciloleucel) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices
More informationLung hilar Ga-67 uptake in patients with lymphoma following chemotherapy
ORIGINAL ARTICLE Annals of Nuclear Medicine Vol. 18, No. 5, 391 397, 2004 Lung hilar Ga-67 uptake in patients with lymphoma following chemotherapy Emel Ceylan GUNAY,* Bilge Volkan SALANCI,* Ibrahim BARISTA**
More information2012 by American Society of Hematology
2012 by American Society of Hematology Common Types of HIV-Associated Lymphomas DLBCL includes primary CNS lymphoma (PCNSL) Burkitt Lymphoma HIV-positive patients have a 60-200 fold increased incidence
More informationHodgkin and Non-Hodgkin Lymphoma (LYM) Post-Infusion Data
Hodgkin and Non-Hodgkin Lymphoma (LYM) Post-Infusion Data Registry Use Only Sequence Number: Date Received: CIBMTR Center Number: CIBMTR Research ID: Event date: / / Visit 100 day 6 months 1 year 2 years
More information