Non-Hodgkin's lymphoma - Chronic
Rahul Soman, M. Pharm
Definition
A heterogeneous group of lymphoproliferative malignancies, each with characteristic patterns of behavior and responses to treatment
Medical History
* Past medical history of Epstein-Barr virus infection
* Past medical history of Helicobacter-associated gastritis
* HIV positive
* History of Antineoplastic Agent use
* Past medical history of Radiation therapy procedure or service
* Family history of Non-Hodgkin's lymphoma
Findings
* Dysphagia - Chronic
* Splenomegaly
* Lymphadenopathy
* Abdominal pain
* Chest pain
* Cough
* Fatigue
* Fever
* Malaise
* Night sweats
* Weight loss
Tests
Suspected and known lymphoma
* Excision of lymph node: If malignancy is strongly considered, a lymph node biopsy is indicated and consultation with a hematologist/oncologist sought immediately.
Suspected and known lymphoma
* Complete blood count with white cell differential, manual: A CBC with differential is sometimes helpful in the diagnosis of lymphoma and in ruling out non-lymphomatous causes of lymphadenopathy, although normal results do not rule out disease.
Lymphoma
* Plasma lactate dehydrogenase measurement: Lactic dehydrogenase (LDH) is a useful test for assessing risk and monitoring progress in lymphomatous disease .
Laboratory evaluation of non-Hodgkin lymphoma
* Hepatic function panel
* Biochemical evaluation of blood urea/renal function
* Blood electrolyte measurement
* Hepatitis B screening test
Initial imaging studies for evaluation of non-Hodgkin lymphoma
* Plain chest X-ray
* Computerized axial tomography
Hodgkin disease and non-Hodgkin lymphoma
* Bone marrow biopsy, needle or trocar: Bone marrow aspiration and biopsy may be recommended in select cases of lymphoma for evaluation, diagnosis, or staging .
Differential Diagnosis
* Hodgkin's disease - Chronic
* Pharyngitis - Acute
* Epstein-Barr virus infection
* Cytomegalovirus infection - Acute
* Toxoplasmosis - Acute
* Cat scratch disease - Acute
* Herpesvirus infection
* Sarcoidosis - Chronic
* Brucellosis - Acute
* Acute lymphoid leukemia - Acute
* Tuberculosis - Chronic
* Neoplasm of head and neck
* Lung cancer
* Breast cancer - Chronic
* Malignant tumor of thyroid gland - Chronic
Treatment
Drug Therapy
Non-Hodgkin's lymphoma
RITUXIMAB
CYCLOPHOSPHAMIDE
DOXORUBICIN HYDROCHLORIDE
VINCRISTINE SULFATE
ETOPOSIDE \
FLUDARABINE PHOSPHATE
IFOSFAMIDE
CYTARABINE
METHOTREXATE SODIUM
PREDNISONE
DEXAMETHASONE
TOSITUMOMAB
Procedural Therapy
Non-Hodgkin lymphoma
* Radiation therapy: Radiotherapy alone may be curative in early non-Hodgkin lymphoma, and often is used in conjunction with chemotherapy in more advanced disease .
Relapsed non-Hodgkin lymphoma
* Hemopoietic stem cell transplant
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