Overview of Lymphomas

Overview of Lymphomas

• Lymphomas are cancers of the lymphatic system.
• Can present with a lump in the neck, armpit, or groin.
• Can affect the chest and abdomen, which may only be detected on scans.
• Can affect the function of an organ leading to related symptoms.
• Can cause bone marrow failure, leading to fatigue, loss of appetite, weight loss, fever, and night sweats.
• Can occur almost anywhere in the body, including the brain, eye, and skin.

Classification of Lymphomas

• WHO Lymphoma Types:
  • Precursor B-lymphoblastic leukemia/lymphoma
  • Precursor T-lymphoblastic leukemia/lymphoma
  • Aggressive NK-Cell leukemia
  • Burkitt's lymphoma/leukemia
  • Extranodal NK/T-cell nasal type
  • Diffuse large B-cell lymphoma
  • Anaplastic large cell lymphoma
  • Prolymphocytic leukemia
  • Adult T cell lymphoma/leukemia
  • Mantle cell lymphoma
  • T cell prolymphocytic leukemia
  • Chronic lymphocytic leukemia
  • Enteropathy-associated T-cell lymphoma
  • Lymphoplasmacytic lymphoma
  • Hepatosplenic gamma/delta T-cell lymphoma
  • Marginal zone lymphoma
  • Subcutaneous panniculitis-like T-cell lymphoma
  • Hairy cell leukemia
  • Peripheral T cell lymphoma, NOS
  • Follicular lymphoma
  • Angioimmunoblastic T cell lymphoma
  • Mycosis fungoides/Sézary syndrome
  • T-cell large granular lymphocytic leukemia
  • Hodgkin’s lymphoma

Lymphoma Management

• Intention of Management:

  • Curative: Usually for aggressive malignancies, with intensive chemotherapy and other treatments.
  • Non-Curative (Control): Usually for indolent malignancies, with less intensive treatments.

• Management Options:

  • Chemotherapy
  • Radiation Therapy
  • Immunotherapy:
    • Monoclonal antibodies
    • Cellular therapy (allogeneic stem cell transplant)
    • Immunostimulants
    • CAR (chimeric antigen receptor) T-cell therapy
  • Targeted therapy

• Treatment Considerations:

  • Disease factors: low-grade vs high-grade lymphoma
  • Patient factors: fitness
  • Drug efficacy and toxicity

Prognostic Factors for Diffuse Large B Cell Lymphoma (DLBCL)

• Clinical:
  • Age
  • Performance status
  • LDH levels
  • Extranodal sites
  • Stage
• Biologic:
  • Cell of origin (germinal center or non-GC)
  • Double-hit (c-myc, Bcl-2)
  • Molecular subtype

Treatment of Diffuse Large B Cell Lymphoma (DLBCL)

• R-CHOP Regimen: One of the standard treatment regimens for DLBCL.
• R-CHOP with Polatuzumab Vedotin (Pola): Shows superior outcomes compared to R-CHOP.
• Other Novel Therapies: CAR T-cell therapy, targeted therapies are emerging options in treating DLBCL.