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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the underlying pathophysiologic mechanisms of the lymphomas and how they relate to presenting symptoms of the disease.

  2. Differentiate the pathologic findings of Hodgkin's lymphoma (HL), follicular indolent non-Hodgkin's lymphoma (NHL), and diffuse aggressive NHL and how this information yields a specific diagnosis.

  3. Describe the general staging criteria for the lymphomas and how it relates to prognosis; evaluate the role of the prognostic systems such as the International Prognostic Score for HL, the Follicular Lymphoma International Prognostic Index (FLIPI), and the International Prognostic Index (IPI) for diffuse, aggressive NHL.

  4. Compare and contrast the treatment algorithms for early and advanced stage disease for HL.

  5. Delineate the clinical course of follicular indolent and diffuse aggressive NHL and the implications for disease classification schemes and treatment goals.

  6. Outline the general treatment approach to follicular indolent and diffuse aggressive NHL for localized and advanced disease.

  7. Interpret the current role for monoclonal antibody therapy in NHL.

  8. Assess the role of autologous hematopoietic stem cell transplantation (SCT) for relapsed lymphomas.

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KEY CONCEPTS

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  • Image not available. There are two broad classifications of lymphoma, Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL), and both contain numerous histologic subtypes that are pathologically distinct disease entities.

  • Image not available. Specific pathologic characteristics distinguishing HL from NHL include morphology, cell surface antigens, and chromosomal mutations.

  • Image not available. Classic signs and symptoms of the lymphomas include lymphadenopathy and B symptoms (i.e., fever, night sweats, and weight loss).

  • Image not available. The diagnosis of malignant lymphomas is established by tumor biopsy sample, analysis of the biopsy tissue, and determination of the extent of the disease in the patient.

  • Image not available. The goal of treatment of HL is cure for all stages of disease and first relapse.

  • Image not available. Initial treatment of HL includes combination chemotherapy, these regimens have demonstrated efficacy and have an acceptable long-term toxicity profile.

  • Image not available. Follicular indolent NHL is incurable, so therapy goals focus on inducing and maintaining remission duration while minimizing treatment-related toxicities.

  • Image not available. Diffuse, aggressive NHL centers on curative-intent therapy using anthracycline-based combination chemotherapy for initial treatment and high-dose chemotherapy with autologous stem cell transplantation for relapsed disease.

  • Image not available. The recombinant monoclonal antibody rituximab is an effective treatment option for patients with B-cell origin CD20+ NHL as a single agent and enhances the efficacy of combination chemotherapy regimens.

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INTRODUCTION

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The malignant lymphomas are a clonal disorder of hematopoiesis with the primary malignant cells consisting of lymphocytes of B-, T-, or natural killer (NK) cell origin. These cells originate from a small population of lymphocytes that have undergone malignant transformation from a series of genetic mutations. Lymphoma cells predominate in the lymph nodes; however, they can infiltrate lymphoid and nonlymphoid tissues, such as the bone marrow, central nervous system (CNS), gastrointestinal (GI) tract, liver, mediastinum, skin, and spleen. An overview of the lymph node regions is depicted in Figure 97–1. Image not available. There are two broad classifications of lymphoma, Hodgkin's lymphoma (HL) and ...

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