Upon completion of the chapter, the reader will be able to:
Discuss the underlying pathophysiologic mechanisms of the lymphomas and how they relate to presenting symptoms of the disease.
Differentiate the pathologic findings of Hodgkin lymphoma (HL), follicular indolent non-Hodgkin lymphoma (NHL), and diffuse aggressive NHL and how this information yields a specific diagnosis.
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, and the International Prognostic Index for diffuse, aggressive NHL.
Compare and contrast the treatment algorithms for early and advanced stage disease for HL.
Delineate the clinical course of follicular indolent and diffuse aggressive NHL and the implications for disease classification schemes and treatment goals.
Outline the general treatment approach to follicular indolent and diffuse aggressive NHL for localized and advanced disease.
Interpret the current role for monoclonal antibody therapy in NHL.
Assess the role of autologous hematopoietic stem cell transplantation for relapsed lymphomas.
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. 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. KEY CONCEPT There are two broad classifications of lymphoma, Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), and both contain numerous histologic subtypes that are pathologically distinct disease entities.
Representation of the anatomic regions used in the staging of Hodgkin disease. (From Rosenberg SA. Staging of Hodgkin disease. Radiology. 1966;87:146.)
The clinical course varies widely among histologies of lymphoma. More aggressive lymphoma subtypes are highly proliferating tumor cells that require aggressive therapeutic intervention with chemotherapy, radiation therapy, or both. By contrast, certain subtypes of NHL are characterized by a disease course that flares and remits intermittently over a period of years regardless of treatment.
EPIDEMIOLOGY AND ETIOLOGY
Approximately 9050 new cases of HL were estimated to be diagnosed in the United States in 2015, with 1150 deaths attributed to the disease.1 The incidence of HL is bimodal, with its peaks occurring in the third decade of life and in patients older than 50 years of age.2 The precise cause of HL is unknown, but certain associations have been reported and provide insight about possible etiologic factors. Epstein-Barr virus (EBV) has been associated with HL, its viral genome is detected in Reed-Sternberg (RS) cells in up to 40% of cases in developed countries. Other viruses ...