Continue....

TREATMENT GROUPS

Treatment of Recurrent Non-Hodgkin's Lymphoma

Aggressive treatment should be considered for patients who relapse after completion of therapy. Following induction of remission, allogenic or autologous bone marrow transplantation should be considered.

Radiation Therapy

Generally, radiotherapy is not indicated on an elective basis. It is only indicated for acute life-threatening complications, such as superior vena cava syndrome, ureteric obstruction from the tumor, or hyperbilirubinemia from severe liver involvement, which might preclude initiation of chemotherapy at diagnosis. In B-cell NHL with central nervous system (CNS) involvement, cranial irradiation should not be used. The use of cranial irradiation for CNS prophylaxis is controversial. However, it is used in many of the protocols to treat advanced-stage lymphoblastic lymphoma.

Surgical Therapy

The role of surgery in NHL treatment is limited. It should be performed on patients in whom there is good reason to believe that total resection can be achieved (e.g. localized bowel disease) without a mutilating procedure (e.g. amputation, extensive faciomaxillary surgery, exenterations) or an excessively risky procedure. Patients with widespread lymphoma are not eligible for surgical resection, but the presence of single nonresectable mass in addition to a totally resectable mass will not exclude patients from surgical treatment.

Table 6. Factors Associated with Favorable and Unfavorable Prognosis

Favorable Prognosis

• Primary site
• Stage I and II : Head and neck (non-parameningeal)
• Peripheral nodes
• Abdominal site : 80% or greater 2-year survival (recurrence after 2 years rare)

Unfavorable Prognosis

• Stage of disease : Stage III or IV
• Stage IV with CNS involvement : Worst prognosis
• Site of disease:
  
  
  • Parameningeal stage II
  • All stages of extranodal, extralymphatic NHL in head and neck area (sinus, jaw, orbit, scalp)
  • Presence of pleural effusion in stage III small noncleaved cell lymphoma

Incomplete initial remission within 2 months
Soluble IL-2R level : > 1000 units/ml
Lactic dehydrogenase (LDH) level : > 1000 units/l
Uric acid level : > 7.1 ug/dl