FOLLICULAR LYMPHOMAS AND MANTLE
FOLLICULAR LYMPHOMA
THE mass TUMORALE specialists include follicular lymphomas into two major groups according to the tumor mass.
The strong tumor mass lymphomas
THE DECISION TO START A CYTOTOXIC TREATMENT...
It is based on specific clinical criteria that have been developed and validated by him GELA and the BNLI.
The clinical criteria of the GELA they combine:
A strong tumor mass, defined by: a tumor more of 7 cm, 3 more affected lymph node areas of 3 cm, symptomatic splenomegaly, a breach of the PEL
The presence of B symptoms
An increase of the LDH and β2 microglobulin
BNLI Ils criteria are based on the other on the following criteria:
A rapid progression of the disease (within 3 months)
A breach of the bodies said to be vital, extra-nodale impairment (kidney, liver, reached bone)
The presence of B symptoms
Spinal cord failure by Medullary infiltration (Hg < 10 g/dl;) GB < 3 x 10 9/l or inserts < 100 x 10 9 L)
PROGNOSTIC INDEX
The overall PS > 2
The presence of clinical signs B
Adenocarcinoma: > 7 cm, > 3 sites > 3 cm a fluid effusion of PEL, ascites, Pleurisy
The existence of a compressive syndrome
More than two extra-nodales locations
A high rate of LDH
A beta2 microglobulinemie rate higher than 3 mg/l.
LOW TUMOR MASS FOLLICULAR LYMPHOMAS
A SIMPLE monitoring given the slow progressive disease, monitoring without treatment may be considered, especially in the elderly, if the tumor mass is low, the asymptomatic patient, if the questioning is the notion little evolutionary Lymphadenopathy known for a long time. Indeed, in almost 20% of the cases, spontaneous regression of the Lymphadenopathy, transients can be observed.
In I0 stages where there is more residual adenopathy after the biopsy with resection, abstention may be recommended.
TREATMENT stages I and II this localized forms are only accountable forms of radiation therapy. It will be applied on the nodes of the affected area.
A weekly injection of Mabthera™ for a month is a possible alternative.
Forms in stages III and IV two options can you are proposed. A treatment at least orally, by clinical™ or the Cytoxan™. This treatment will impose the follow-up of your counts (NFS).
You may, also, be offered treatment with Mabthera™.
LYMPHOMAS FOLLICULAR ADENOCARCINOMA STRONG
OBJECTIVES the objective of the treatment is obtaining a comprehensive, clinical and molecular remission which determines the further development of the disease and its prognosis.
THE criteria a significant tumor mass is defined by the presence of one at least of the following criteria: tumor mass originally > 7 cm
Achievement of at least 3 ganglion sites (each > 3 cm)
Systemic symptoms (weight loss > 10%, fever > 38 ° C for more than 8 days or night sweats)
An increase in the size of the spleen (splenomegaly) exceeding the umbilicus
A syndrome of compression or obstruction of a major organ, a breach of orbital or epidural, the serous effusions (risk of compression).
THE IMMUNO-CHEMOTHERAPY
The first line treatment of the standard treatment combines a multidrug, usually of type R - CVP (rituximab, cyclophosphamide, vincristine at reduced doses, prednisone) or R-CHOP (rituximab, cyclophosphamide, doxorubicin, Vincristine and prednisone).
It is administered on a day for 6-8 spaced cycles of 3 weeks.
If this treatment is impossible in the case of contraindication to rituximab, for example, a CHOP-interferon alpha association can be proposed.
Its goal of consolidation treatment is of "consolider" complete the remission induced by the chemo-immunotherapy of induction and prevent relapses because all clinical research trials have shown this treatment to prolong the duration of " remission and increasing the rate of complete remissions, clinical and molecular.
The consolidation therapy is called upon by rituximab immunotherapy. This medication will be administered until disease progression or for a maximum period of 2 years.
The second-line treatment in the absence of response to treatment of first line, ibritumomab (Zevalin™) quality may be an option in the second line if the initial immunochimiotherapie consisted of rituximab.
Treatment scheme consists of two intravenous administration of rituximab and Zevalin™ administration 1'.
In case of relapse relapses are fairly common, ganglion, or extra-ganglionnaires, regardless of the site initially reached.
Treatment of consolidation by a transplant of haematopoietic stem cell (bone marrow ex-greffe) may be considered.
Radio-immunotherapy by ibritumomab (Zevalin™) is indicated for follicular Lymphoma in treatment of relapses after treatment with rituximab.
OTHER LOW GRADE LYMPHOMAS
OF WHAT IS?
Apart from the follicular lymphomas, your doctor can have talked you to one of the following diseases, diffuse Lymphoma in small lymphocytes which is chronic lymphoid leukemia to ganglionic location, a Lymphoma of the coat or Lymphoma of the MALT
THE GUIDANT principles the therapeutic choice treatment of lymphomas is function:
The type of cells proliferating
The stage of the disease.
Your age
Of the existence or not of bad prognosis factors.
Outside the more aggressive lymphomas of the mantle that fall within a specific therapeutic approach, other forms of low grade Lymphoma, have a common therapeutic approach with that of follicular lymphomas.
Most of the teams agree to deal only with lymphomas that present strong tumor masses criteria:
A tumor mass greater than 7 cm
More than three masses greater than 3 cm
Impairment of the general condition, the liqidiens, blood Cytopenias effusions
Two conflicting considerations must be taken into account in the choice of treatment. On the one hand the spontaneous evolution is slow, over several years with an excellent life for the most part. As a result, the initial treatment must have a mortality zero and reduced morbidity. On the other hand, the response to the initial treatment, prognostic factor, in case of failure, the more intensive therapeutic attempts are, then, justified.
LYMPHOMAS OF THE COAT
There is no reference chemotherapy.
Conventional treatment includes 4 to 8 cycles of CHOP or CVAD associated or not with radiation therapy. The use of rituximab (Mabthera™) has become widespread, "R" in the protocols. " The other options, often with autograft, possible are:
R CHOP
CHOP/DHAP with autograft
Rhyper-CVAD/MTX
R - DHAP with or without autograft (R) CHOP with autograft
R maxiCHOP/R-DHAP with autograft
Recently, very promising results obtained with the proteasome inhibitor Velcade™ could lead to a new treatment option. This drug is currently approved only for the treatment of second-line multiple myeloma.
BTK inhibitors seem promising.
Other options can be proposed based on the initial assessment of extension, as an allogeneic bone marrow transplant.
IN CASE OF RELAPSE
THE context of low-grade lymphomas or "indolents" are diseases that tend to become chronic and that expose so relapses that can be controlled. "
Important factors to determine the type of treatment and intensity are, age, the nature of the first treatment, the free time before the relapse, the existence of a resistance to rituximab, histological type, especially if there is a transformation and FLIPI index.
THE ways they include chemotherapy associated or not with rituximab.
The Hematologists can use, bendamustine, fludarabine, chlorambucil with or without autograft of hematopietiques stem cells. You may also be offered a radio-immunotherapy with the Zevalin™.
The other option is an immunotherapy with new monoclonal antibodies.
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