Klinikum Grosshadern, Med. Klinik III, Hämatologie/Onkologie, München, Germany
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Incidence |
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Diagnosis |
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Fine-needle aspirations or core biopsies are inappropriate for a proper diagnosis and should only be used in the rare patients requiring emergency treatment.
The histological report should give the diagnosis according to the WHO classification.
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Staging and risk assessment |
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A complete blood count, routine blood chemistry including LDH and uric acid as well as screening tests for HIV and hepatitis B and C are required.
The staging is given according to the Ann Arbor system with mentioning of bulky disease.
For prognostic purposes, the International Prognostic Index (IPI) is recommended by several groups, although its relevance for follicular lymphomas is not proven [III, C].
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Treatment plan |
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In the large proportion of patients with advanced stage III and IV disease no curative therapy is yet established. Since the natural course of the disease is characterised by spontaneous regressions in 1520% of cases and varies from case to case, it is appropriate to initiate chemotherapy upon the occurrence of symptoms including B-symptoms, haematopoietic impairments, bulky disease or lymphoma progression [II, B].
Primary chemotherapy includes combination regimens such as COP, CHOP or single agents such as fludarabine or chlorambucil. The addition of anti-CD20 antibodies to initial chemotherapy is under investigation. Purine analogues have not proven superior to conventional cytoreductive regimens [II, B].
After initial treatment the standard procedure is wait and see. Further treatment modalities, i.e. interferon or myeloablative radiochemotherapy followed by autologous stem cell transplantation, are investigational [II, B].
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Response evaluation |
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Follow-up |
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Blood count and LDH at 3, 6, 12 and 24 months, then only as needed for evaluation of suspicious symptoms.
Evaluation of thyroid function in patients with irradiation to the neck at 1, 2 and 5 years.
Minimal adequate radiological or ultrasound examinations at 6, 12 and 24 months after end of treatment.
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Note |
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Literature |
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Coordinating author for the ESMO Guidelines Task Force: W. Hiddemann, Klinikum Grosshadern, Med. Klinik III, Hämatologie/Onkologie, München, Germany.
Approved by the ESMO Guidelines Task Force: August 2002.
Correspondence to:
ESMO Guidelines Task Force
ESMO Head Office
Via La Santa 7
CH-6962 Viganello-Lugano
Switzerland
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References |
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2. Stuschke M, Hoederath A, Sack H. Extended field and total central lymphatic radiotherapy for early stages nodal centroblasticcentrocytic lymphoma: results of a prospective multicenter study. Cancer 1997; 80: 22732284.[CrossRef][ISI][Medline]
3. Horning SJ, Rosenberg SA. The natural history of initially untreated low-grade non-Hodgkins lymphomas. N Engl J Med 1984; 311: 14711475.[Abstract]
4. Solal-Céligny P, Lepage E, Brousse N et al. Doxorubicin-containing regimen with or without interferon alpha2b for advanced follicular lymphomas: final analysis of survival and toxicity in the Groupe dEtude des Lymphomes Folliculaires 86 trial. J Clin Oncol 1998; 16: 23322338.[Abstract]
5. Hiddemann W, Unterhalt M., Wandt H et al. Myeloablative radiochemotherapy followed by blood-stem cell-transplantation significantly prolongs the disease-free interval in patients with low-grade lymphomas as compared to standard maintenance with interferon alpha: results of a prospective randomized comparison by the German Low Grade Lymphoma Study Group (GLSG). Blood 1998; 94 (Suppl 1): 610a (Abstr 2715).