DOCSLIB.ORG

Hodgkin Lymphoma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hodgkin Lymphoma Hodgkin Lymphoma Page 1 of 18 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. TABLE OF CONTENTS Pathologic Diagnosis/Initial Evaluation……………………………………………………….. Page 2 Classical Hodgkin Lymphoma Stage I-II …………………………………………………….. Pages 3-4 Classical Hodgkin Lymphoma Advanced Stages III, IV ……………………………………. Pages 5-6 Lymphocyte Predominant Hodgkin Lymphoma …………………………………………….. Page 7 Follow-up After Completion of Treatment …………………………………………………... Page 8 Salvage Therapy ……………………………………………………………………………….. Page 9 APPENDIX A: Unfavorable Risk Factors for Stage I-II Classic Hodgkin Lymphoma …… Page 10 APPENDIX B: Deauville Criteria ……………………………………………………………...Page 10 APPENDIX C: Radiation Therapy Guidelines ………………………………………………. Page 11 APPENDIX D: Response Criteria for Malignant Lymphoma………………………………..Page 12 APPENDIX E: International Prognostic Score (Hasenclaver Index)……………………….. Page 13 APPENDIX F: Systemic Therapy for Relapsed or Refractory Disease ….…………………. Page 14 Suggested Readings …………………………………………………………………………….. Pages 15-17 Development Credits …………………………………………………………………………... Page 18 Department of Clinical Effectiveness V6 Approved by the Executive Committee of the Medical Staff on 06/16/2020 Hodgkin Lymphoma Page 2 of 18 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. NOTE: Consider Clinical Trials as treatment options for eligible patients. PATHOLOGIC DIAGNOSIS INITIAL EVALUATION ESSENTIAL: ESSENTIAL: ● History and physical including: ● FNA alone is insufficient ○ Alcohol intolerance ○ Performance Status ● Hematopathology review of all slides with at least one tumor paraffin ○ Pruritus ○ Fatigue block. Rebiopsy if consult material is non-diagnostic. Core needle See Pages 3-4: ○ Exam of nodes ○ Size of spleen, liver Classical biopsy may be adequate if diagnostic, but an excisional nodal biopsy ○ B symptoms (Unexplained fever > 38°C during the previous month; is recommended. Hodgkin Recurrent drenching night sweats during the previous month; Weight Lymphoma ● Flow cytometry often not helpful loss > 10% of body weight ≤ 6 months of diagnosis) Stage I-II ● Adequate immunophenotype to confirm diagnosis ● CBC with differential, LDH, BUN, creatinine, albumin, AST, ALT, total ○ Immunohistochemistry on paraffin panel for Hodgkin bilirubin, alkaline phosphatase, serum calcium, uric acid lymphoma (HL) including nodular lymphocyte predominant HL: ● Erythrocyte sedimentation rate (ESR) - CD20, PAX-5, CD30, CD3, CD15, CD21, and CD45 (LCA) ● Screening for HIV 1, HIV 2, hepatitis B and C (HBcAb, - EBER HBsAg, HCVAb) See Page 5-6: OF USE IN CERTAIN CIRCUMSTANCES: ● PET/CT with contrast Classical Hodgkin ● Immunohistochemical studies: ● Pulmonary Function Tests Lymphoma ○ LMP1 ● Consider bone marrow biopsy if there are cytopenias and/or Advanced Stages ○ BOB1, OCT2, and CD79a (differential diagnosis with B-cell inconclusive PET III, IV lymphoma, unclassifiable with features intermediate between ● MUGA scan or echocardiogram classical HL and DLBCL and primary mediastinal large B-cell ● Counseling: psychosocial if clinically indicated lymphoma). 1 ● Lifestyle risk assessment ○ CD23, or CD35 (follicular dendritic cell markers), ● Discuss fertility preservation See Page 7: BCL6 in cases of nodular lymphocyte predominant HL OF USE IN SELECTED CASES: Lymphocyte (may help with T-cell/histiocyte rich large B-cell lymphoma) ● Chest x-ray, PA and LAT Predominant ○ CD2, CD43, ALK (differential diagnosis with anaplastic ● Pregnancy test Hodgkin large cell lymphoma) ● Cardiology consultation at baseline if risk factors for cardiac toxicity Lymphoma STRONGLY RECOMMEND: [i.e., obesity, abnormal echocardiogram, hypertension (HTN), ● Core biopsy for tissue banking by protocol hyperlipidemia (HLD)] 1 See Physical Activity, Nutrition, and Tobacco Cessation algorithms; ongoing reassessment of lifestyle risks should be a part of routine clinical practice Department of Clinical Effectiveness V6 Approved by the Executive Committee of the Medical Staff on 06/16/2020 Hodgkin Lymphoma Classical Hodgkin Lymphoma Stage I-II Combined Modality Therapy Page 3 of 18 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. NOTE: Consider Clinical Trials as treatment options for eligible patients. CLINICAL PRIMARY TREATMENT RESPONSE EVALUATION TREATMENT PRESENTATION Deauville2 See Page 8: Follow-up After ISRT3 1-3 Completion of Treatment Yes Deauville2 ABVD for 2 cycles Complete No Biopsy 4 followed by PET/CT response4? ABVD for PET/CT 2 cycles Classical ● Multidisciplinary conference Yes with disease site specialist Hodgkin Yes Deauville2 Biopsy ● Excisional biopsy if available Lymphoma Biopsy Stage I-II with 5 negative? preference to Favorable per No See Page 9: Salvage Therapy 1 treat with GHSG ? 3 combined Deauville2 ● ABVD for 2 cycles with ISRT or See Page 8: Follow-up After 3 modality No 1-3 ● AVD for 4 cycles with or without ISRT Completion of Treatment therapy Yes ISRT3 ABVD for Deauville2 ABVD for 2 cycles Complete PET/CT 4 2 cycles 4 followed by PET/CT response ? No Biopsy ABVD = doxorubicin, bleomycin, vinblastine, dacarbazine AVD = doxorubicin, vinblastine, dacarbazine ● Multidisciplinary conference ISRT = involved site radiation therapy Yes with disease site specialist GHSG = German Hodgkin Study Group 2 ● Excisional biopsy if available Deauville Biopsy Biopsy 1 See Appendix A: Unfavorable Risk Factors for Stage I-II Classic Hodgkin Lymphoma 5 negative? 2 See Appendix B: Deauville Criteria No 3 See Appendix C: Radiation Therapy Guidelines See Page 9: Salvage Therapy 4 See Appendix D: Response Criteria for Malignant Lymphoma Department of Clinical Effectiveness V6 Approved by the Executive Committee of the Medical Staff on 06/16/2020 Hodgkin Lymphoma Classical Hodgkin Lymphoma Stage I-II Chemotherapy Alone Page 4 of 18 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. NOTE: Consider Clinical Trials as treatment options for eligible patients. CLINICAL PRIMARY RESPONSE EVALUATION TREATMENT PRESENTATION TREATMENT ● ABVD for 1 to 2 cycles or AVD for 4 cycles Classical Deauville3 ● For initial stage IIB or ≥ 3 nodal regions or ESR > 50: AVD for 4 cycles 1-2 Hodgkin (total 6 cycles) Lymphoma See Page 8: Follow-up Stage I-II After Completion of Treatment Favorable/ ABVD for ● ABVD for 2 cycles or AVD for 4 cycles 1 PET/CT Deauville3 Unfavorable 2 cycles ● For initial stage IIB or ≥ 3 nodal regions with ESR > 50: AVD for 4 cycles Non-bulky with 3-4 (total of 6 cycles) 17 preference to treat with chemotherapy ● Multidisciplinary conference 2 alone Yes with disease site specialist 3 Biopsy ● Excisional biopsy if available Deauville Biopsy 5 negative? No See Page 9: Salvage Therapy ABVD = doxorubicin, bleomycin, vinblastine, dacarbazine AVD = doxorubicin, vinblastine, dacarbazine 1 See Appendix A: Unfavorable Risk Factors for Stage I-II Classic Hodgkin Lymphoma 2 A subset of patients who meet criteria as per the UK Rapid study with stage IA and stage IIA Hodgkin Lymphoma with no mediastinal bulk and negative PET findings after treatment may receive 3 cycles of chemotherapy with or without additional involved site radiation therapy (ISRT) 3 See Appendix B: Deauville Criteria Department of Clinical Effectiveness V6 Approved by the Executive Committee of the Medical Staff on 06/16/2020 Hodgkin Lymphoma Classical Hodgkin Lymphoma Advanced Stages III, IV Page 5 of 18 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be
Load more

Recommended publications
  • Follicular Lymphoma
    Follicular Lymphoma What is follicular lymphoma? Let us explain it to you. www.anticancerfund.org www.esmo.org ESMO/ACF Patient Guide Series based on the ESMO Clinical Practice Guidelines FOLLICULAR LYMPHOMA: A GUIDE FOR PATIENTS PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES This guide for patients has been prepared by the Anticancer Fund as a service to patients, to help patients and their relatives better understand the nature of follicular lymphoma and appreciate the best treatment choices available according to the subtype of follicular lymphoma. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of disease. The medical information described in this document is based on the clinical practice guidelines of the European Society for Medical Oncology (ESMO) for the management of newly diagnosed and relapsed follicular lymphoma. This guide for patients has been produced in collaboration with ESMO and is disseminated with the permission of ESMO. It has been written by a medical doctor and reviewed by two oncologists from ESMO including the lead author of the clinical practice guidelines for professionals, as well as two oncology nurses from the European Oncology Nursing Society (EONS). It has also been reviewed by patient representatives from ESMO’s Cancer Patient Working Group. More information about the Anticancer Fund: www.anticancerfund.org More information about the European Society for Medical Oncology: www.esmo.org For words marked with an asterisk, a definition is provided at the end of the document. Follicular Lymphoma: a guide for patients - Information based on ESMO Clinical Practice Guidelines – v.2014.1 Page 1 This document is provided by the Anticancer Fund with the permission of ESMO.
    [Show full text]
  • Follicular Lymphoma with Leukemic Phase at Diagnosis: a Series Of
    Leukemia Research 37 (2013) 1116–1119 Contents lists available at SciVerse ScienceDirect Leukemia Research journa l homepage: www.elsevier.com/locate/leukres Follicular lymphoma with leukemic phase at diagnosis: A series of seven cases and review of the literature a c c c c Brady E. Beltran , Pilar Quinones˜ , Domingo Morales , Jose C. Alva , Roberto N. Miranda , d e e b,∗ Gary Lu , Bijal D. Shah , Eduardo M. Sotomayor , Jorge J. Castillo a Department of Oncology and Radiotherapy, Edgardo Rebagliati Martins Hospital, Lima, Peru b Division of Hematology and Oncology, Rhode Island Hospital, Brown University Alpert Medical School, Providence, RI, USA c Department of Pathology, Edgardo Rebaglati Martins Hospital, Lima, Peru d Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA e Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA a r t i c l e i n f o a b s t r a c t Article history: Follicular lymphoma (FL) is a prevalent type of non-Hodgkin lymphoma in the United States and Europe. Received 23 April 2013 Although, FL typically presents with nodal involvement, extranodal sites are less common, and leukemic Received in revised form 25 May 2013 phase at diagnosis is rare. There is mounting evidence that leukemic presentation portends a worse Accepted 26 May 2013 prognosis in patients with FL. We describe 7 patients with a pathological diagnosis of FL who presented Available online 20 June 2013 with a leukemic phase. We compared our cases with 24 additional cases reported in the literature. Based on our results, patients who present with leukemic FL tend to have higher risk disease.
    [Show full text]
  • Hodgkin Lymphoma Treatment Regimens
    HODGKIN LYMPHOMA TREATMENT REGIMENS (Part 1 of 5) Clinical Trials: The National Comprehensive Cancer Network recommends cancer patient participation in clinical trials as the gold standard for treatment. Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced health care team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are provided only to supplement the latest treatment strategies. These Guidelines are a work in progress that may be refined as often as new significant data become available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way. Classical Hodgkin Lymphoma1 Note: All recommendations are Category 2A unless otherwise indicated. Primary Treatment Stage IA, IIA Favorable (No Bulky Disease, <3 Sites of Disease, ESR <50, and No E-lesions) REGIMEN DOSING Doxorubicin + Bleomycin + Days 1 and 15: Doxorubicin 25mg/m2 IV push + bleomycin 10units/m2 IV push + Vinblastine + Dacarbazine vinblastine 6mg/m2 IV over 5–10 minutes + dacarbazine 375mg/m2 IV over (ABVD) (Category 1)2-5 60 minutes.
    [Show full text]
  • HODGKIN LYMPHOMA TREATMENT REGIMENS (Part 1 of 2)
    HODGKIN LYMPHOMA TREATMENT REGIMENS (Part 1 of 2) The selection, dosing, and administration of anticancer agents and the management of associated toxicities are complex. Drug dose modifications and schedule and initiation of supportive care interventions are often necessary because of expected toxicities and because of individual patient variability, prior treatment, and comorbidities. Thus, the optimal delivery of anticancer agents requires a healthcare delivery team experienced in the use of such agents and the management of associated toxicities in patients with cancer. The cancer treatment regimens below may include both FDA-approved and unapproved uses/regimens and are provided as references only to the latest treatment strategies. Clinicians must choose and verify treatment options based on the individual patient. NOTE: GREY SHADED BOXES CONTAIN UPDATED REGIMENS. REGIMEN DOSING Classical Hodgkin Lymphoma—First-Line Treatment General treatment note: Routine use of growth factors is not recommended. Leukopenia is not a factor for treatment delay or dose reduction (except for escalated BEACOPP).1 CR=complete response IPS=International Prognostic Score PD=progressive disease PFTs=pulmonary function tests PR=partial response RT=radiation therapy SD=stable disease Stage IA, IIA Favorable ABVD (doxorubicin [Adriamycin] Days 1 and 15: Doxorubicin 25mg/m2 IV + bleomycin 10mg/m2 IV + vinblastine + bleomycin + vinblastine + 6mg/m2 IV + dacarbazine 375mg/m2 IV. dacarbazine [DTIC-Dome]) + Repeat cycle every 4 weeks for 2–4 cycles. involved-field radiotherapy (IFRT)1–4 Follow with IFRT after completion of chemotherapy. Abbreviated Stanford V Weeks 1, 3, 5 and 7: Vinblastine 6mg/m2 IV + doxorubicin 25mg/m2 IV. (doxorubicin + vinblastine + Weeks 1 and 5: Mechlorethamine 6mg/m2.
    [Show full text]
  • Non-Hodgkin Lymphoma Booklet
    Understanding Non-Hodgkin Lymphoma A Guide for Patients, Survivors, and Loved Ones October 2017 Lymphoma Research Foundation (LRF) Helpline and Clinical Trials Information Service CONTACT THE LRF HELPLINE Trained staff are available to answer questions and provide support to patients, caregivers and healthcare professionals in any language. Our support services include: • Information on lymphoma, treatment options, side effect management and current research fi ndings • Financial assistance for eligible patients and referrals for additional fi nancial, legal and insurance help • Clinical trial searches based on patient’s diagnosis and treatment history • Support through LRF’s Lymphoma Support Network, a national one-to one volunteer patient peer program Monday through Friday, Toll-Free (800) 500-9976 or email [email protected] Understanding Non-Hodgkin Lymphoma A Guide For Patients, Survivors, and Loved Ones October 2017 This guide is an educational resource compiled by the Lymphoma Research Foundation to provide general information on adult non- Hodgkin lymphoma. Publication of this information is not intended to replace individualized medical care or the advice of a patient’s doctor. Patients are strongly encouraged to talk to their doctors for complete information on how their disease should be diagnosed, treated, and followed. Before starting treatment, patients should discuss the potential benefits and side effects of cancer therapies with their physician. Contact the Lymphoma Research Foundation Helpline: (800) 500-9976 [email protected] Website: www.lymphoma.org Email: [email protected] This patient guide is supported through unrestricted educational grants from: © 2017 Lymphoma Research Foundation. Information contained herein is the property of the Lymphoma Research Foundation (LRF).
    [Show full text]
  • MINI-REVIEW Large Cell Lymphoma Complicating Persistent Polyclonal B
    Leukemia (1998) 12, 1026–1030 1998 Stockton Press All rights reserved 0887-6924/98 $12.00 http://www.stockton-press.co.uk/leu MINI-REVIEW Large cell lymphoma complicating persistent polyclonal B cell lymphocytosis J Roy1, C Ryckman1, V Bernier2, R Whittom3 and R Delage1 1Division of Hematology, 2Department of Pathology, Saint Sacrement Hospital, 3Division of Hematology, CHUQ, Saint Franc¸ois d’Assise Hospital, Laval University, Quebec City, Canada Persistent polyclonal B cell lymphocytosis (PPBL) is a rare immunoglobulin (Ig) M with a polyclonal pattern on protein lymphoproliferative disorder of unclear natural history and its electropheresis. Flow cytometry cell analysis displays the pres- potential for B cell malignancy remains unknown. We describe the case of a 39-year-old female who presented with stage IV- ence of the CD19 antigen and surface IgM with a normal B large cell lymphoma 19 years after an initial diagnosis of kappa/lambda ratio. In contrast to CLL, CD5 is absent. There PPBL; her disease was rapidly fatal despite intensive chemo- is an association between HLA-DR 7 and PPBL in more than therapy and blood stem cell transplantation. Because we had two-thirds of the patients but the reason for such an associ- recently identified multiple bcl-2/lg gene rearrangements in ation remains unclear.3,6 There has been one report of PPBL blood mononuclear cells of patients with PPBL, we sought evi- occurring in identical female twins.7 No other obvious genetic dence of this oncogene in this particular patient: bcl-2/lg gene rearrangements were found in blood mononuclear cells but not predisposition or familial inheritance has yet been described in lymphoma cells.
    [Show full text]
  • Hodgkin Lymphoma
    Hodgkin Lymphoma Erica, Hodgkin lymphoma survivor Revised 2016 Publication Update Hodgkin Lymphoma The Leukemia & Lymphoma Society wants you to have the most up-to-date information about blood cancer treatment. See below for important new information that was not available at the time this publication was printed. In May 2017, the Food and Drug Administration (FDA) approved nivolumab (Opdivo®) for the treatment of adult patients with classical Hodgkin lymphoma (HL) that has relapsed or progressed after 3 or more lines of systemic therapy that includes autologous hematopoietic stem cell transplantation (HSCT). It is also approved for the treatment of adult patients with classical HL that has relapsed or progressed after autologous HSCT and brentuximab vedotin. These indications are approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. In March 2017, the Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) for the treatment of adult and pediatric patients with refractory classical Hodgkin lymphoma (cHL), or who have relapsed after 3 or more prior lines of therapy. This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. For more information, contact an Information Specialist at (800) 955-4572 or [email protected]. Information Specialists: 800.955.4572 I www.LLS.org PS57 A Message from Louis J. DeGennaro, PhD President and CEO of The Leukemia & Lymphoma Society The Leukemia & Lymphoma Society (LLS) is the world’s largest voluntary health organization dedicated to finding cures for blood cancer patients.
    [Show full text]
  • Lymphoproliferative Disorders
    Lymphoproliferative disorders Dr. Mansour Aljabry Definition Lymphoproliferative disorders Several clinical conditions in which lymphocytes are produced in excessive quantities ( Lymphocytosis) Lymphoma Malignant lymphoid mass involving the lymphoid tissues (± other tissues e.g : skin ,GIT ,CNS …) Lymphoid leukemia Malignant proliferation of lymphoid cells in Bone marrow and peripheral blood (± other tissues e.g : lymph nods ,spleen , skin ,GIT ,CNS …) Lymphoproliferative disorders Autoimmune Infection Malignant Lymphocytosis 1- Viral infection : •Infectious mononucleosis ,cytomegalovirus ,rubella, hepatitis, adenoviruses, varicella…. 2- Some bacterial infection: (Pertussis ,brucellosis …) 3-Immune : SLE , Allergic drug reactions 4- Other conditions:, splenectomy, dermatitis ,hyperthyroidism metastatic carcinoma….) 5- Chronic lymphocytic leukemia (CLL) 6-Other lymphomas: Mantle cell lymphoma ,Hodgkin lymphoma… Infectious mononucleosis An acute, infectious disease, caused by Epstein-Barr virus and characterized by • fever • swollen lymph nodes (painful) • Sore throat, • atypical lymphocyte • Affect young people ( usually) Malignant Lymphoproliferative Disorders ALL CLL Lymphomas MM naïve B-lymphocytes Plasma Lymphoid cells progenitor T-lymphocytes AML Myeloproliferative disorders Hematopoietic Myeloid Neutrophils stem cell progenitor Eosinophils Basophils Monocytes Platelets Red cells Malignant Lymphoproliferative disorders Immature Mature ALL Lymphoma Lymphoid leukemia CLL Hairy cell leukemia Non Hodgkin lymphoma Hodgkin lymphoma T- prolymphocytic
    [Show full text]
  • (Rituxan®), Rituximab-Abbs (Truxima®), Rituximab-Pvvr (Ruxience®) Prior Authorization Drug Coverage Policy
    1 Rituximab Products: Rituximab (Rituxan®), Rituximab-abbs (Truxima®), Rituximab-pvvr (Ruxience®) Prior Authorization Drug Coverage Policy Effective Date: 2/1/2021 Revision Date: n/a Review Date: 7/2/20 Lines of Business: Commercial Policy type: Prior Authorization This Drug Coverage Policy provides parameters for the coverage of rituximab (Rituxan®), rituximab-abbs (Truxima®), and rituximab-pvvr (Ruxience®). Consideration of medically necessary indications are based upon U.S. Food and Drug Administration (FDA) indications, recommended uses within the Centers of Medicare & Medicaid Services (CMS) five recognized compendia, including the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium (Category 1 or 2A recommendations), and peer-reviewed scientific literature eligible for coverage according to the CMS, Medicare Benefit Policy Manual, Chapter 15, section 50.4.5 titled, “Off- Label Use of Anti-Cancer Drugs and Biologics.” This policy evaluates whether the drug therapy is proven to be effective based on published evidence-based medicine. Drug Description1-3 Rituximab (Rituxan®), rituximab-abbs (Truxima®), and rituximab-pvvr (Ruxience®) are monoclonal antibodies that target the CD20 antigen expressed on the surface of pre-B and mature B- lymphocytes. Upon binding to cluster of differentiation (CD) 20, rituximab mediates B-cell lysis. Possible mechanisms of cell lysis include complement dependent cytotoxicity (CDC) and antibody dependent cell mediated cytotoxicity (ADCC). B cells are believed to play a role in the pathogenesis of rheumatoid arthritis (RA) and associated chronic synovitis. In this setting, B cells may be acting at multiple sites in the autoimmune/inflammatory process, including through production of rheumatoid factor (RF) and other autoantibodies, antigen presentation, T-cell activation, and/or proinflammatory cytokine production.
    [Show full text]
  • R-Chop-21 / Chop-21
    Lymphoma group R-CHOP-21 / CHOP-21 INDICATION Lymphoma Omit rituximab if CD20-negative. TREATMENT INTENT Curative or disease modification depending on clinical circumstances PRE-ASSESSMENT 1. Ensure histology is confirmed prior to administration of chemotherapy and document in notes. 2. Record stage and IPI of disease - CT scan (neck, chest, abdomen and pelvis), and/or PET- CT, presence or absence of B symptoms, clinical extent of disease, consider bone marrow aspirate and trephine. 3. Blood tests – FBC, U&Es, LDH, ESR, urate, calcium, Vitamin D level,magnesium, creatinine, LFTs, glucose, Igs, β2 microglobulin, hepatitis B core antibody and hepatitis B surface Ag, hepatitis C antibody, EBV, CMV, VZV, HIV 1+2 after consent, group and save. 4. Urine pregnancy test • before cycle 1 of each new chemotherapy course for women of child- bearing age unless they are post-menopausal, have been sterilised or undergone a hysterectomy. 5. ECG +/- Echo and baseline BP in all patients with a cardiac history or at risk of cardiac complications (hypertension, smokers, diabetes). 6. Record performance status (WHO/ECOG). 7. Record height and weight. 8. Consent - ensure patient has received adequate verbal and written information regarding their disease, treatment and potential side effects. Document in medical notes all information that has been given. Obtain written consent on the day of treatment. 9. Fertility - it is very important the patient understands the potential risk of infertility. All patients should be offered fertility advice by referring to the Oxford Fertility Unit. 10. Hydration – in patients with bulky disease pre-hydrate with sodium chloride 0.9% 1 litre over 4- 6 hours.
    [Show full text]
  • Anaplastic Large Cell Lymphoma (ALCL)
    Helpline (freephone) 0808 808 5555 [email protected] www.lymphoma-action.org.uk Anaplastic large cell lymphoma (ALCL) This page is about anaplastic large-cell lymphoma (ALCL), a type of T-cell lymphoma. On this page What is ALCL? Who gets it? Symptoms Treatment Relapsed and refractory ALCL Research and targeted treatments We have separate information about the topics in bold font. Please get in touch if you’d like to request copies or if you would like further information about any aspect of lymphoma. Phone 0808 808 5555 or email [email protected]. What is ALCL? Anaplastic large cell lymphoma (ALCL) is a type of T-cell lymphoma – a non-Hodgkin lymphoma that develops from white blood cells called T cells. Under a microscope, the cancerous cells in ALCL look large, undeveloped and very abnormal (‘anaplastic’). There are four main types of ALCL. They have complicated names based on their features and the types of proteins they make: • ALK-positive ALCL (also known as ALK+ ALCL) is the most common type. In ALK-positive ALCL, the abnormal T cells have a genetic change (mutation) that means they make a protein called ‘anaplastic lymphoma kinase’ (ALK). In other words, they test positive for ALK. ALK-positive ALCL is a fast-growing (high-grade) lymphoma. Page 1 of 6 © Lymphoma Action • ALK-negative ALCL (also known as ALK- ALCL) is a high-grade lymphoma that accounts for around 3 in every 10 cases of ALCL. The abnormal T cells do not make the ALK protein – they test negative for ALK.
    [Show full text]
  • Mantle Cell Lymphoma (MCL)
    Mantle Cell Lymphoma (MCL) Page 1 of 9 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. PATHOLOGIC DIAGNOSIS INITIAL EVALUATION ESSENTIAL: ● Physical exam: attention to node-bearing areas, including Waldeyer's ring, ESSENTIAL: size of liver and spleen, and patient’s age ● Hematopathology review of all slides with at least one tumor paraffin block. ● Performance status (ECOG) Hematopathology confirmation of classic versus aggressive variant of MCL ● B symptoms (fever, drenching night sweats, unintentional weight loss) (blastoid/pleomorphic). Re-biopsy if consult material is non-diagnostic. ● CBC with differential, LDH, BUN, creatinine, albumin, AST, total bilirubin, 1 ● Adequate immunophenotype to confirm diagnosis alkaline phosphatase, serum calcium, uric acid ○ Paraffin panel: ● Screening for HIV 1 and 2, hepatitis B and C (HBcAb, HBaAg, HCVAb) - Pan B-cell marker (CD19, CD20, PAX5), CD3, CD5, CD10, and cyclin D1 ● Beta-2 microglobulin (B2M) - Ki-67 (proliferation rate) ● Chest x-ray, PA and lateral or ● Bone marrow bilateral biopsy with unilateral aspirate Induction ○ Flow cytometry immunophenotyping:
    [Show full text]