Lymphoma :Pathology, Diagnosis, and Treatment

Publication subTitle :Pathology, Diagnosis, and Treatment

Author: Robert Marcus; John W. Sweetenham; Michael E. Williams  

Publisher: Cambridge University Press‎

Publication year: 2013

E-ISBN: 9781107595989

P-ISBN(Paperback): 9781107010598

Subject: R55 Blood and lymphatic system disorders

Keyword: 血液及淋巴系疾病

Language: ENG

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Lymphoma

Description

Major advances have occurred in the diagnosis and treatment of lymphoma in recent years. Our understanding of the molecular biology and genetics of the disease has increased exponentially, and significant imaging developments have resulted in earlier and more accurate diagnosis. The new edition of this landmark text places these advances in the context of daily clinical practice. Each chapter has been updated to reflect recent developments, including new treatment agents such as immunomodulatory drugs and the next generation of antibodies, and the increasing prognostic role of PET scanning. Results from recent large-scale clinical trials are presented, and pathology and cytogenetics are integrated into discussion of each disease entity, enabling the reader to review all the key diagnostic information in one place. Featuring many color illustrations, and written and edited by leading authorities in the field, Lymphoma provides all the information you need to diagnose and manage these complex disorders.

Chapter

Gene expression profiling

Treatment-related prognostic factors

Prognostic factors at relapse

Mantle cell lymphomas

Prognostic factors at diagnosis

Clinical factors

Histological factors

Genetic abnormalities

Peripheral T-cell lymphomas

Prognostic factors at diagnosis

Clinical factors

Histological factors

Treatment-related prognostic factors

Marginal zone lymphomas

MALT lymphomas

Other MZL lymphomas

Burkitt’s lymphoma

Prognostic factors at diagnosis

Clinical factors

Treatment-related prognostic factors

Primary central nervous system lymphoma

Prognostic factors at diagnosis

Clinical factors

Histological factors

Treatment-related prognostic factors

Hodgkin’s lymphoma

Prognostic factors at diagnosis

Clinical factors

Related to tumor spread and tumor burden

Related to patient characteristics

Related to interaction of tumor and host

Prognostic models

Histological factors

Other biological factors

Treatment-related prognostic factors

Dose intensity and time to complete remission

Positron emission tomography (PET) using 18F-fluorodeoxyglucose (18FDG)

Prognostic factors at relapse

Further reading

Chapter 3 Imaging

Introduction

Staging techniques

Staging classifications

Response assessment

Complications of therapy

Further reading

Chapter 4 Clinical trials in lymphoma

Introduction

Background

Informed consent

Endpoints

Response criteria

Outcome data

Evaluating treatment effect

Precision and error control

Phase I trials

Phase II trials

Randomized phase II trials

Phase III trials

The future

Conclusion

Further reading

General reviews

Lymphoma-specific

Phase I, II, III trials

Interpretation

Future issues

Chapter 5 Hodgkin lymphoma

Introduction

Epidemiology

Clinical presentation of Hodgkin lymphoma

Pathology

Nodular lymphocyte-predominant Hodgkin lymphoma (nLPHL)

Classical Hodgkin lymphoma (cHL)

Lymphocyte-rich classical Hodgkin lymphoma (LR-cHL)

Mixed cellularity Hodgkin lymphoma (MC-HL)

Nodular sclerosis Hodgkin lymphoma (NS-HL)

Lymphocyte-depleted Hodgkin lymphoma (LD-HL)

Rare patterns of nodal infiltration

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma

Molecular pathology and cytogenetics

Diagnosis, staging, and risk stratification

Diagnosis and staging

Risk stratification

Response assessment

Treatment

First line treatment

Early-stage favorable Hodgkin lymphoma

Early-stage unfavorable disease

Advanced Hodgkin lymphoma

Treatment of primary progressive and relapsed Hodgkin lymphoma

Relapse after initial radiotherapy

Relapse after initial chemotherapy

Salvage radiotherapy

Relapse after high-dose chemotherapy and autologous stem cell transplantation

Allogeneic stem cell transplantation

Targeted therapy of HL

Anti-CD30 monoclonal antibodies/immunotoxins

Protein-specific “small molecules”

Histone deacetylase inhibitors (HDAC inhibitors)

mTOR inhibitors

Targeting the microenvironment

Rituximab

Lenalidomide

Nodular lymphocyte-predominant Hodgkin lymphoma (NLP-HL)

Treatment of Hodgkin lymphoma in children and adolescents

Treatment-associated toxicity

Short-term toxicity

Long-term toxicity

Secondary malignancies

Cardiac toxicity

Fertility

Summary

Further reading

Chapter 6 Follicular lymphoma

Introduction

Clinical presentation

Histology

Molecular and cytogenetics

Staging investigations

Prognostic factors

Treatment of early-stage disease

Summary

Treatment of advanced disease in asymptomatic patients

First line treatment of advanced disease in symptomatic patients

Conventional chemotherapy

Immunotherapy

Combined immunochemotherapy

Rituximab maintenance

Autologous stem cell transplant (ASCT) in first remission

Radioimmunotherapy

Summary: first line treatment of advanced lymphoma

Management of relapsed follicular lymphoma

Immunochemotherapy

Rituximab maintenance

Summary of immunochemotherapy as second line treatment

Novel agents

High-dose therapy and autologous stem cell transplantation

Allogeneic stem cell transplantation in FL (allo-SCT)

Summary of allogeneic transplantation

Radioimmunotherapy

High-grade transformation of FL

Summary of relapsed follicular lymphoma

Further reading

Chapter 7 MALT and other marginal zone lymphomas

Extranodal marginal zone B-cell lymphoma (MALT lymphoma)

Clinical features

MALT lymphoma pathology

The molecular biology of MALT lymphomas

Malt lymphoma staging

Diagnosis and staging of gastric MALT lymphoma

Staging procedures in non-gastric MALT lymphoma

Management and follow-up

Helicobacter pylori eradication in gastric MALT lymphoma

Anti-Helicobacter therapy in gastric diffuse large B-cell lymphoma

Post-treatment histologic evaluation

Factors predicting the lymphoma response to H. pylori eradication

Clinical and molecular follow-up

Management of H. pylori-negative or antibiotic-resistant cases

Management of non-gastric localizations

Immunoproliferative small intestinal disease (IPSID)

Primary splenic marginal zone lymphoma

Clinical features

Pathology of splenic MZL

Molecular pathogenesis of splenic MZL

Clinical course and management

Nodal marginal zone lymphoma

Clinical features

Pathology and genetics

Management

Further reading

Chapter 8 Small lymphocytic lymphoma/chronic lymphocytic leukemia

Introduction

B-cell small lymphocytic lymphoma/chronic lymphocytic leukemia

B-cell prolymphocytic leukemia (B-PLL)

Molecular pathology and cytogenetics

Therapy

Treatment of CLL by risk stratification

Minimal residual disease

Chemotherapeutic approach

Factors defining the choice of therapy

Patient-specific factors

Alkylating agents in CLL

Choice of first line therapy in CLL

Previously untreated patients without 17p deletion who are fit

Previously untreated patients without 17p deletion with significant comorbidity

Previously untreated patients with 17p deletion and/or p53 mutation

Monoclonal antibody therapy in CLL

Choice of therapy in relapsed CLL

Role of allogeneic stem cell transplantation in CLL

Novel therapeutic agents

1. Interfering with the microenvironment and its interaction with the CLL cell

2. Targeting downstream signaling from the B-cell receptor

3. Apoptosis

4. Cyclin-dependent kinase inhibition

5. Immune-mediated approaches

6. Novel monoclonal antibodies

Recommended therapeutic approaches in CLL

Conclusion

Further reading

Chapter 9 Waldenström’s macroglobulinemia/lymphoplasmacytic lymphoma

Introduction

Epidemiology and etiology

Biology

Cytogenetics

Nature of the clonal cell

Bone marrow microenvironment

Clinical features

Morbidity mediated by the effects of IgM

Hyperviscosity syndrome

Cryoglobulinemia

Autoantibody activity

IgM-related neuropathy

Cold agglutinin hemolytic anemia

Tissue deposition

Manifestations related to tissue infiltration by neoplastic cells

Laboratory investigations and findings

Hematological abnormalities

Biochemical investigations

Serum viscosity

Bone marrow findings

Other investigations

Prognosis

Treatment of Waldenström’s macroglobulinemia

Treatment indications

Treatment options

Chlorambucil

Nucleoside analogs

Monoclonal antibodies

Bortezomib

Immunomodulatory agents

Bendamustine

Everolimus

Combination strategies

Maintenance therapy

High-dose therapy and stem cell transplantation

Response criteria in Waldenström’s macroglobulinemia

Further reading

Chapter 10 Mantle cell lymphoma

Introduction

Clinical presentation

Pathology

Molecular pathogenesis

Staging

Prognostic factors

Phenotypic and molecular markers

Initial therapy

Conventional chemotherapy

Monoclonal antibody and combined immunochemotherapy

Radioimmunotherapy (RIT)

Dose-intensified regimens

Sequential dose intensification and autologous transplantation

Rituximab maintenance therapy

Allogeneic stem cell transplantation

Management of relapsed disease

Novel therapeutic approaches

Future directions

Further reading

Chapter 11 Burkitt and lymphoblastic lymphoma: clinical therapy and outcome

Introduction and presentation

Pathology

Burkitt lymphoma

Precursor B-lymphoblastic lymphoma/ lymphoblastic leukemia

Precursor T-lymphoblastic lymphoma/lymphoblastic leukemia

Molecular pathology and cytogenetics

Burkitt lymphoma

B-cell lymphoma, unclassified, with features intermediate between DLBCL and Burkitt lymphoma

Precursor B-lymphoblastic leukemia/lymphoma

Precursor T-lymphoblastic leukemia/lymphoma

Staging

Treatment principles of Burkitt lymphoma

Treatment of Burkitt lymphoma

Management of relapse in Burkitt lymphoma

HIV-associated Burkitt lymphoma

Treatment recommendations in Burkitt lyphoma

Treatment principles of lymphoblastic lymphoma

Treatment of lymphoblastic lymphoma

CNS treatment of lymphoblastic lymphoma

Management of relapse in lymphoblastic lymphoma

Treatment recommendations for lymphoblastic lymphoma

Supportive care of Burkitt and lymphoblastic lymphoma

Further reading

Chapter 12 Therapy of diffuse large B-cell lymphoma

Introduction

Clinical presentation

Pathology

Diffuse large B-cell lymphoma not otherwise specified (NOS)

T-cell/histiocyte-rich B-cell lymphoma (TCHRBCL)

Diffuse large B-cell lymphoma with expression of full length anaplastic lymphoma kinase (ALK)

Intravascular large B-cell lymphoma

Diffuse large B-cell lymphoma associated with inflammation

EBV-positive diffuse large B-cell lymphoma of the elderly

Mediastinal (thymic) large B-cell lymphoma

Molecular pathology and cytogenetics

Staging investigations

Prognostic factors

Treatment of early-stage DLBCL

Primary extranodal disease

Early-stage DLBCL – conclusions

Treatment of advanced-stage DLBCL

Dose-intensified and dose-dense therapy

High-dose therapy and autologous stem cell transplantation as a component of first line therapy

Addition of rituximab to chemotherapy

Addition of other new agents to chemotherapy

Use of involved-field radiation therapy in advanced DLBCL

Advanced stage DLBCL – conclusions

Primary mediastinal (thymic) large B-cell lymphoma

Management of relapsed DLBCL

Second line therapy prior to ASCT

High-dose therapy and autologous stem cell transplantation

Allogeneic stem cell transplantation in DLBCL

Prognostic factors for relapsed DLBCL

Other treatment approaches for relapsed disease

Radiolabeled monoclonal antibodies

Relapsed DLBCL – conclusions

New therapeutic targets in DLBCL

Further reading

Chapter 13 Central nervous system lymphomas

Histopathology

Conventional therapeutic strategies

Chemotherapy

Methotrexate and cytarabine

Corticosteroids

Other active drugs

Radiotherapy

Combined chemoradiotherapy

Experimental therapeutic strategies

High-dose chemotherapy supported by autologous stem cell transplantation

Blood–brain barrier disruption

Particular clinical conditions

Leptomeningeal lymphoma

Intraocular lymphoma

Spinal cord lymphoma

Relapsed disease

CNS involvement in HIV-related lymphomas

Secondary CNS lymphomas

Prophylaxis against CNS relapse

Treatment of SCNSL

Autologous transplantation

Allogeneic transplantation

Rare forms of CNS lymphoma

Indolent lymphomas

Aggressive lymphomas

Further reading

Chapter 14 T-cell non-Hodgkin lymphoma

Introduction

Etiology

Prognosis

Specific disease types

Adult T-cell leukemia/lymphoma (ATL)

Pathology

Molecular pathology and cytogenetics

Subtypes

Treatment

Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS)

Pathology

Molecular pathology and cytogenetics

Treatment

Angioimmunoblastic T-cell lymphoma (AITL)

Pathology

Molecular pathology and cytogenetics

Treatment

Anaplastic large-cell lymphoma (ALCL), systemic type, ALK+ and ALK–

Pathology – ALK-positive

Common variant

Lymphohistiocytic variant (10%)

Small-cell variant (5–10%)

Other morphological patterns

Pathology – ALK-negative

Molecular pathology and cytogenetics

Treatment

Subcutaneous panniculitis-like T-cell lymphoma (SCPTL)

Pathology

Treatment

Cutaneous gamma delta (γδ) T-cell lymphoma (CGD-TCL)

Pathology

Treatment

Hepatosplenic T-cell lymphoma (HSTCL)

Pathology

Molecular pathology and cytogenetics

Treatment

Extranodal NK-/T-cell lymphoma, nasal and nasal-type

Pathology

Molecular pathology and cytogenetics

Treatment

Enteropathy-type intestinal T-cell lymphoma (EITCL)

Pathology

Molecular pathology and cytogenetics

Treatment

Autologous stem cell transplantation

Frontline consolidative therapy

Relapsed disease

Allogeneic stem cell transplantation

Radiation therapy

Emerging and novel therapies

Further reading

Chapter 15 Primary cutaneous lymphoma

Primary cutaneous T-cell lymphomas (CTCL)

Mycosis fungoides

Sézary syndrome

Pathology of MF and Sézary syndrome

Molecular pathology of cutaneous lymphomas

Treatment of MF and SS

Skin-directed therapies

Topical corticosteroids

Topical chemotherapy

Other topical treatments

Phototherapy and photochemotherapy

Radiotherapy and total skin electron beam therapy

Systemic therapies

Extracorporeal photopheresis

Immunotherapy

Monoclonal antibody therapy

Retinoids/rexinoids

Systemic chemotherapy

Toxin therapies

Histone deacetylase (HDAC) inhibitors

Bone marrow transplantation

Emerging novel therapies

MF clinicopathologic variants

Pagetoid reticulosis

Folliculotropic and syringotropic MF

Granulomatous variants of MF

CD30+ T-cell lymphoproliferative disorders of the skin

Lymphomatoid papulosis

Pathology

Primary cutaneous (anaplastic) CD30-positive large-cell lymphoma

Pathology

Molecular pathology of CD30+ T-cell lymphoproliferative disorders of the skin (CD30+ LPD)

Subcutaneous panniculitis-like T-cell lymphoma

Pathology

Primary cutaneous peripheral T-cell lymphoma (PTL), unspecified

Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma

Primary cutaneous CD4+ small-/medium-sized pleomorphic T-cell lymphoma

Primary cutaneous B-cell lymphomas

Primary cutaneous marginal zone B-cell lymphoma/immunocytoma

Pathology

Molecular pathology

Primary follicle center-cell lymphoma

Pathology

Molecular cytogenetics

Primary cutaneous large B-cell lymphoma (leg type and cutaneous large B-cell lymphoma at other sites)

Pathology

Molecular pathology

Further reading

Chapter 16 Lymphoma in the immunosuppressed

Tumors following solid organ transplantation (PTLD)

T-cell post-transplant lymphoproliferative disorders

Hodgkin lymphoma

Burkitt lymphoma

Lymphomas in patients with HIV infection

Diffuse large B-cell lymphoma

Burkitt lymphoma (BL)

Primary effusion lymphoma (PEL)

Plasmablastic lymphoma (PBL)

Primary central nervous system lymphoma

Salvage treatment

Hodgkin lymphoma

Further reading

Chapter 17 Atypical lymphoproliferative, histiocytic, and dendritic cell disorders

Introduction

Benign lymphoproliferative disorders

Kikuchi’s disease

Presentation/diagnosis

Prognosis/treatment

Progressive transformation of germinal centers

Vascular transformation of sinuses

Inflammatory pseudotumor of lymph nodes

Histiocytic disorders

Rosai–Dorfman disease

Presentation/diagnosis

Prognosis/treatment

Histiocytic sarcoma

Presentation/diagnosis

Prognosis/treatment

Langerhans cell histiocytosis

Presentation/diagnosis

Prognosis/treatment

Interdigitating dendritic cell sarcoma

Follicular dendritic cell sarcoma

Erdheim–Chester disease

Hemophagocytic lymphohistiocytosis

Presentation/diagnosis

Prognosis/treatment

Atypical lymphoproliferative disorders

Polyclonal disorders

Unicentric Castleman’s disease

Presentation/diagnosis

Prognosis/treatment

Multicentric Castleman’s disease

Presentation/diagnosis

Prognosis/treatment

Malignant disorders

Lymphomatoid papulosis

Lymphomatoid granulomatosis

Presentation/diagnosis

Prognosis/treatment

Further reading

Index

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