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Management of Anaplastic Thyroid Cancer and Lymphoma
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Thyroid lymphoma with aggressive histology is the most common, accounting for 65–70% of cases. Patients are more often female, with the mean age at presentation being 65. Patients typically present with a rapidly enlarging mass that is often as much as 10 cm+ when diagnosed. Cervical lymph nodes are frequently involved. Aggressive lymphoma can arise de novo or in pre-existing Hashimoto's thyroiditis. Diffuse large B-cell lymphoma is the most frequent histology, for which there is a well-established treatment, combining chemotherapy and radiotherapy. Systemic treatment is used, given the high rate of occult systemic disease. Patients will typically receive the CHOP-R regimen (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab), with chemotherapy given for 3–6 cycles followed by radiotherapy (30–40 Gy) 3–6 weeks later. This systemic treatment can achieve cure rates of 70–85%. Radiotherapy coverage and volume are dependent on the stage at presentation; stage IE patients can have radiotherapy limited to the primary thyroid disease only, without cover of the cervical lymph nodes, while stage IIE patients will typically have radiotherapy coverage of the thyroid primary site and the draining lymph nodes (Levels III–VI). Long-term cure is 75%.
The lymphoreticular system and bone marrow
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
The EBV has an important role in the development of Burkitt lymphoma, and its genome is found in the cells in most endemic cases. Both endemic and sporadic variants are characterized by a translocation involving chromosomes 8 and 14, which causes deregulation of the c-myc gene, resulting in cell proliferation. Intensive chemotherapeutic regimens have led to a cure rate of 60%–90% depending on the stage in this highly aggressive lymphoma.
Palliative Care and End-of-Life Issues
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Rashmi Khadilkar, Hilary Yehling, Quill Timothy E.
A 90-year-old woman with a 7-year history of mild-to-moderately aggressive lymphoma previously treated with chemotherapy and radiation presents to the hospital with several weeks of increasing weakness, fatigue, and confusion. Workup reveals no cause for these symptoms, although it is felt that her underlying cancer may be contributing. No further treatment is available for her malignancy. During hospitalization, she lacks decision-making capacity, but is pleasant and able to converse and follow instructions. Her oral intake is poor, and she is unable to get out of bed. Her prognosis is felt to be a few weeks to a few months based on her current trajectory. Her family agrees, based on her previously expressed wishes, that she would prefer to be at home on hospice. However, they think that it would be much easier to care for her if she were stronger and able to transfer more easily and are requesting rehab admission for this reason.
Primary cutaneous indolent B-cell lymphomas – a retrospective multicenter analysis and a review of literature
Published in Acta Oncologica, 2021
Magdalena Olszewska-Szopa, Marta Sobas, Kamel Laribi, Laura Bao Perez, Joanna Drozd-Sokołowska, Edyta Subocz, Monika Joks, Krzysztof Zduniak, Małgorzata Gajewska, Anna Kulikowska de Nalecz, Joanna Romejko-Jarosińska, Beata Kumiega, Anna Waszczuk-Gajda, Tomasz Wróbel, Anna Czyz
The median duration of response was relatively long in our study, however, 52% of patients relapsed during the follow-up time, with an equal recurrence rate among PCFCL and PCMZL patients. With regard to treatment modality, the relapse rates after radiotherapy, immunotherapy and immunochemotherapy were comparable (33%, 30%, and 43% respectively), in contrast to some previously published data indicating less benefits from surgical excision [7]. The observations seem to suggest that relapses are nearly always confined to the skin, both in PCFCL and PCMZL, which is concordant with most of the previous publications [8,18]. However, some authors showed that a small proportion of patients, about 5-10%, experienced extracutaneous relapses [7]. Golling et al. reported most of the recurrences in primary localizations [18], whereas in our observation relapses appear in distant areas with the same frequency as in previously affected locations. Transformation to more aggressive lymphoma has been uncommon in our cohort, which is in line with the previously published data [10].
R-CHOP compared to R-CHOP + X for newly diagnosed diffuse large B-cell lymphoma: a systematic review and meta-analysis
Published in Acta Oncologica, 2021
Oren Pasvolsky, Alon Rozental, Pia Raanani, Anat Gafter-Gvili, Ronit Gurion
We searched PubMed until September 2020, The Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library, until September 2020, and the following conference proceedings: Annual Meeting of the American Society of Hematology (till December 2019), Annual Meeting of the American Society of Clinical Oncology Annual Meeting (till May 2020), Annual Meeting of the European Hematology Association (till June 2020), and International Conference of Malignant Lymphoma (till June 2019). We cross‐searched the terms ‘diffuse large cell lymphoma’ or ‘aggressive lymphoma’ and similar terms, ‘RCHOP’ and ‘first line’ and similar terms. For PubMed, we added the Cochrane highly sensitive search term for identification of clinical trials. In addition, we scanned references of all included trials and reviews identified for additional studies.
The management of hematologic malignancies during the COVID-19 pandemic
Published in Expert Opinion on Pharmacotherapy, 2021
Iwona Hus, Aleksander Salomon-Perzyński, Krzysztof Tomasiewicz, Tadeusz Robak
In spite of the many challenges arising during COVID-19 pandemic, patients with cancer and hematological malignancies should still be managed properly and provided with prompt diagnosis and the most effective treatment. Any delays in these key issues might have a negative impact on the results of therapy, worsening the outcome, and potentially being more harmful than SARS-CoV-2 infection itself. Therefore, every effort should be made to provide curative anticancer treatments to the patients. In our practice, we provide the therapy to the patients with acute leukemias and aggressive lymphoma and postpone the start of the treatment in patients with indolent malignancies whenever possible. This is particularly important among patients with B-cell malignancies, where having limited access to ibrutinib, we need to use rituximab or bendamustine as anticancer therapy.