MISRAKE GHION COLLEGE
DEPARTMENT OF PHARMACY
ASSIGNMENT FOR 4TH YEAR REGULAR PHARMACY
STUDENTS
INTEGRATED THERAPEUTICS-IV
GROUP 4
PHARMACOTHERAPY OF LYMPHOMA
GROUP MEMBERS ID NUMBERS
1. HANAN AHMED ------------------------------ 55/2013
2. KAWSER NURU------------------------------- 50/2013
3. SAMRAWIT BIRHANU---------------------- 53/2013
4. SINTAYEHU CHANIE----------------------- 56/2013
5. HAYMANOT TAMENE---------------------- 59/2013
6. BEZAWIT DEJENE--------------------------- 60/2013
7. ADEM MOHAMMED------------------------ 17/2013
8. ZEHARA AYALEW-------------------------- 25/2013
9. KALKIDAN MITIKU------------------------ 74/2013
SUBMITTED TO MR. MINIMIZE HASSEN
JULY, 2024
DESSIE, ETHIOPIA
Pharmacotherapy of Lymphoma
Definition
Lymphoma is a group of malignant neoplasms of lymphocytes with more than 90 subtypes. It is
traditionally classified broadly as non-Hodgkin or Hodgkin lymphoma.
Lymphoma is a type of cancer that begins in infection-fighting cells of the immune system,
called lymphocytes. These cells are in the lymph nodes, spleen, thymus, bone marrow, and other
parts of the body. When you have lymphoma, lymphocytes change and grow out of control.
Lymphoma is very treatable, and the outlook can vary depending on the type and stage of the
illness. Understand the basics of lymphoma, the differences between Hodgkin and non-Hodgkin
lymphoma, and why some people may be more susceptible to this type of cancer. Your doctor
can help you find the right treatment for your type and stage of the illness.
Lymphoma is different from leukemia. Each of these cancers starts in a different type of cell.
Lymphoma starts in infection-fighting lymphocytes.
Leukemia starts in blood-forming cells inside the bone marrow.
Lymphoma is also not the same as lymphedema, a collection of fluid that forms in body tissues
when the lymph system is damaged or blocked. Approximately 82,000 new U.S. patients are
diagnosed with lymphoma annually. Any tobacco use and obesity are major modifiable risk
factors, with genetic, infectious, and inflammatory etiologies also contributing. Lymphoma
typically presents as painless adenopathy, with systemic symptoms of fever, unexplained weight
loss, and night sweats occurring in more advanced stages of the disease. An open lymph node
biopsy is preferred for diagnosis.
Types of Lymphoma
There are two main types of lymphoma:
A. Non-Hodgkin — most people with lymphoma have this type.
B. Hodgkin
A. Non-Hodgkin lymphoma
Non-Hodgkin lymphoma (NHL) makes up about 90% of lymphoma diagnoses. This form of the
disease has two categories: B-cell lymphomas and T-cell lymphomas. B-cell lymphomas affect
80% of people with non-Hodgkin lymphoma. There are different subtypes of B-cell and T-cell
lymphomas, some of which are more aggressive and need treatment right away, usually
chemotherapy. More slow-growing (indolent) types of NHL may not require immediate
treatment. Instead, doctors take a watch-and-wait approach.
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B-cell lymphomas include:
Diffuse large B-cell lymphoma
Follicular lymphoma
Primary mediastinal B cell lymphoma
Mantle cell lymphoma
Post-transplant lymphoproliferative disorder
Marginal zone lymphoma
Waldenström’s macroglobulinemia
Burkitt lymphoma
T-cell lymphomas include:
Anaplastic large cell lymphoma
Peripheral T cell lymphoma not otherwise specified
Angioimmunoblastic lymphoma
Hepatosplenic T-cell lymphoma
Extranodal NK/T-cell lymphoma
Cutaneous T-cell lymphoma is a rare skin-related form of the condition that usually requires only
ointments applied to the skin for treatment.
B. Hodgkin lymphoma
Hodgkin lymphoma (HL) is one of the most curable forms of cancer. If you've formed mutant
cells called Reed-Sternberg cells, your doctor will diagnose you with Hodgkin lymphoma. There
are two main types: classical and nodular lymphocyte predominant. Cancer treatments such as
chemotherapy can cure many people with this type of lymphoma. And if it comes back, chemo
combined with stem cell transplants works well to wipe out the disease.
The most common sign of Hodgkin lymphoma is one or more enlarged (swollen) lymph nodes.
The enlarged lymph node may be in the neck, upper chest, armpit, abdomen or groin. It is
usually painless. A sign is a change in the body that the doctor sees in an exam or a test result. A
symptom is a change in the body that a patient can see or feel. Signs and symptoms of Hodgkin
lymphoma may include
Swollen lymph nodes
Cough and shortness of breath
Fever
Night sweats
Tiredness
Weight loss
Itchy skin.
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Clinical Presentation
Lymphoma typically presents as painless adenopathy (enlarged lymph nodes). The most
common sign of NHL is one or more enlarged lymph nodes in the neck, armpit or groin.
Enlarged lymph nodes also can be near the ears or elbow.
A sign is a change in the body that the doctor sees in an exam or a test result. A symptom is a
change in the body that a patient can see or feel.
Signs and symptoms of NHL may include
Swollen lymph nodes
Fever
Night sweats
Tiredness
Loss of appetite
Weight loss
Rash.
Diagnosis
Having the correct diagnosis is important for getting the right treatment. Some patients may need
to get a second medical opinion about the diagnosis before they begin treatment. Doctors do a
test called a lymph node biopsy to find out if a patient has NHL. Sometimes a biopsy is done to
examine cells from other parts of the body, such as the lungs. The Lugano classification system
considers symptoms and disease extent seen on positron emission tomography/computed
tomography (PET/CT) scans to stage lymphoma.
Immunophenotyping is done to find out if the patient’s NHL cells are B cells or T cells. This is a
lab test that can be done using the sample of cells from the lymph node biopsy or with blood or
bone marrow biopsy samples.
A physical exam, lab and imaging tests help the doctor to see how widespread the disease is. The
doctor will check
The number of lymph nodes that are affected
Where the affected lymph nodes are located (for example, in the abdomen or the chest or
in both parts of the body)
Whether any cancer cells are in other parts of the body besides the lymph nodes or
lymphatic system, such as the lungs or liver.
The tests for staging include
Blood tests – to check red blood cell, white blood cell and platelet counts. Blood tests are
also used to look for other signs of disease.
Bone marrow tests – to look for NHL cells in the marrow.
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Imaging tests – to create pictures of the chest and abdomen to see if there are lymphoma
masses in the lymph nodes, liver, spleen or lungs.
Examples of imaging tests include a
Chest x-ray
CT (computed tomography) scan
MRI (magnetic resonance imaging)
PET (positron emission tomography) scan.
Treatment (Both Non-Pharmacologic and Pharmacologic)
Lymphoma can be treated with drugs, such as chemotherapy, steroids and targeted therapies. It
can also be treated with radiotherapy or a stem cell transplant. For some people, active
monitoring is recommended, which means you don’t have treatment straightaway.
The doctor has to take into account many factors to make a treatment plan for a patient with
NHL, including
The type of NHL
The stage and category of the disease
The patient’s overall health.
Types of treatment are
Watch and wait – means that a doctor watches a patient’s condition but does not treat
with drugs or radiation therapy. Patients may think that they should have treatment right
away. But for patients with slow-growing disease and no symptoms, it is common not to
start treatment. This allows the patient to avoid side effects of therapy until treatment is
needed.
Chemotherapy – the main type of treatment for NHL
Drug therapy – Rituxan (rituximab) and certain other drugs are used to treat some types
of NHL
Radiation therapy – uses high-energy rays to kill lymphoma cells in one area. It can be
used along with chemotherapy when there are very large masses of lymphoma cells in a
small area of the body. Radiation can also be used when large lymph nodes are pressing
on an organ (such as the bowel) and chemotherapy cannot control the problem.
Stem cell transplantation – a procedure used for some types of NHL
New types of treatment – now under study in clinical trials.
In general, the treatment you get depends on your type of lymphoma and its stage.
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Treating non-Hodgkin lymphoma
The main treatments for non-Hodgkin lymphoma are:
Chemotherapy, which uses drugs to kill cancer cells
Radiation therapy, which uses high-energy rays to destroy cancer cells
Immunotherapy, which uses your body's immune system to attack cancer cells
Targeted therapy, which targets aspects of lymphoma cells to curb their growth
Treating Hodgkin lymphoma
The main treatments for Hodgkin lymphoma are:
Chemotherapy
Radiation therapy
Immunotherapy
If these treatments don't work, you might have a stem cell transplant. First, you'll get very high
doses of chemotherapy. This treatment kills cancer cells but also destroys stem cells in your bone
marrow that make new blood cells. After chemotherapy, you will get a transplant of stem cells to
replace the ones that were destroyed.
Your doctor can do two types of stem cell transplants:
An autologous transplant uses your own stem cells.
An allogeneic transplant uses stem cells taken from a donor.
Some types of lymphoma can go away without treatment, but it depends on the type of
lymphoma and the person who has it:
Follicular lymphoma. This type of lymphoma can go away without treatment, especially
if it's not causing health problems beyond swollen lymph nodes. It often grows slowly
and responds well to treatment, but it's hard to cure and can come back after treatment.
Low-grade lymphoma. This type of lymphoma grows so slowly that patients can live for
many years without symptoms, and some may never need treatment.
Intermediate-grade lymphoma. This type of lymphoma gets worse quickly without
treatment, but treatment can cause remission in many cases.
Hodgkin lymphoma and high-grade non-Hodgkin lymphoma. These types of lymphoma
can often go into complete remission and may not need further treatment.
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Evaluation of Therapeutic Outcomes
Once remission is achieved, patients need routine surveillance for complications and
relapse.
Age-appropriate screenings recommended by the U.S. Preventive Services Task Force
are essential.
Immunizations, including pneumococcal vaccines, are crucial due to lymphoma’s
immunosuppressive nature
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References
[1]. The Lymphoma Guide Information for Patients and Caregivers, Revised 2013
[2]. Lymphoma: Diagnosis and Treatment | AAFP
[3]. Pharmacotherapy Handbook, Eleventh Edition
[4]. [Link]/cancer/lympoma/lymphoma-cancer
[5]. [Link]
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