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Mantle Cell Lymphoma Toronto-Sunnybrook Regional Cancer Centre Hematology Site Group - Treatment Policies 1/8 Mantle Cell Lymphoma Treatment policy prepared by Dr. Kevin Imrie 1. Introduction Mantle cell lymphoma accounts for ~ 3% of all non-Hodgkin’s lymphomas [1]. This subtype of lymphoma has only been well characterized in the last 5–7 years [2]. The prognosis is poor with a median survival of approximately 3 years. As standard therapy is relatively ineffective, these patients should be considered for clinical trials. 2. Diagnosis The diagnosis of mantle cell lymphoma is dependent on an adequate biopsy specimen (preferably open surgical biopsy) with immunohistochemistry and flow [3]. In most cases the tumor is composed exclusively of small to medium lymphoid cells. The tumor cells are Slg M + , usually Ig ...

Diagnosis and Monitoring of Malignant Lymphoma with Nuclear Medicine Techniques Robert E. Henkin, MD, FACNP, FACR, Editor Clinical Synopsis “ When diagnostic imaging examinations or clinical findings suggest recurrent disease, the gallium-67 scan can help document the presence of this disease as well as the extent. ” NucMedNet Online Physicians’ Guide Fig 1 Whole-body gallium-67 scan showing abnormal uptake in the mediastinum, the spleen, the inferior periaortic nodes, and the femoral nodes bilaterally. All sites represent lymphoma . The femoral and periaortic sites were unknown prior to the scan. INTRODUCTION Hodgkin’s and non-Hodgkin’s lymphomas represent a growing problem in medicine. These diseases have a peak incidence in the late teens and early twenties and again ...

474 Annals Academy of Medicine Orbital Lymphoma Treated with Radiotherapy—H Y Lau et al Orbital Lymphoma : Results of Radiation Therapy H Y Lau,* MD, FRCP (Canada) , E T Chua,** FAMS, MBBS, FRCR , T L Yang,*** FAMS, MBBS, FRCR , E J Chua,**** FAMS, MD, DMRT Abstract Orbital lymphoma is a rare presentation of non-Hodgkin’s lymphoma . Treatment with radiotherapy is well-established. Twenty cases of orbital lymphoma treated at the Singapore General Hospital with radiation therapy were reviewed. All patients had improvement of their initial presenting symptoms and complete remission after radiation. Long-term local control was achieved in 17 of 20 (85%) of the treated orbits. Ann Acad Med Singapore 1998; 27:474-7 Key words: Eye, Non-Hodgkin’s lymphoma , Orbit, Radiotherapy * Senior ...

Abstract. Peripheral T-cell lymphomas (PTCL) account for approximately 10% of all non-Hodgkin's lymphomas. The aim of this retrospective study was to analyse the presentation, management, outcome and significant prognostic factors in a large series of patients with PTCL. It includes 104 consecutive patients who presented to the Sheffield Lymphoma Group between 1977 and 2001. Clinical parameters were recorded for each subgroup. End points were response to treatment and survival. Survival analysis was used to assess the prognostic value of the variables. PTCL not otherwise specified contributed 52% of cases followed by anaplastic large cell lymphoma with 17% and angiocentric type with 13% of cases. The overall complete remission (CR) of the series was 59%. Stage at diagnosis affected response to treatment with 81% of cases in stage 1 and 2 achieving CR compared to 43% in stages 3 and 4 (p ...

Abstract. The prognostic significance of 20 putative markers has been assessed in a consecutive series of 1,198 patients with malignant lymphoma seen by the Sheffield Lymphoma Group over three decades. Univariate analysis disclosed that ten factors for both Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) Grade I, and twelve factors for NHL Grade II had prognostic significance. However, multivariate analysis selected only three (age, serum albumin and lymphocyte count) for HD, one (serum albumin) for NHL Grade I and five (age, stage, erythrocyte sedimentation rate, serum albumin and serum lactate dehydrogenase) for NHL Grade II as independent predictors for survival. Risk adjusted prognostic models were derived for Hodgkin's disease and NHL Grade II. For Hodgkin's disease the presence of 3 risk factors predicted for only 35% long-term survival for this group of patients. For ...

Abstract . An in vivo comparative study of 45 Ca-uptake and lipid peroxidation in tissues of mice treated with ATP complex of iron and sodium salt of ATP shows that only the iron complex produces a sustained increase of intracellular calcium on the organs susceptibles to develop lymphomas. A paralled study of 59 Fe-uptake from 59 Fe-iron complex of ATP presents a coincidental increase of iron uptake in those organs. To prove the involvement of the calcium homeostasis change in lymphoma -induction we have studied it with the lanthanum complex of ATP. Lanthanum is a well known cellular calcium entry modifier. Based on the results, the increased and sustained entry of extracellular calcium ion appears as the cause of lymphoma -induction by the iron complex. The effects of the calcium-overload in proliferation and neoplastic transformation ...

abc H o d g k i n ’s disease & other lymphomas myeloma • myelodysplasia • aplastic anaemia the myeloproliferative disorders • the leukaemias Page 2 A c k n o w l e d g e m e n t s Leukaemia Research Fund gratefully acknowledges the help and advice of Professor A. V. Hoffbrand in reviewing this series of publications and the assistance of Professor A. Burnett, Professor D. Catovsky, Professor J. Chessells, Professor J. Goldman, Dr A. Haynes, Professor G. Morg a n , Dr S. O’Brien, and Professor J. Sweetenham in the preparation of specific titles. Published by Leukaemia Research Fund , April 2001 43 Great Ormond Street L o n d o n WC1N 3JJ Tel: 020 7405 0101 Email: info@lrf.org . u k Fax: 020 7242 1488 Web: www. l r f . o rg . u k Registered Charity 216032 © All rights reserved. No part of this publication may be reproduced ...

BCCA Protocol Summary for Treatment of Lymphoma with Doxorubicin, Cyclophosphamide, Vincristine, Prednisone and Rituximab (CHOP-R) Protocol Code LYCHOP-R Tumour Group Lymphoma Contact Physician Dr. Joseph Connors ELIGIBILITY : Special: Only patients with previously untreated, advanced stage diffuse large B-cell lymphoma (with or without discordant lower grade lymphoma ) should be treated with LYCHOP-R. LYCHOP should be used for all other patients being treated for aggressive histology lymphoma . Histology: Diffuse large B-cell (with or without discordant lower grade lymphoma ) A “Class II Drug Registration Form” must be submitted at the time of initiation of treatment. Rituximab must be used in combination with CHOP in order to be reimbursed by BCCA. EXCLUSIONS : Congestive cardiac failure requiring current treatment (LYCHOP-R ...

B.C. Cancer Agency Protocol Summary LYPALL Page 1 of 2 H:\Pharm-prov\UPDATE\UpdateImplementation\LYPALL.doc BCCA Protocol Summary for Lymphoma Palliative Chemotherapy Protocol Code LYPALL Tumour Group Lymphoma Contact Physician Dr. Joseph Connors ELIGIBILITY/TESTS : The following chemotherapeutic agents are occasionally useful as single agents in the palliative or symptomatic management of lymphoproliferative disease. Their use always requires knowledge of the diagnosis, other co-morbid illnesses, prior treatment and toxicity and current goals of treatment. In general these uses of chemotherapy should be based on prior experience in similar situations. Clinicians without such experience should discuss these uses with a chemotherapist from the Lymphoma Tumour Group. Because the doses and schedules of the chemotherapy agents listed ...

B.C. Cancer Agency Protocol Summary LYFLU Page 1 of 2 H:\Pharm-prov\UPDATE\UpdateImplementation\LYFLU.doc Printed on 6/1/2004 4:17 PM BCCA Protocol Summary for Treatment of Low Grade Lymphoma or Chronic Lymphocytic Leukemia with Fludarabine Protocol Code LYFLU Tumour Group Lymphoma Contact Physician Dr. Joseph Connors ELIGIBILITY : Symptomatic or threatening advanced stage indolent lymphoma (small lymphocytic lymphoma , lymphoplasmacytic lymphoma [formerly Waldenstrom's macroglobulinemia], marginal zone lymphoma or follicular lymphoma ) or chronic lymphocytic leukemia TESTS : Baseline: CBC & diff, serum creatinine, HBsAg, HBcAb Before each treatment: CBC & diff, serum creatinine PREMEDICATIONS : None TREATMENT : Drug Dose BCCA Administration Guideline Fludarabine ...

BCCA Protocol Summary for Treatment of Leptomeningeal Lymphoma or Recurrent Intracerebral Lymphoma with High Dose Methotrexate Protocol Code LYHDMTXR (Recurrent) Tumour Group Lymphoma Contact Physician Dr. Tamara Shenkier ELIGIBILITY : 1. Age: 16 y or greater 2. Performance status: ECOG 0-3 3. Diagnosis: Leptomeningeal lymphoma or recurrent intracerebral lymphoma 4. Acceptable hematologic, renal and hepatic function EXCLUSIONS : 1. Estimated glomerular filtration rate (GFR) or estimated creatinine clearance (CrCl) below 60 mL/min N (140 - age) wt (kg) Estimated creatinine clearance: = ----------------------------------- serum creatinine ( µmol/L ) N = 1.23 male 1.04 female 2. Pleural effusion, ascites, full extremity edema. ...

BCCA Protocol Summary for Treatment of Advanced Indolent Lymphoma using Cyclophosphamide, Vincristine, Prednisone (CVP) Protocol Code LYCVP Tumour Group Lymphoma Contact Physician Dr. Richard Klasa ELIGIBILITY : Indolent lymphoma Follicular small cleaved, mixed or large cell Small Lymphocytic Lymphoplasmacytic Marginal zone lymphoma Stage IIA with more than 3 contiguous nodal sites of disease; IIB; III A or B; or IV A or B This protocol is for patients receiving CVP on a specific clinical trial. Off trial the lymphoma tumor group recommends cyclophosphamide (LYCYCLO) with or without prednisone instead of CVP. TESTS : Baseline: CBC and diff, bilirubin, LDH, HBsAg, HBcAb Before each treatment: CBC and diff PREMEDICATIONS : Ondansetron 8 mg PO pre-chemotherapy Dexamethasone 12 mg PO pre-chemotherapy ...

BCCA Protocol Summary for Treatment of Lymphoma using Intrathecal Methotrexate and Cytarabine Protocol Code LYIT Tumour Group Lymphoma Contact Physician Dr. Joseph Connors ELIGIBILITY : Large cell lymphoma or any other aggressive histology lymphoma (see Cancer Management Manual) with concordant involvement of any paranasal sinus TESTS : Baseline: CBC and differential, CSF cytology, HBsAg, HBcAb Weekly before treatment: CBC and differential PREMEDICATIONS : not usually required TREATMENT : Drug Dose BCCA Administration Guideline • by physician only • lumbar puncture tray required if no Ommaya reservoir Methotrexate 12 mg on days 1, 8 and 15 Intrathecal (via lumbar puncture or Ommaya ventricular reservoir) qs to 6 mL with preservative-free ...

The incidence of lymphomas has increased steadily for both men (29% increase) and women (45% increase) over the last 20 years. The level of mortality for men and women has increased only slightly during that time. Background notes Lymphoma (Hodgkins & Non-Hodgkins Lymphomas combined) Page 2 Male Lymphoma - Incidence and Mortality* 1977-2000 All Ages Includes Hodgkins and Non-Hodgki ns Lymphomas Source - SA Cancer Registry 0 5 10 15 20 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Year *Age Standardised for World Population Ra te/ 10 00 00 Incidence Mortality Male Lymphoma ~ Incidence and Mortality* 1977-2000 All Ages Source: SA Cancer ...

BCCA Protocol Summary for Treatment of Cutaneous T-cell Lymphoma (Mycosis Fungoides/Sézary syndrome) with Bexarotene Protocol Code ULYMFBEX Tumour Group Lymphoma Contact Physician Dr. Nicholas Voss ELIGIBILITY : Special: Only patients with advanced, progressive, refractory mycosis fungoides or Sézary syndrome who disease has not been controlled by at least one prior systemic chemotherapy agent should be considered for treatment with Bexarotene. Those with advanced but still exclusively cutaneous disease must have progressive disease despite topical nitrogen mustard and PUVA (if available) and, if appropriate, total body electron beam irradiation. Histology: mycosis fungoides or Sézary syndrome An undesignated indication application must be completed. Approval from the Health Canada Special Access Programme must be obtained for each patient. ...

BCCA Protocol Summary for the Consolidation for Lymphoma Using Etoposide, Cyclophosphamide and Vincristine Protocol Code LYECV Tumour Group Lymphoma Contact Physician Dr. Joseph Connors FOR INPATIENT USE AT VCC ONLY BACKGROUND INFORMATION Approximately 20% of patients with advanced Hodgkin’s lymphoma have a less than 50% likelihood of cure with standard chemotherapy and may do better with more intensified treatment. ELIGIBILITY : Ages 16 to 65 years Advanced stage Hodgkin’s lymphoma : Histological Subgroup Stage Special Characteristics Hodgkin’s disease 2B or 2 bulky or Presence of at least four (4) of the following: 3 or 4 Age greater than 44 years Gender male Stage IV Albumin less than 40 g/L WBC greater than 15 x 10 9 /L ...

B.C. Cancer Agency Protocol Summary LYHDMTXP Page 1 of 6 BCCA Protocol Summary for Treatment of Primary Intracerebral Lymphoma with High Dose Methotrexate Protocol Code LYHDMTXP (Primary) Tumour Group Lymphoma Contact Physician Dr. Tamara Shenkier ELIGIBILITY : 1. Age: 16 y or greater 2. Performance status: ECOG 0-3 3. Diagnosis : Biopsy proven diagnosis of primary CNS lymphoma (PCNSL) (with or without intraocular involvement) or classic radiologic picture with resolution on steroids. 4. Acceptable hematologic, renal and hepatic function EXCLUSIONS : 1. Estimated glomerular filtration rate (GFR) or estimated creatinine clearance (CrCl) below 60 mL/min N (140 - age) wt (kg) Estimated creatinine clearance: = ----------------------------------- ...

BCCA Protocol Summary for Therapy for Low Grade Lymphoma and Chronic Lymphocytic Leukemia Using Chlorambucil Protocol Code LYCHLOR Tumour Group Lymphoma Contact Physician Dr. J.M. Connors ELIGIBILITY : Malignant lymphoma , low grade Chronic lymphocytic leukemia EXCLUSIONS : Active hemolytic anemia or immune-related thrombocytopenia TESTS : Baseline: CBC & diff, platelets, HBsAg, HBcAb Before each treatment: CBC & diff, platelets PREMEDICATIONS : None TREATMENT : Four available schedules, choice determined by individual patient characteristics. Drug Dose BCCA Administration Guideline Schedule 1: Chlorambucil 0.4 mg/kg once every 2 weeks. Increase by 0.1 mg/kg/every other treatment until mild leukopenia (ANC < 3.5 x 10 9 /L) or definite ...

BCCA Protocol Summary for the Treatment of Lymphoma with Single Agent Rituximab Protocol Code LYRITUX Tumour Group Lymphoma Contact Physician Dr. Joseph Connors ELIGIBILITY : Age: any Histology: follicular lymphoma progressive despite alkylating agents and purine analogues (fludarabine or cladribine) or post-transplant lymphoproliferative disease Stage: any A “Class II Drug Registration Form” must be submitted at the time of initiation of treatment. Four treatments with Rituximab will be reimbursed by BCCA. For further treatments, an “Individual use of Benefit Drug List Medication for an Undesignated Indication” form must be approved. TESTS : • Baseline: CBC & diff, creatinine, bilirubin, AST, alkaline phosphatase, LDH, HBsAg, HBcAg Before treatment #1 and #4: CBC & diff PREMEDICATIONS : (Note: ...

B.C. Cancer Agency Protocol Summary LYSNCC Page 1 of 3 Last printed 6/2/2004 9:28 AM BCCA Protocol Summary for Treatment of Burkitt Lymphoma with Cyclophosphamide and Methotrexate Protocol Code : LYSNCC Tumour Group : Lymphoma Contact Physician : Dr. Joseph Connors ELIGIBILITY : Site: any Histology: Burkitt lymphoma (formerly small non-cleaved Burkitt-type) Stage IA, bulk < 10 cm EXCLUSIONS : 1. Serum Creatinine above 150 µmol/L or estimated creatinine clearance below 60 mL/min N (140 - age) wt (kg) Estimated creatinine clearance: = ----------------------------------- serum creatinine (µmol/L) N = 1.23 male 1.04 female 2. Pleural effusion, ascites, full extremity edema 3. Hemoglobin < 90 g/L; neutrophils < 1.5 x 10 9 /L; platelets < 75 ...

Vol. 4, No. 2, 2004 • The Journal of Applied Research 234 prednisolone at 100 mg/m 2 on days 3-7 were administered, followed by a 2- week period of no treatment. Toxicities are acceptable, and both patients achieved complete remission after six and five courses respectively. INTRODUCTION Among the non-Hodgkin’s lymphomas (NHL), low-grade B-cell lymphomas refer to small lymphocytic lymphoma , follicular lymphoma , marginal-zone B- cell lymphoma , and lymphoplasmacytic lymphoma . In Europe and the United States, low-grade B-cell lymphomas account for 25 to 40% of NHL. Recent studies of Japanese patients with lym- phoma have reported that low-grade B- cell lymphomas, follicular lymphomas, and marginal-zone B-cell lymphomas account for 15 to 25%, 7 of 15%, and 10 of 12% of the total NHL, respectively. 1,2 The main characteristics ...

1 MEET THE EXPERT ON NON-HODGKIN LYMPHOMA : N E W I N S I G H T S A N D T R E AT M E N T S LLS 04-05 Sullivan 6/10/04 MR. SULLIVAN: My name is Larry Sullivan. I was diagnosed with non-Hodgkin lymphoma approximately 3 years ago. It was discovered by myself while shaving. I felt a lump, went to the doctor, had a fine-needle biopsy, CAT scans, and it was identified as indolent non-Hodgkin lymphoma . The treatment options presented to me at the time were to do nothing, just watch and wait, or to actively pursue the disease. I chose with my doctor to pursue it, and the options that were made available to me were radiation or Rituxan ® (Rituximab), which was emphasized, and that is the one that we chose. At that time, I had two enlarged lymph nodes that were identified, and both of them were removed and ...

1 MEET THE EXPERT ON NON-HODGKIN LYMPHOMA : N E W I N S I G H T S A N D T R E AT M E N T S LLS 04-05 Q&A 6/10/04 QUESTION AND ANSWER SESSION LIVE AUDIENCE QUESTION #1: Thank you so much for sharing your knowledge with us and for your very informative presentation. I have a question about a young patient, 25, with extra nodules, aggressive, diffuse B-cell lymphoma treated successfully with Rituxan ® and CHOP. She had a stem cell transplant, and it was recommended because it was a bone involvement, not marrow, but bone involvement. Is this more assurance that this disease is truly cured? The doctor thinks she is cured, since she had a complete response to the CHOP and the Rituxan, and then had radiation on top of that- DR. GOLDBERG: The question is when do you know someone’s cured? And ...

1 MEET THE EXPERT ON NON-HODGKIN LYMPHOMA : N E W I N S I G H T S A N D T R E AT M E N T S LLS 04-05 Goldberg 6/10/04 DR. GOLDBERG: Patients who have a new diagnosis of lymphoma , as well as patients who have an established diagnosis, always need to know a little bit more about their disease so that they can participate in their own care. The doctor is just one part of dealing with this disease. The doctor may give you advice on how to treat and may actually initiate the therapy, but treatment doesn’t just stop when you leave the doctor’s office. It actually starts then, as you deal with family at home, as you deal with decisions about what you’re going to do for the long-term, and the more you know about your disease, the more you know about the treatment and what may come down the road. Not only could you help the doctor, ...

Technology in Cancer Research & Treatment ISSN 1533-0346 Volume 2, Number 6, December (2003) Adenine Press Dynamic Infrared Imaging of Newly Diagnosed Malignant Lymphoma Compared with Gallium-67 and Fluorine-18 Fluorodeoxyglucose (FDG) Positron Emission Tomography www.tcrt.org Staging and therapy monitoring of malignant lymphomas relies heavily on imaging using arbi- trary size criteria from computed tomography (CT) and sometimes non-specific radionuclide studies to assess the activity of the disease. Treatment decisions are based on early assess- ment of the response to therapy and the residual volume of the disease. Our initial experience is reported using a new noninvasive, inexpensive, and reproducible passive imaging modality, Dynamic Infrared Imaging (DIRI), which may add a new dimension to functional imaging. This system relies on its ability to filter the ...

a report by M V a n G l a b b e k e and I T e o d o r o v i c EORTC Data Center, Brussels I n t r o d u c t i o n For the last 30 years, the European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group has successfully faced the challenge of conducting large international randomised trials in aggressive as well as indolent subtypes of non-Hodgkin’s Lymphoma (NHL). The present paper summarizes the achieved results, and the objectives of on-going projects of the group. I n d o l e n t S u b t y p e s For follicular disease, the group has mainly focussed on the evaluation of new agents. In 1985 a randomised trial was started comparing maintenance treatment with interferon-alpha for one year versus no further treatment in patients with stages III or IV low-grade NHL who had reached a response to cyclophosphamide, ...

©2002 Charities Review Council of Minnesota, Inc. 2610 University Avenue West, Suite 375 Saint Paul, MN 55114-2007 Phone: 651-224-7030 Toll-free: 800-733-GIVE Fax: 651-224-7330 E-mail: charity@crcmn.org Web site: http://www.crcmn.org Charity report about: EIN: 13-5644916 LEUKEMIA & LYMPHOMA SOCIETY 1311 Mamaroneck Avenue White Plains, NY 10605 Web: www.leukemia- lymphoma .org Phone: (914) 949-5213 Fax: (914) 821-8937 Charity Profile The Leukemia & Lymphoma Society is a nonprofit health organization dedicated to seeking the cause and eventual cure of leukemia, lymphoma , Hodgkin’s disease and myeloma and improving the quality of life of patients and their families. It was founded in 1949 as the de Villiers Foundation to honor a teenager who died of leukemia. The Leukemia & Lymphoma Society’s services include: • ...

161 Abstract: Though oral candidosis is an opportunistic fungal infection that commonly affects immuno- compromised patients, little is known of its occurrence as a complication of Non-Hodgkin’s lymphoma . This paper reports a case of oral candidosis in a 20-year-old Indonesian woman with this lymphoproliferative disease. She presented with acute pseudomembranous candidosis on the dorsum and lateral borders of the tongue, bilateral angular cheilitis and cheilocandidosis. The latter is a rare clinical variant of oral candidosis, and the lesions affecting the vermilion borders presented as an admixture of superficial erosions, ulcers and white plaques. Clinical findings were confirmed with oral smears and swabs that demonstrated the presence of hyphae, pseudohyphae and blastospores, and colonies identified as Candida albicans . A culture from a saline ...

1 MEET THE EXPERT ON NON-HODGKIN LYMPHOMA : N E W I N S I G H T S A N D T R E AT M E N T S LLS 04-05 6/10/04 Treatments for Non-Hodgkin Lymphoma DR. GOLDBERG: That brings us to the issue of treatment. How do we go about treating these patients? Once again, we go back to basics and ask, is this a slow-growing tumor or is this an aggressive tumor? I always tell the story to my patients of the tortoise and the hare. Everybody remembers that fable, which fits lymphoma perfectly. As you remember, the hare gets out of the gate real fast, grows, grows, grows, grows, and he’s eating the whole time, and he’s running away, but he loses the race. Well, some types of lymphomas grow, grow, grow, grow, and if you put poison down, they’re going to take up all the poison, and you’re going to kill off those lymphomas, and these ...