eMedicine Specialties > Orthopedic Surgery > Neoplasms

Malignant Lymphoma: Treatment

Author: Sharad Mathur, MD, Staff Physician, Department of Pathology, Kansas City VA Medical Center
Coauthor(s): Timothy A Damron, MD, David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse
Contributor Information and Disclosures

Updated: Jan 8, 2008

Treatment

Medical Therapy

Medical treatment is the mainstay therapy for primary lymphoma of bone. Chemotherapy and radiation therapy are used in conjunction in most cases.

The usual chemotherapy utilizes CHOP (cyclophosphamide, Adriamycin, vincristine, prednisone) or another, similar regimen for several cycles.13,14 This may be combined with radiation therapy to the affected bone in a 40-60 Gy dose, fractionated over several weeks. Some studies indicate that the results of combined modality therapy (chemotherapy and radiation therapy) are better than those from radiation therapy alone, while other studies have not documented any statistically significant difference.13,15,16,17,18 Because of the relative rarity of this disease, standard treatment protocols have not been developed and followed, and the data in the literature are retrospective.

In children, aggressive chemotherapy alone appears to be as effective as combined modality therapy. Because radiation therapy in children is associated with an increased incidence of adverse, growth-related consequences, it should be avoided in this population.

Therapeutic agents, such as rituximab (an anti-CD20 antibody), have been employed against B-cell lymphomas.19 Refractory cases have been treated with allogeneic bone marrow transplantation.

See also the following related topics in Medscape:
Resource Center Biologic Therapies in Cancer
CME Antibody Therapy in Diffuse Large B-Cell Non-Hodgkin's Lymphoma
CME Biologic Therapies in Oncology: Volume 4

Surgical Therapy

No standard role for surgical therapy exists in the primary management of bone lymphomas, beyond its use as a means of obtaining tissue for diagnosis and of treating complications, such as pathologic fracture. Before the advent of radiation and chemotherapy, some patients were treated with amputation, but with current medical treatment, amputation is generally not necessary.

Complications

Complications of treatment include the following:

  • Fracture
  • Fracture nonunion
  • Wound infection
  • Osteonecrosis
  • Secondary arthritis following collapse of osteonecrotic bone
  • Neuropathy
  • Toxicity of chemotherapy
  • Thrombophlebitis

Fractures are most common in weight-bearing bones and have been associated with the primary disease, with radiation therapy, and with avascular necrosis following chemotherapy.

More on Malignant Lymphoma

Overview: Malignant Lymphoma
Workup: Malignant Lymphoma
Treatment: Malignant Lymphoma
Follow-up: Malignant Lymphoma
Multimedia: Malignant Lymphoma
References
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Further Reading

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Keywords

osteolymphoma, reticulum cell sarcoma, primary lymphoma of bone, bone cancer, Paget disease, bone lymphoma, bone pain

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Contributor Information and Disclosures

Author

Sharad Mathur, MD, Staff Physician, Department of Pathology, Kansas City VA Medical Center
Sharad Mathur, MD is a member of the following medical societies: Academy of Clinical Laboratory Physicians and Scientists, American Society of Clinical Pathologists, American Society of Cytopathology, American Society of Hematology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

Timothy A Damron, MD, David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse
Timothy A Damron, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, Children's Oncology Group, Connective Tissue Oncology Society, Musculoskeletal Tumor Society, Orthopaedic Research Society, and Society for Experimental Biology and Medicine
Disclosure: Nothing to disclose.

Medical Editor

Lynn A Crosby, MD, FACS, Chief of Shoulder Division, Professor, Department of Orthopedic Surgery, Wright State University School of Medicine
Lynn A Crosby, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Fracture Association, American Medical Association, American Medical Tennis Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Arthroscopy Association of North America, Mid-America Orthopaedic Association, and Orthopaedic Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center, Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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