eMedicine Specialties > Hematology > Stem Cells and Disorders

Lymphoma, Diffuse Large Cell: Follow-up

Author: Andre M Kallab, MD, Clinical Associate Professor of Oncology, Medical College of Georgia; Consulting Staff, Department of Oncology, Northeast Georgia Diagnostic Clinic
Contributor Information and Disclosures

Updated: Nov 4, 2009

Follow-up

Further Inpatient Care

  • Admit the patient if a treatment complication arises.
  • Chemotherapy usually is given on an outpatient basis.

Further Outpatient Care

  • Follow patients very carefully while they are receiving chemotherapy.
  • Treatment is administered every 3 weeks.
  • Complete blood counts and chemistries are ordered frequently for outpatient monitoring.
  • Patients are seen immediately if they develop any chemotherapy-related adverse effects.

Inpatient & Outpatient Medications

  • Antiemetics are always prescribed prior to and after the administration of chemotherapy.
  • Intravenous fluids are given as necessary.
  • Supportive care with analgesics and growth factors are provided as necessary.
  • Patients often are started on allopurinol with the induction of chemotherapy to avoid acute renal failure from tumor lysis syndrome (TLS) and uric acid nephropathy.

Transfer

  • Transfer may be necessary for further diagnostic evaluation and medical or surgical interventions.

Complications

  • TLS is a potential complication.
    • It manifests as a rapid rise in potassium, phosphorus, and uric acid and a drop in calcium.
    • It can lead to a sudden death from electrolyte abnormalities.
    • Aggressive intravenous hydration, alkalinization of the urine, and the administration of allopurinol usually prevents TLS. Occasionally, patients with significant tumor volume and rapidly growing disease can avoid TLS by receiving dose-modified or attenuated chemotherapy as the first treatment, followed by conventional chemotherapy in subsequent treatment cycles.
  • Uric acid nephropathy, with or without TLS, usually can be prevented by administering allopurinol or alkalinizing the urine.
  • Neutropenic fevers and sepsis are the most common potentially serious complications of chemotherapy. If not recognized and treated aggressively, these infections can cause rapid deterioration of the patient's condition, which could lead to death. The use of cytokines (granulocyte colony-stimulating factors or granulocyte-macrophage colony-stimulating factors) has been helpful in preventing infections by shortening, and in some cases preventing, the neutropenic period. The use of prophylactic antibiotics (especially with the fluoroquinolones [eg, ciprofloxacin, levofloxacin]) has been shown to be effective in preventing neutropenic infections.

Prognosis

  • The prognosis of patients with DLCLs can be assessed by applying the 5 lymphoma prognostic factors as described by the International Prognostic Index. These are as follows:
    • Age
    • Tumor stage
    • Number of extranodal sites involved
    • Performance status
    • LDH value
  • Patients with low risk, ie, 0 or 1 adverse factors, have a 5-year survival rate of 73%.
  • In the high-risk group, ie, people with 4-5 adverse factors, 5-year survival rate drops to 26%.

Miscellaneous

Medicolegal Pitfalls

  • Failure to completely stage the patient
  • Failure to initiate treatment as soon as possible
  • Failure to prevent uric acid nephropathy and TLS
  • Failure to recognize and treat neutropenic sepsis
 


More on Lymphoma, Diffuse Large Cell

Overview: Lymphoma, Diffuse Large Cell
Differential Diagnoses & Workup: Lymphoma, Diffuse Large Cell
Treatment & Medication: Lymphoma, Diffuse Large Cell
Follow-up: Lymphoma, Diffuse Large Cell
Multimedia: Lymphoma, Diffuse Large Cell
References
Further Reading
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References

  1. Lu Y, Prescott J, Sullivan-Halley J, et al. Body size, recreational physical activity, and B-cell non-Hodgkin lymphoma risk among women in the California Teachers Study. Am J Epidemiol. Oct 12 2009;[Medline].

  2. Wu XC, Andrews P, Chen VW, et al. Incidence of extranodal non-Hodgkin lymphomas among whites, blacks, and Asians/Pacific Islanders in the United States: anatomic site and histology differences. Cancer Epidemiol. Oct 21 2009;[Medline].

  3. De Roos AJ, Davis S, Colt JS, et al. Residential proximity to industrial facilities and risk of non-Hodgkin lymphoma. Environ Res. Oct 17 2009;[Medline].

  4. Terasawa T, Nagai H. Current clinical evidence on interim fluorine-18 fluorodeoxy glucose positron emission tomography for advanced-stage Hodgkin lymphoma and diffuse large B-cell lymphoma to predict treatment outcomes. Leuk Lymphoma. Oct 28 2009;[Medline].

  5. Villa D, Connors JM, Shenkier TN, et al. Incidence and risk factors for central nervous system relapse in patients with diffuse large B-cell lymphoma: the impact of the addition of rituximab to CHOP chemotherapy. Ann Oncol. Oct 27 2009;[Medline].

  6. Coltman CA, Dahlberg S, Jones SE. Southwest Oncology Group Studies in diffuse large cell lymphoma: a subset analysis. Tokyo, Japan: Excerpta Medica; 1988:. 194-202.

  7. Gao G, Liang X, Jiang J, et al. A systematic review and meta-analysis of immunochemotherapy with rituximab for B-cell non-Hodgkin's lymphoma. Acta Oncol. Aug 27 2009;1-11. [Medline].

  8. Gross TG, Hale GA, He W, et al. Hematopoietic stem cell transplantation for refractory or recurrent non-Hodgkin lymphoma in children and adolescents. Biol Blood Marrow Transplant. Sep 29 2009;[Medline].

  9. International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. Sep 30 1993;329(14):987-94. [Medline].

  10. Cabanillas F, Hagemeister FB, Bodey GP, Freireich EJ. IMVP-16: an effective regimen for patients with lymphoma who have relapsed after initial combination chemotherapy. Blood. Sep 1982;60(3):693-7. [Medline].

  11. Cabanillas F, Hagemeister FB, McLaughlin P, et al. Results of MIME salvage regimen for recurrent or refractory lymphoma. J Clin Oncol. Mar 1987;5(3):407-12. [Medline].

  12. Connors JM, Klimo P, Fairey RN, Voss N. Brief chemotherapy and involved field radiation therapy for limited-stage, histologically aggressive lymphoma. Ann Intern Med. Jul 1987;107(1):25-30. [Medline].

  13. Doggett RS, Wood GS, Horning S, et al. The immunologic characterization of 95 nodal and extranodal diffuse large cell lymphomas in 89 patients. Am J Pathol. May 1984;115(2):245-52. [Medline].

  14. Fisher RI, Gaynor ER, Dahlberg S, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med. Apr 8 1993;328(14):1002-6. [Medline].

  15. Hallahan DE, Farah R, Vokes EE, et al. The patterns of failure in patients with pathological stage I and II diffuse histiocytic lymphoma treated with radiation therapy alone. Int J Radiat Oncol Biol Phys. Oct 1989;17(4):767-71. [Medline].

  16. Hartge P, Devesa SS, Fraumeni JF. Hodgkin's and non-Hodgkin's lymphomas. Cancer Surv. 1994;19-20:423-53. [Medline].

  17. Miller TP, Dahlberg S, Cassady JR. et al. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med. Jul 2 1998;339(1):21-6. [Medline].

  18. Nakamura H, Said JW, Miller CW, Koeffler HP. Mutation and protein expression of p53 in acquired immunodeficiency syndrome-related lymphomas. Blood. Aug 1 1993;82(3):920-6. [Medline].

  19. Philip T, Guglielmi C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med. Dec 7 1995;333(23):1540-5. [Medline].

  20. Ries LAG, Miller BA, Hankey BF. SEER Cancer Statistics Review 1973-1991: Tables and Graphs. Bethesda, Md: National Cancer Institute; 1994:. NIH publication no 94-2789.

  21. Skarin AT, Dorfman DM. Non-Hodgkin's lymphomas: current classification and management. CA Cancer J Clin. Nov-Dec 1997;47(6):351-72. [Medline].

  22. Stein H, Dallenbach F. Diffuse Large Cell Lymphomas of B and T Cell Type. In: Knowles DM, ed. Neoplastic Hematology. Baltimore, Md: Williams and Willkins; 1992:. 675.

  23. Velasquez W, Hagemeister F, McLaughlin P. E-SHAP: an effective treatment for refractory and relapsing lymphoma. A long follow-up (meeting abstract). Proc Am Soc Clin Oncol. 1992;11:A1111.

  24. Velasquez WS, Cabanillas F, Salvador P, et al. Effective salvage therapy for lymphoma with cisplatin in combination with high-dose Ara-C and dexamethasone (DHAP). Blood. Jan 1988;71(1):117-22. [Medline].

  25. Vose JM, Link BK, Grossbard ML, et al. Phase II study of rituximab in combination with chop chemotherapy in patients with previously untreated, aggressive non-Hodgkin's lymphoma. J Clin Oncol. Jan 15 2001;19(2):389-97. [Medline].

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Keywords

diffuse large cell lymphoma, lymphoma, non-Hodgkin's lymphoma, B-cell lymphoma, large B-cell lymphoma, diffuse B-cell lymphoma, non-Hodgkin lymphoma, B-cell lymphoma, diffuse large B-cell lymphoma, intermediate-grade lymphoma, large cell lymphoma, immunoblastic lymphoma

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Contributor Information and Disclosures

Author

Andre M Kallab, MD, Clinical Associate Professor of Oncology, Medical College of Georgia; Consulting Staff, Department of Oncology, Northeast Georgia Diagnostic Clinic
Andre M Kallab, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

Michael Paul Kosty, MD, Associate Director, Associate Professor, Department of Internal Medicine, Divisions of Supportive Care Services and Hematology and Oncology, Ida M and Cecil H Green Cancer Center, Scripps Clinic
Michael Paul Kosty, MD is a member of the following medical societies: American College of Physicians, American Society of Hematology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wendy Hu, MD, Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center
Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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