eMedicine Specialties > Hematology > Stem Cells and Disorders

Lymphoma, Malignant Anaplastic (Ki 1+): Follow-up

Author: Delong Liu, MD, PhD, Associate Professor of Medicine, Division of Oncology/Hematology, New York Medical College; Chief of Hematology, Phelps Memorial Hospital Center; Director of Non-ablative Allogeneic Stem Cell Transplantation Program, Westchester Medical Center; Editor-in-Chief, Journal of Hematology and Oncology
Coauthor(s): Koyamangalath Krishnan, MD, FRCP, FACP, Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University; Christine Urbanski, MD, Consulting Staff, Hematology/Oncology Associates, RMH Regional Cancer Center
Contributor Information and Disclosures

Updated: Dec 12, 2008

Follow-up

Further Outpatient Care

  • Although late relapses can occur, patients with diffuse aggressive lymphomas usually experience recurrence within 2 years of completion of treatment. Early detection allows identification of potential candidates for high-dose therapy and stem cell transplantation. Periodic physical examinations and reimaging are recommended as follow-up care for those in remission. Long-term survivors need continued surveillance for potential treatment-associated complications.

Complications

  • Tumor lysis syndrome (TLS) is a common complication of treatment for any high-grade, bulky, treatment-sensitive lymphoma and occurs after intracellular contents are released rapidly into the blood. The syndrome manifests as renal failure, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia; these metabolic derangements may lead to sudden death if left uncorrected. Prophylactic and treatment measures include allopurinol, alkaline diuresis, and correction of potassium and phosphate abnormalities. Patients with bulky or advanced-stage anaplastic large cell lymphoma (ALCL) are at high risk of TLS and should receive prophylaxis, with close monitoring of fluid status, urine output, electrolytes, and renal function.
  • Untreated or treatment-resistant systemic anaplastic large cell lymphoma (ALCL), like other aggressive systemic lymphomas, ultimately results in death, with variable earlier complications depending on the bulk and sites of disease.
  • Long-term survivors of non-Hodgkin lymphoma are at increased risk of second malignancies, including all solid tumors, melanoma, Hodgkin disease, and acute myelogenous leukemia (AML).

Prognosis

  • Primary systemic anaplastic large cell lymphoma (ALCL): The prognostic factors applied to other non-Hodgkin lymphomas are also relevant to ALCL and include age, LDH values, performance status, number of extranodal sites, and stage. These features are compiled in the International Prognostic Index, which provides stratification into risk groups and serves to identify patients for whom early experimental approaches may be considered. ALK status is also an important prognostic indicator because ALK-positive cases have demonstrated a significantly improved 5-year overall survival rate of 70-80%, versus 15-45% reported for those without ALK expression.
  • Primary cutaneous ALCL: Localized skin presentation in those with pure cutaneous disease is associated with good long-term survival.
  • Secondary ALCL: This is associated with poor prognosis.
  • ALC has been reported to be an independent prognostic factor.15 ALC <1000/μ L correlates with shorter survival and lower complete remission rate.

Patient Education

 


More on Lymphoma, Malignant Anaplastic (Ki 1+)

Overview: Lymphoma, Malignant Anaplastic (Ki 1+)
Differential Diagnoses & Workup: Lymphoma, Malignant Anaplastic (Ki 1+)
Treatment & Medication: Lymphoma, Malignant Anaplastic (Ki 1+)
Follow-up: Lymphoma, Malignant Anaplastic (Ki 1+)
References
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References

  1. Dalla-Favera R, Gaidano G. Lymphomas. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. Vol 2. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:2215-387.

  2. Rodriguez J, Pugh W, Romaguera J, Cabanillas F. Anaplastic Ki-1 + large-cell lymphoma. Cancer Invest. 1993;11(5):554-8. [Medline].

  3. Stein H, Foss HD, Durkop H, et al. CD30(+) anaplastic large cell lymphoma: a review of its histopathologic, genetic, and clinical features. Blood. Dec 1 2000;96(12):3681-95. [Medline]. [Full Text].

  4. Zinzani PL, Bendandi M, Martelli M, et al. Anaplastic large-cell lymphoma: clinical and prognostic evaluation of 90 adult patients. J Clin Oncol. Mar 1996;14(3):955-62. [Medline].

  5. Benharroch D, Meguerian-Bedoyan Z, Lamant L, et al. ALK-positive lymphoma: a single disease with a broad spectrum of morphology. Blood. Mar 15 1998;91(6):2076-84. [Medline]. [Full Text].

  6. Lamant L, de Reynies A, Duplantier MM, et al. Gene-expression profiling of systemic anaplastic large-cell lymphoma reveals differences based on ALK status and two distinct morphologic ALK+ subtypes. Blood. Mar 1 2007;109(5):2156-64. [Medline]. [Full Text].

  7. Gaidano G, Dalla-Favera R. Pathobiology of non-Hodgkin lymphomas. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. New York, NY: Churchill Livingstone; 2000:1213-29.

  8. Coiffier B. Treatment of aggressive non-Hodgkin's lymphoma. Semin Oncol. Oct 1999;26(5 suppl 14):12-20. [Medline].

  9. Lister TA, Armitage JO. Non-Hodgkin's lymphomas. In: Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE, eds. Clinical Oncology. 2nd ed. Philadelphia, Pa: Churchill Livingstone; 2000:2658-719.

  10. Pugh WC, McBride JA. The pathologic basis for the classification of non-Hodgkin lymphomas. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. New York, NY: Churchill Livingstone; 2000:1263-93.

  11. van Besien K, Cabanillas F. Clinical manifestations, staging, and treatment of non-Hodgkin lymphoma. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. New York, NY: Churchill Livingstone; 2000:1293-339.

  12. Beljaards RC, Kaudewitz P, Berti E, et al. Primary cutaneous CD30-positive large cell lymphoma: definition of a new type of cutaneous lymphoma with a favorable prognosis. A European Multicenter Study of 47 patients. Cancer. Mar 15 1993;71(6):2097-104. [Medline].

  13. Paulli M, Berti E, Rosso R, et al. CD30/Ki-1-positive lymphoproliferative disorders of the skin -- clinicopathologic correlation and statistical analysis of 86 cases: a multicentric study from the European Organization for Research and Treatment of Cancer Cutaneous Lymphoma Project Group. J Clin Oncol. Jun 1995;13(6):1343-54. [Medline].

  14. Willemze R, Kerl H, Sterry W, et al. EORTC classification for primary cutaneous lymphomas: a proposal from the Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer. Blood. Jul 1 1997;90(1):354-71. [Medline]. [Full Text].

  15. Porrata LF, Ristow K, Witzig TE, et al. Absolute lymphocyte count is independent of the anaplastic lymphoma kinase and predicts survival in primary anaplastic large cell lymphoma [abstract]. Blood. 2007;110:abstract 1335. [Full Text].

  16. Foss HD, Anagnostopoulos I, Araujo I, et al. Anaplastic large-cell lymphomas of T-cell and null-cell phenotype express cytotoxic molecules. Blood. Nov 15 1996;88(10):4005-11. [Medline]. [Full Text].

  17. Deconinck E, Lamy T, Foussard C, et al. Autologous stem cell transplantation for anaplastic large-cell lymphomas: results of a prospective trial. Br J Haematol. Jun 2000;109(4):736-42. [Medline].

  18. Brugieres L, Deley MC, Pacquement H, et al. CD30(+) anaplastic large-cell lymphoma in children: analysis of 82 patients enrolled in two consecutive studies of the French Society of Pediatric Oncology. Blood. Nov 15 1998;92(10):3591-8. [Medline]. [Full Text].

  19. Chabner BA, Allegra CJ, Curt GA, Calabresi P. Antineoplastic agents. In: Goodman LS, Limbird LE, Milinoff PB, et al, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill; 1996:1273.

  20. Longo G, Federico M, Pieresca C, et al. Anaplastic large cell lymphoma (CD30+/Ki-1+). Analysis of 35 cases followed at GISL centres. Eur J Cancer. Oct 1995;31A(11):1763-7. [Medline].

  21. Reiter A, Schrappe M, Tiemann M, et al. Successful treatment strategy for Ki-1 anaplastic large-cell lymphoma of childhood: a prospective analysis of 62 patients enrolled in three consecutive Berlin-Frankfurt-Munster group studies. J Clin Oncol. May 1994;12(5):899-908. [Medline].

  22. Tilly H, Gaulard P, Lepage E, et al. Primary anaplastic large-cell lymphoma in adults: clinical presentation, immunophenotype, and outcome. Blood. Nov 1 1997;90(9):3727-34. [Medline]. [Full Text].

  23. Zhang M, Yao Z, Zhang Z, et al. Effective therapy for a murine model of human anaplastic large-cell lymphoma with the anti-CD30 monoclonal antibody, HeFi-1, does not require activating Fc receptors. Blood. Jul 15 2006;108(2):705-10. [Medline]. [Full Text].

  24. Zinzani PL, Pileri S, Bendandi M, et al. Clinical implications of serum levels of soluble CD30 in 70 adult anaplastic large-cell lymphoma patients. J Clin Oncol. Apr 1998;16(4):1532-7. [Medline].

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Further Reading

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Keywords

malignant anaplastic lymphoma, Ki-1+ anaplastic lymphoma, anaplastic large-cell lymphoma, Ki-1 lymphoma, CD30+, ALCL, anaplastic lymphoma kinase-positive lymphoma, ALK-positive lymphoma, anaplastic Ki-1+ large cell lymphoma, lymphoma, large cell anaplastic CD30+ Ki-1 lymphoma, Ki-1 large cell lymphoma, cutaneous and nodal Ki-1 positive anaplastic large cell lymphoma, cutaneous lymphoma, skin cancer, cancer, extranodal lymphoma, extra-nodal lymphoma, systemic lymphoma, systemic cancer, anaplastic lymphoma, systemic anaplastic large-cell lymphoma

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Contributor Information and Disclosures

Author

Delong Liu, MD, PhD, Associate Professor of Medicine, Division of Oncology/Hematology, New York Medical College; Chief of Hematology, Phelps Memorial Hospital Center; Director of Non-ablative Allogeneic Stem Cell Transplantation Program, Westchester Medical Center; Editor-in-Chief, Journal of Hematology and Oncology
Delong Liu, MD, PhD is a member of the following medical societies: American Society of Clinical Oncology and American Society of Hematology
Disclosure: Nothing to disclose.

Coauthor(s)

Koyamangalath Krishnan, MD, FRCP, FACP, Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians
Disclosure: Nothing to disclose.

Christine Urbanski, MD, Consulting Staff, Hematology/Oncology Associates, RMH Regional Cancer Center
Christine Urbanski, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

David Aboulafia, MD, Medical Director, Bailey-Boushay House; Clinical Professor, Department of Medicine, Division of Hematology, University of Washington
David Aboulafia, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Directors Association, American Society of Hematology, Infectious Diseases Society of America, 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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