B-Cell Lymphoma Treatment & Management

Updated: Oct 23, 2017
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Treatment

Approach Considerations

Treatment of B-cell lymphoma varies according to the disease type. See Guidelines.

In addition, in October 2017 the US Food and Drug Administration approved chimeric antigen receptor (CAR) T-cell therapy with axicabtagene ciloleucel (Yescarta) for use in adults with diffuse large B-cell lymphoma (DLBCL) who have not responded to or who have relapsed after at least two other kinds of treatment. Approved uses include DLBCL, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma and DLBCL arising from follicular lymphoma. Axicabtagene ciloleucel is not indicated for the treatment of primary central nervous system lymphoma. [16]

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Complications

Complications arising from therapy include the following:

  • Neutropenic fever after chemotherapy is not uncommon and can be life-threatening if associated with sepsis
  • Tumor lysis syndrome after chemotherapy is possible in patients with bulky disease
  • Severe hemorrhagic cystitis is sometimes observed after high-dose cyclophosphamide therapy
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Consultations

Radiation oncologists are often consulted because radiation plays a role in management of B-cell lymphoma; it is considered the treatment of choice in early stage indolent lymphoma and has a role in consolidation of treatment in localized aggressive lymphoma.

A surgical consultation is indicated when central venous access devices are employed, especially when stem cell or bone marrow transplantation is considered.

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Transfer

Patients with lymphoma who are being managed at peripheral health care facilities may require their care to be transferred to a tertiary care or research institute for access to clinical trials and investigational agents.

Patients who are profoundly ill or are experiencing significant complications from either the disease or its therapy also warrant transfer to a facility that is better equipped to handle such emergencies.

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Diet

Typically, no dietary restrictions exist for patients with non-Hodgkin lymphoma (NHL). Patients with prolonged neutropenia following chemotherapy, especially those undergoing high-dose chemotherapy with hematopoietic precursor cell rescue, are provided with a reduced-bacteria diet. Patients with high tumor burden undergoing chemotherapy may be at risk for tumor lysis syndrome and sometimes require a diet low in uric acid and potassium.

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