Blood cancer – Lymphoma and Leukemia
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Blood cancer – Lymphoma and Leukemia
Blood cancer
Increasing in both children and adults, with treatment centers expanding across India.
1. Lymphoma
Lymphomas are malignancies of lymphoid tissue, primarily affecting lymph nodes, spleen, and bone marrow.
Types
Major Category
Subtypes
Hodgkin Lymphoma (HL)
Classical HL (nodular sclerosis, mixed cellularity), Nodular lymphocyte predominant HL
Non-Hodgkin Lymphoma (NHL)
B-cell (e.g., DLBCL, follicular, mantle cell), T-cell (e.g., PTCL, cutaneous T-cell lymphoma)
Risk Factors
- Immunosuppression (HIV/AIDS, post-transplant)
- Epstein-Barr Virus (EBV) (esp. Hodgkin and Burkitt lymphoma)
- Autoimmune diseases
- Environmental exposures (e.g., pesticides, radiation)
Treatment
Subtype
Treatment Approach
Hodgkin Lymphoma
ABVD chemotherapy (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) ± radiation
DLBCL (aggressive NHL)
R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone)
Indolent NHL (e.g., Follicular)
Observation if asymptomatic; R-CHOP or rituximab-based if needed
T-cell Lymphomas
CHOP-based regimens; prognosis is often poorer
Radiation
Used for localized disease, bulky disease, or residual nodes post-chemo
2. Leukemia
Leukemia is a cancer of the bone marrow and blood, characterized by uncontrolled proliferation of white blood cells.
Types
Type
Common Features
Acute Lymphoblastic Leukemia (ALL)
Common in children; rapid onset
Acute Myeloid Leukemia (AML)
Adults; often secondary to chemo/radiation
Chronic Lymphocytic Leukemia (CLL)
Elderly patients; slow progression
Chronic Myeloid Leukemia (CML)
Associated with Philadelphia chromosome (BCR-ABL)
Risk Factors
- Genetic syndromes (e.g., Down syndrome – ALL/AML)
- Prior chemotherapy/radiation
- Exposure to benzene, smoking
- Viral infections (e.g., HTLV-1 for adult T-cell leukemia)
Treatment
Leukemia Type
Standard Treatments
ALL
Multi-agent chemotherapy (induction → consolidation → maintenance) ± CNS prophylaxis
AML
“7+3” regimen (cytarabine + anthracycline) → possible bone marrow transplant
CML
Tyrosine kinase inhibitors (TKIs) – imatinib, dasatinib
CLL
Observation for early-stage; targeted therapy (ibrutinib, venetoclax, anti-CD20 drugs)
Role of Radiation Therapy
- Lymphoma: RT is curative in early-stage Hodgkin and some NHLs
-
Leukemia:
- CNS prophylaxis in ALL (cranial irradiation in some protocols)
- Total body irradiation (TBI) as part of conditioning for stem cell transplant
- Palliative RT for bone pain or bulky extramedullary disease
Key Points
- Hodgkin lymphoma has excellent cure rates with chemo ± RT
- NHL and leukemia treatments depend on subtype, age, and risk factors
- Targeted therapies have revolutionized CML and CLL management
- RT is used selectively in lymphoma and leukemia for local control or conditioning