There are always newer developments in treatment and diagnosis, so here I discuss what’s new with non-Hodgkin’s disease. Note that often non-Hodgkin’s disease is used synonymously to non-Hodgkins lymphoma (NHL).
Fine needle aspiration is becoming the method of choice in the diagnosis of both Hodgkin’s disease and non-Hodgkin’s disease. (Ref. 5).
Using this method diagnosing the disease has become more accurate than it was possible with a smear. Also the samples can be tested easier for histocompatibility and tumor markers, which helps in the “grey zone” cases. As in other diseases, it is imperative that there is an accurate diagnosis prior to treatment. Without proper diagnosis for the treating physician it would be like driving a car without a map and hoping to reach a specific goal in a foreign country.
A group of children with recurrent Hodgkin’s disease and non-Hodgkin’s lymphoma were treated with a combination chemotherapy regimen consisting of dexamethasone, etoposide, cisplatin, high-dose cytarabine, and L-asparaginase (DECAL). This was given in two courses as a salvage procedure. The responders were given a bone marrow transplant.
The others were given up to 4 courses of chemotherapy with ifosfamide, mesna, and etoposide and DECAL maintenance therapy. The overall 5-year survival rate was 31% for the Hodgkin’s lymphoma group and 30% for the non-Hodgkin’s lymphoma group, which otherwise likely would have been 0% (Ref.6).
References:
1. N Engl J Med 329(14):987-994,1997.
2. The Merck Manual of Diagnosis and Therapy. 17th edition, editors M.Beers and R.Berkow. Whitehouse Station, N.J., 1999.
3. Cancer: Principles & Practice of Oncology. 4th edition, edited by V.T. DeVita et al., Lippincott Co., Philadelphia, 1993. Chapters 51 and 52.
4. Cancer: Principles&Practice of Oncology. 5th edition, volume 2. Edited by Vincent T.DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter 44,Lymphomas.
5. HY Dong et al. Mod Pathol 2001 May;14(5):472-481.
6. NL Kobrinsky et al. J Clin Oncol 2001 May 1;19(9):2390-2396.
7. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
