West Virginia University Eastern Division, Harpers Ferry, WV, USA.
Am Fam Physician. 2020 Jan 1;101(1):34-41.
Lymphoma is a group of malignant neoplasms of lymphocytes with more than 90 subtypes. It is traditionally classified broadly as non-Hodgkin or Hodgkin lymphoma. Approximately 82,000 new U.S. patients are diagnosed with lymphoma annually. Any tobacco use and obesity are major modifiable risk factors, with genetic, infectious, and inflammatory etiologies also contributing. Lymphoma typically presents as painless adenopathy, with systemic symptoms of fever, unexplained weight loss, and night sweats occurring in more advanced stages of the disease. An open lymph node biopsy is preferred for diagnosis. The Lugano classification system incorporates symptoms and the extent of the disease as shown on positron emission tomography/computed tomography to stage lymphoma, which is then used to determine treatment. Chemotherapy treatment plans differ between the main subtypes of lymphoma. Non-Hodgkin lymphoma is treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), bendamustine, and lenalidomide. Hodgkin lymphoma is treated with combined chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), Stanford V (a chemotherapy regimen consisting of mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone), or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) with radiotherapy. Subsequent chemotherapy toxicities include neuropathy, cardiotoxicity, and secondary cancers such as lung and breast, and should be considered in the shared decision-making process to select a treatment regimen. Once remission is achieved, patients need routine surveillance to monitor for complications and relapse, in addition to age-appropriate screenings recommended by the U.S. Preventive Services Task Force. Patients should receive a 13-valent pneumococcal conjugate vaccine followed by a 23-valent pneumococcal polysaccharide vaccine at least eight weeks later with additional age-appropriate vaccinations because lymphoma is an immunosuppressive condition. Household contacts should also be current with their immunizations.
淋巴瘤是一组淋巴细胞的恶性肿瘤，超过 90 种亚型。它传统上被广泛分为非霍奇金或霍奇金淋巴瘤。美国每年约有 82000 名新患者被诊断患有淋巴瘤。任何烟草使用和肥胖都是主要的可改变风险因素，遗传、感染和炎症病因也有贡献。淋巴瘤通常表现为无痛性淋巴结病，在疾病的更晚期出现发热、不明原因体重减轻和盗汗等全身症状。首选开放性淋巴结活检进行诊断。卢加诺分类系统将症状和疾病的范围纳入正电子发射断层扫描/计算机断层扫描，以分期淋巴瘤，然后用于确定治疗方案。化疗治疗方案因主要的淋巴瘤亚型而异。非霍奇金淋巴瘤采用 CHOP（环磷酰胺、多柔比星、长春新碱和泼尼松）加或不加利妥昔单抗（R-CHOP）、苯达莫司汀和来那度胺治疗。霍奇金淋巴瘤采用 ABVD（多柔比星、博来霉素、长春碱和达卡巴嗪）联合化疗、斯坦福 V（一种由氮芥、多柔比星、长春碱、长春新碱、博来霉素、依托泊苷和泼尼松组成的化疗方案）或 BEACOPP（博来霉素、依托泊苷、多柔比星、环磷酰胺、长春新碱、丙卡巴肼和泼尼松）联合放疗。随后的化疗毒性包括神经病变、心脏毒性和肺癌、乳腺癌等继发性癌症，在选择治疗方案的共同决策过程中应加以考虑。一旦达到缓解，患者需要常规监测以监测并发症和复发，此外还需要接受美国预防服务工作组推荐的适合年龄的筛查。患者应接种 13 价肺炎球菌结合疫苗，至少 8 周后接种 23 价肺炎球菌多糖疫苗，并根据年龄进行额外的疫苗接种，因为淋巴瘤是一种免疫抑制状态。家庭接触者也应及时接种疫苗。
