The prognosis of the former is better than that of the latter, and the prognosis of the young patients is better than that of the old patients
Pathological typing:
Hodgkin's lymphoma includes: lymphocyte-predominant, lymphocyte-absent (microscopically characterized by R-S cells, also known as mirror cells), nodular sclerotic, and mixed-cell lymphomas, among which the lymphocyte-predominant type has the best prognosis, and lymphocyte-absent type the worst. The lymphocyte-dominant type has the best prognosis, and the lymphocyte-ablative type has the worst; the types can be interchanged.
Non-Hodgkin's lymphomas include:
1. B-cell lymphoma
Precursor B-cell tumors: precursor B lymphoblastic leukemia/lymphoma
Mature (peripheral) B-cell lymphomas
B-chronic lymphocytic leukemia/lymphoma
B-cell lymphocytic leukemia
Lymphoplasmacytic lymphomas
Lymphoplasmacytic lymphoma
Marginal zone B-cell tumor
Hirschsprung cell leukemia
Plasma cell myeloma/plasmacytoma
Extranodal marginal zone B-cell tumor, MALT-type
Nodal marginal zone B-cell tumor
Follicular lymphoma
Rhabdomyoblastic lymphoma
Rhabdomyoblastic lymphoma
Diffuse large B-cell lymphoma
Burkitt lymphoma
2. T/NK cell tumors
Precursor T-cell tumors Precursor T-lymphoblastoid lymphoma/leukemia
Mature (peripheral) T-cell tumors
T -cell juvenile lymphoblastic leukemia
T -Large granular lymphocytic leukemia
Aggressive NK-cell leukemia
Adult T-cell lymphoma/leukemia
Extraconjunctival T/NK-cell lymphoma, nasal type
Enteropathic T-cell lymphoma
Hepatosplenic T-cell lymphoma
Subcutaneous seborrheic-like T-cell Lymphoma
Mycosis fungoides/Sezary
Interstitial large cell lymphoma T and nude cells, primary cutaneous type
Peripheral T-cell lymphoma, non-specific type
Angio-immunoblastic T-cell lymphoma
Interstitial large cell lymphoma T and nude cells, primary systemic type
With B-cell origin lymphomas are more common than those of T/NK cell origin, and the prognosis varies according to the typology. It is worth mentioning that the famous CCTV announcer, Comrade Luo Jing, died of lymphoma with the pathologic typing: diffuse large B-cell lymphoma.
Treatment options:
Due to the rational application of radiotherapy and the active promotion of combination chemotherapy, the efficacy of lymphoma has been rapidly improved, especially HD no, most of the early cases can be long-term disease-free survival. the efficacy of NHL is poorer than that of HD, but the number of people who have long term remission or no and survival is also gradually increasing. The histologic type and clinical stage are closely related to the treatment method and prognosis.
I. Radiation therapy
Radiation therapy for HD has made remarkable achievements. It is more effective, but it is better to apply linear gas pedal. The method of irradiating large area of HD ⅠA to ⅡB with high-energy rays has two kinds of irradiation: expanded and whole-body lymph node irradiation. Expanded irradiation in addition to the accumulated lymph nodes and tumor tissue, but also must include the nearby lymph nodes may invade the area, such as lesions in the septum using a cloak. For example, the lesion is irradiated in a cape style at the top of the compartment and in an inverted "Y" style at the bottom of the compartment. The irradiation site of the cape style includes the lymph nodes on both sides from the mastoid tip of the clavicle up and down, the axilla, the hilum, the mediastinum and the septum; the humeral head, the larynx and the lungs should be protected from irradiation. The inverted "Y" irradiation included lymph nodes from the subphrenic lymph nodes to the abdominal aorta, the pelvis and the inguinal lymph nodes, and the splenic region was irradiated at the same time. The dose is 30~40Gy, and 3~4 weeks as a course of treatment. Whole body lymph node irradiation, i.e., diaphragm for the cape style and additional irradiation of the diaphragm below the inverted "Y" style. HNL is also sensitive to radiotherapy but has a high recurrence rate. The importance of large irregular irradiation fields in the cape and inverted "Y" styles is much less than in HD because the pathway of spread is not along the lymphatic areas. The therapeutic dose should be larger than that of HD.At present, only the low malignant group with clinical stages I and II and the moderate malignant group with pathological stage I can be irradiated with expanded field alone or localized irradiation of the involved field alone. There is no consensus on whether chemotherapy should be used after radiotherapy. Stage Ⅲ and Ⅳ are mostly used Walleye-based, if necessary, local radiotherapy for palliative care.
Second, chemotherapy
The majority of the use of combination chemotherapy, to strive for the first treatment that is a complete remission, to create favorable conditions for long-term survival.
(I) Hodgkin's disease Since DeVita created the MOPP program in 1964, the prognosis of advanced HD has been greatly improved, and the complete remission rate of the initially treated patients has been increased from 65% to 85%. the MOPP program should be used for at least 6 courses of treatment or until complete remission, and then 2 additional courses of treatment should be given. MOPP is less effective in patients with significant systemic symptoms; bone marrow involvement; history of repeated chemotherapy; and lymphatic depletion or tuberous sclerosis with mediastinal involvement. For MOPP, ABVD can be used, and 75%~80% can be relieved, or MOPP and ABVD can be used alternately, and MOPP can be used again in cases of relapse treated with MOPP, and 59% get the second remission. If the first remission period is more than one year, 93% have hope for second remission.
(II) Non-Hodgkin's lymphoma Chemotherapy efficacy is determined by the pathological tissue type, and the clinical stage is not as important as HD. according to the degree of malignancy of the pathological classification, respectively, select the combination of chemotherapy regimens:
1. low malignancy group (Table 6-10-2) this group of stage Ⅰ and Ⅱ can be free of recurrence after radiotherapy and survive up to 10 years; however, in stage Ⅲ and Ⅳ, no matter the radiotherapy and chemotherapy failed to achieve Stage III and IV, however, could not be cured by either radiotherapy or chemotherapy. Portlock retrospectively analyzed the results of 44 patients in the low malignancy group who delayed treatment, the median survival time of all patients was 10 years, and 7 cases had spontaneous tumor regression. Therefore, it is advocated that this group of patients should postpone chemotherapy treatment as much as possible and should be closely observed periodically. COP or CHOP can be given if the disease progresses or complications occur, and nitrogen mustard phenylbutyrate (4~12mg orally daily) or cyclophosphamide (100mg orally daily) can be given alone to alleviate the symptoms of those with systemic symptoms. If blood suppression is not obvious, it can be given orally continuously for several months.
2. Moderate malignant group This group of types, once the diagnosis is clear and clinical staging is Ⅲ, Ⅳaccumulation and a wider range of Ⅱ stage, should be immediately given COP, CHOP (Table 6-10-6), such as a course of treatment per month, counting 6~9 months, can make 70% get complete remission, and 35%~45% can have a more field remission period. Newer generation chemotherapy regimens, such as m-BACOD and ProMACE-MOPP (Table 6-10-6), can increase the number of patients with long-term uncomplicated survival to 55%-60%. The addition of equal doses of methotrexate to the new regimen is aimed at preventing CNS lymphomas. More intense geosynthesis regimens include COP-BLAM-III and MACOP-B, which increase long-term disease-free survival to 60% to 70%, but are not suitable for the elderly and infirm because of excessive toxicity.MACOP-B is characterized by alternating myelosuppressive agents with non-suppressive agents, so that remission rates (84%) and relapse-free survival (90%) are improved.COP-BLAM is particularly used with diffuse large cellularity.
3. All highly malignant groups should be treated with intense combination chemotherapy. Selected lymphoblastic and Burkitt lymphoma progresses faster ah, if not treated, death within weeks or months. For the highly malignant group with second- or third-generation combination chemotherapy is worse.
Three, bone marrow transplantation
For patients under 60 years of age, those who can tolerate high-dose chemotherapy can consider whole lymph node radiotherapy and high-dose combination chemotherapy, combined with allogeneic or own bone marrow transplantation, with a view to achieving a longer-term remission and disease-free survival. At present, domestic and foreign studies on auto-bone marrow transplantation for diffuse and progressive lymphoma have achieved encouraging results, of which more than 40%~50% obtained tumor load reduction, and 18%~25% of relapsed cases were cured. The problem of in vitro purification of bone marrow for autologous bone marrow transplantation remains to be solved.
Fourth, surgical treatment
It is limited to biopsy only; in the case of combined hypersplenism, splenectomy is indicated in order to improve the blood picture and create favorable conditions for future chemotherapy.
V. Interferon
It has growth regulating and antiproliferative effects. For mycosis fungoides, follicular schwann cell-based and diffuse large cell type has a partially mitigating effect. The method of application and exact efficacy are still being explored in practice.
[Prognosis]The prognosis of Hodgkin's disease is closely related to the tissue type and clinical stage, lymphocyte-dominant type has the best prognosis, with a 5-year survival rate of 94.3%, while lymphocyte-depleted type is the worst, with a 5-year survival rate of only 27.4%; nodular sclerosis and mixed-cell type are in between. Clinical staging of Hodgkin's disease, the 5-year survival rate is 92.5% in stage I, 86.3% in stage II, 69.5% in stage III, and 31.9% in stage IV; the 5-year survival rate is worse with systemic symptoms than without systemic symptoms. The prognosis of children and the elderly is generally worse than that of young and middle-aged people; women are better than men after treatment.
The type of pathology is more important in the prognosis of non-Hodgkin's lymphoma. Diffuse lymphocytes are well differentiated with a 6-year survival rate of 61%, diffuse lymphocytes are poorly differentiated with a 6-year survival rate of 42%, and lymphoblastic lymphoma has a 4-year survival rate of only 30%. The presence or absence of systemic symptoms had less prognostic impact than HD. The course of non-Hodgkin's lymphoma in the low malignancy group is relatively mild, but there is a lack of effective radical treatment, so it is a chronic process with many relapses, and there are also cases of death due to the transformation to other rosettes and resistance to chemotherapy. However, if the low malignant group is detected early, the reasonable treatment can take 5~10 years or even longer survival period.
The use of his son's bone marrow is an allogeneic hematopoietic stem cell transplant (HSCT), which requires human leukocyte antigen (HLA) matching during timely treatment, with success depending on the number of loci matched.
Please note: In biological parents or relatives, there is a type of matching called "half-matching". Because a person inherits half of the genetic material from each parent, a full match with a biological parent is essentially impossible, but there are exceptions. The success rate of a full match between siblings is 1 in 4, which is calculated based on genetic probability. However 80% of patients can find a half-match donor between parents, children, siblings, and cousins in time.
So don't be discouraged even if you don't get a match with a parent or child. You can ask for help from the patient's siblings or check with the Chinese bone marrow bank, which will take some time.
HSCT costs about $300,000, but it's hard to estimate the price of medication when it comes to the later stages of the process, when anti-immune rejection drugs are expensive and the risk of infection is often due to immunocompromise.
These are the answers for you for now, I hope they can help you.