Experience in the treatment of lymphoma

  The treatment of lymphoma is a highly specialized study, and the choice of early treatment plan is related to the patient’s eradication/cure. Even for relapsed, advanced and refractory lymphoma, if a reasonable treatment plan is formulated by an experienced hematologist at the early stage of treatment, it can achieve the purpose of significantly prolonging survival and improving quality of life.  1. Before formulating the treatment plan, it is necessary to understand and grasp in detail the patient’s medical history and physical examination, the condition of the tumor (including pathological type, invasion range, clinical or pathological stage, tumor load, prognostic indicators) and the condition of the body (function of important organs such as heart, liver and kidney, general behavioral status, previous treatment efficacy, adverse reactions, etc.). Except for a few cases of limited, low-grade malignant lymphoma that can be cured by local radiotherapy, most NHL should be regarded as a systemic disease because of the occurrence of hematological spread and frequent invasion of extra-nodal lymphatic tissues, and a correct and reasonable comprehensive treatment plan should be formulated according to different patients.  2.Comprehensive treatment includes chemotherapy, targeted therapy, radiotherapy, surgery, biological response modifiers, etc. At present, chemotherapy is still the main treatment means. A comprehensive treatment plan should be formulated according to the specific situation, and the treatment plan should be adjusted in a timely manner according to the changes of the disease, striving for early diagnosis, early diagnosis and early treatment, striving to achieve complete remission with the first treatment, and then carrying out sufficient consolidation therapy to improve the long-term survival rate.  3. For moderate and highly malignant lymphoma, in order to achieve cure, complete remission should be strived for first, of which the first treatment is the key to success, and the regular program of treatment with sufficient dose intensity must be given at the beginning. If incomplete chemotherapy with irregular and insufficient doses is used first, relapse or deterioration will follow after short-term efficacy is achieved, thus losing the chance of cure. At the same time, attention should be paid to the tumor lysis syndrome (TLS) that may result from intense shock chemotherapy – anuria, hyperkalemia, or even life-threatening – in some sensitive cases with high tumor load, especially in pediatric patients. Therefore, preventive measures and corresponding emergency treatment measures should be taken at this time. If necessary, a slightly lighter induction therapy can be used first and the dose intensity can be increased in a short period of time to achieve a cure.  4.For the treatment of moderate and highly malignant aggressive lymphoma, except for those who are old, have poor systemic condition or combined with other diseases, the treatment goal should be eradication. For stage III and IV low-grade malignant lymphoma, the goal of cure has not been achieved yet, and only palliative treatment can be performed.  5. The efficacy of remedial treatment is limited in moderate and highly malignant cases that have failed treatment. High-dose chemotherapy supported by stem cell transplantation may be considered for cases with first relapse after complete remission or for high-risk cases with initial treatment.  6. In general, radiation therapy can be used as an adjuvant treatment after chemotherapy in huge tumor sites, and also as one of the treatments for invasion of the central nervous system.