Australian Doctor 14th July Issue 14JULY2023 issue | Seite 38

38 HOW TO TREAT : LYMPHOMA

38 HOW TO TREAT : LYMPHOMA

14 JULY 2023 ausdoc . com . au
Table 1 . Examples of prophylactic antimicrobial agents used for certain immunosuppressed patients receiving anti-lymphoma treatment
Figure 3 . Staging of lymphoma .
Cervical lymph nodes
Cervical lymph nodes
Organism
Viruses — herpes simplex virus , varicella-zoster virus ( see figure 8 )
Common prophylactic medications
Valaciclovir , acyclovir
Diaphragm
Axillary lymph nodes
Diaphragm
Pneumocystis jirovecii ( see figure 8 )
Sulfamethoxazole — trimethoprim
Fungus Fluconazole , itraconazole , posaconazole
antibodies to protect against COVID- 19 may be utilised .
Immunotherapy
Immunotherapy , a class of cancer treatment , utilises the biology of the immune system itself to target cancer . The immune system plays a key role in preventing the development of all cancers ; immune cells are constantly surveying the body for ‘ foreign ’ cells including cancer cells , which they then target and destroy . 17 The increased risk of cancer , including lymphoma , in immunodeficient states such as HIV is testament to the importance of this function . The range of immunotherapies has expanded from monoclonal antibodies to bispecific antibodies and engineered cell therapies .
Stage 1 . Only one group of lymph nodes affected anywhere in the body .
Stage 2 . Two or more groups of lymph nodes affected , all on the same side of the diaphragm ( either above or below ).
ANTIBODIES TO TARGET CELL
SURFACE PROTEINS
A genetic abnormality or marker that
differentiates cancer cells from normal
cells allows specific targeting of these
cells . Monoclonal antibodies that all have one specific target are manufactured using recombinant technology . 18 Their therapeutic effect is primarily through facilitation of tumour cell death from T-cells , a process known as antibody-dependent cell-mediated
Cervical lymph nodes
Axillary lymph nodes
Cervical lymph nodes
Axillary lymph nodes
Thymus
Lungs
cytotoxicity . The names of these drugs
end in the suffix -mab.
The first therapeutic monoclonal
Diaphragm
Diaphragm
antibody was the anti-CD20 antibody
rituximab , which is the standard of
care in almost all B-cell non-Hodgkin ’ s lymphomas ; this product is now avail-
Spleen
able as a subcutaneous injection as
well as the IV formulation . 19
There is interest in improving the
Liver
efficacy of monoclonal antibodies .
For example , the anti-CD20 antibody
obinutuzumab is PBS listed in the
treatment of CLL and follicular lymphoma . 20 It is engineered to be more potent through enhanced antibody
dependent cell-mediated cytotoxicity . Its main adverse effect is infusion reactions requiring pre-medication
Inguinal lymph nodes
Inguinal lymph nodes
Bone marrow
and careful observation particularly
during the first dose .
ANTIBODY-DRUG CONJUGATES The attachment of chemotherapy drugs to monoclonal antibodies ( antibody-drug conjugates ) is a means to improve the potency of this therapy . 21 The internalisation of these drugs into the targeted cells allows the specific targeting of cancer cells . Moreover , the concentrations of these chemotherapy drugs can be much higher than systemic chemotherapy as they are being delivered to the site
Stage 3 . Lymph nodes affected on both sides of the diaphragm .
Stage 4 . Lymphoma either in organs outside the lymphatic system or in the bone marrow .