Hodgkin's lymphoma treatment and prevention

treatment

The application of modern radiotherapy and chemotherapy has made Hodgkin’s lymphoma a curable tumor, but follow-up results of a large number of long-term surviving patients show that the 15-year mortality rate is 31% higher than that of the general population. The cause of death is except for the recurrence of the original disease. The second tumor accounts for 11% to 38% (solid tumors and acute non-lymphocytic leukemia), 13% of acute myocardial infarction, and 1% to 6% of pulmonary fibrosis. In addition, radiotherapy and chemotherapy can also cause infertility and deformities. These are the results of over-treatment. Therefore, for HL that can be cured, the efficacy and quality of life are equally worthy of attention. This balance needs to be concluded from the results of a large number of prospective randomized controlled studies. Therefore, through the understanding of the complications of long-term treatment of HL, a new treatment strategy is proposed to prevent and reduce serious long-term complications and improve the quality of life. At present, the treatment plan for HL is mainly based on clinical stage and prognostic factors.

1. Radiotherapy alone

It is currently believed that radiotherapy alone is only suitable for patients with stage IA NLPHL, and for other patients, radiotherapy is only used as an adjuvant therapy to chemotherapy. Large-dose and large-scale radiotherapy brings many long-term complications, so it is not recommended as a radical treatment.

2. Early (CSⅠ, Ⅱ) HL with good prognosis

2 to 4 courses of ABVD chemotherapy plus 20 to 30 Gy radiotherapy in the affected field.

3. Early (CSⅠ, Ⅱ) HL with poor prognosis

ABVD chemotherapy for 4 to 6 courses plus 20 to 36 Gy of radiotherapy in the affected field or area.

4. Late HL

ABVD chemotherapy is 6 to 8 courses, and the affected field or area is 30 to 36 Gy radiotherapy for those with large masses.

5. Refractory or relapsed cases

New regimens that have no cross-resistance to the original regimen should be used, such as ICE, DHAP, ESHAP, mini-BEAM, GDP, ABVD/MOPP (or COPP) alternative regimens, etc., and high-dose chemotherapy can be selected after good remission is achieved Combined autologous hematopoietic stem cell transplantation.

6. Prevention and treatment of complications

Especially the prevention and treatment of opportunistic infections in the immunosuppressive phase, such as tuberculosis, fungal infections, hepatitis and cytomegalovirus infections.

prevention

The cause of Hodgkin's lymphoma is unknown, so there is no conclusive evidence that it can be prevented. However, the following measures may be beneficial:

1. Prevent viral infections, such as Epstein-Barr virus, adult T lymphocyte virus, AIDS virus, etc. Prevent colds in spring and autumn, strengthen self-protection, and overcome bad habits.

2. Remove environmental factors, such as avoiding exposure to various rays and some radioactive substances, and avoiding exposure to related toxic substances, such as benzene, vinyl chloride, rubber, arsenic, gasoline, organic solvent coatings, etc.

3. Prevention and treatment of autoimmune deficiency diseases, such as low immune function after transplantation of various organs, autoimmune deficiency diseases, after chemotherapy of various cancers, etc. These conditions can activate various viruses, which can induce abnormal proliferation of lymphatic tissues, and ultimately lead to the occurrence of lymphoma.

4. Maintaining an optimistic, confident and healthy attitude and proper physical exercise will help stabilize the immune function of the body and maintain the ability to monitor tumor immunity.

Prognosis

The following factors have prognostic value at the first diagnosis of Hodgkin's disease:

1. The clinical stage of the disease: the earlier the stage of the disease, the better the prognosis.

2. Histological subtypes: lymphocyte-dominant type and nodular sclerosis type have better prognosis than mixed cell type, and lymphocyte-depleted type has the worst prognosis.

3. The larger tumor cell load is worse.

4. Poor people with systemic symptoms.

5. Those who are older than 45 years old are worse.

6. The number of disease sites, the number of extranodal lesions, and the presence or absence of bone marrow lesions.

7. Gender: Women are slower in disease progression than men.

8. Hemoglobin L, white blood cells>15×109/L, lymphocytes<0.6×109/L.