Protocols - Hemorio

LEUKEMIA / T-CELLS LYMPHOMA OF THE ADULT
DIAGNOSE CRITERIA
Common: Cytopathology / Histopathology
- Infiltration by activated malign lymphocytes (flower cells)
- Expression of CD2, CD3, CD4, CD5
- No expression of CD7 and CD8
- Expression of HLA lymphocyte activation markers class II and receptor of IL2
- Positive serology for HTLV
- Clonal integration of provirus to the tumoral cells
SUBTYPES
SMOLDERING CHRONIC FORM
Skin injury or pulmonary
infiltrate
Absence of adeno /
visceromegaly
1 – 5% leukemic cells at
SP
Absence of
hypercalcemia
Normal LDH
Skin, hepatic, pulmonary
injury, or adenomegaly
With no other visceral
attack.
Lymphocytosis > 4000
with circulating leukemic
cells.
Absence of
hypercalcemia
LDH < 2x normal
140
ACUTE FORM
(LEUKEMIC)
Organomegaly
Multiple visceral attack
Market commitment of
SP by leukemic cells
Frequent hypercalcemia
High LDH
LYMPHOMATOUS
FORM (TUMORAL)
Organomegaly
Multiple visceral attack
< 1% leukemic cells at
SP
Possible hypercalcemia
High LDH
LABORATORIAL TESTS
- Full hemogram with reticulocytes and hematoscopy of peripheral blood
- Biochemistry with hepatogram
- LDH
- Immunophenotype of peripheral blood in case of high leukometry or morphologic evidence of pathologic
cells.
- Ganglial biopsy with immunohistochemistry
- Bone marrow aspirated with immunophenotype
- Bone marrow biopsy with immunohistochemistry
- Lumbar puncture
- Tomographies of Chest, Abdomen and Pelvis.
1 ST LINE TREATMENT
Chronic Form and Smoldering – do not treat
Lymphomatous Form - CHOP x 3 -> INF + AZT
Leukemic Form - INF + AZT
- Interferon up to 3,000,000 U/m 2 /day
- AZT 1g/day
- Cytoreduction with PDN 40mg/m 2 /day/ 7 days if hyper-leukocytary.
CNS Prophylaxis: MADIT at D1 of each cycle of CHOP or 1x/month.
Consider TMO allogenic in 1 st RC in all subjects *
RELAPSE TREATMENT
If you have done CHOP : ICE, ESHAP x 3 -> INF + AZT
If you have done INF + AZT : CHOP x3 -> INF + AZT