1. APPROACH TO LYMPHOID MALIGNANCIES

2. Patient Evaluation of ALL Careful history and PE CBC Chemistry studies Bone marrow biopsy Lumbar puncture

3. Prognostic Factors genetic characteristics of the tumor patient’s age WBC count function of major organs

4. Patient Evaluation of CLL Careful history and PE CBC Chemistry studies Serum protein electrophoresis Bone marrow biopsy Imaging studies of the chest and abdomen for pathologic lymphadenopathy

5. Major Prognostic Groups Good prognosis (+) blood and bone marrow involvement Intermediate prognosis (+) lymphadenopathy (+) organomegaly Poor prognosis (+) bone marrow failure -Hgb <10g/dL -Platelet count <100,000/iL

6. Immunologic abnormalities in CLL Autoimmune hemolytic anemia Autoimmune thrombocytopenia Hypogammaglobulinemia

7. Patient evaluation of Hodgkin’s Disease Careful history and physical examination CBC Erythrocyte sedimentation rate (ESR) Chemistry studies of major organ function CT scan of chest, abdomen and pelvis Bone marrow biopsy

8. Ann Arbor Staging for Hodgkin’s Disease STAGEDEFINITION I Involvement of s single lymph node region or lymphoid structure (e.g. spleen, thymus, Weldeyer’s ring) II Involvement of two or more lymph node regions on the same side of the diaphragm III Involvement of lymph node regions or lymphoid structures on both sides of diaphragm III 1 Subdiaphragmatic involvement limited to spleen, spleenic hila nodes, celiac nodes, or portal nodes III 2 Subdiaphragmatic involvement includes paraaortic, iliac or mesenteric nodes plus structures in III 1 IV Involvement of extranodal site(s) beyond that designated as “E” More than one extranodal deposit at any location Any involvement of liver or bone marrow A No symptoms B Unexplained weight loss of >10% of the body weight during the 6 months before staging Unexplained persistent, or recurrent fever with temperatures >38 o C during previous month Recurrent drenching night sweats during the previous month E Localized, solitary involvement of extralymphatic tissue, excluding liver and bone marrow

9. Patient evaluation of Non – Hodgkin’s Disease Careful history and physical examination CBC Erythrocyte sedimentation rate (ESR) Chemistry studies of major organ function CT scan of chest, abdomen and pelvis – PET and gallium scan for more aggressive subtypes (e.g.diffuse large B cell lympoma) Bone marrow biopsy ESR Serum lactate dehydrogenase (LDH) β 2 – microglobulin Serum protein electrophoresis

10. International Prognostic Index for NHL Five clinical risk factors: Age > 60 years Serum lactase dehydrogenase levels elevated Performance status >2 (ECOG) or <70 (Karnofsky) Ann Arbor stage III or IV >1 site of extranodal involvement

11. International Prognostic Index for NHL Patients are assigned a number for each risk factor they have Patients are grouped differently based upon the type of lymphoma For diffuse large B cell lymphoma: 0,1 factor = low risk35% of cases; 5 – yr survival, 73% 2 factors = low – intermediate risk27% of cases; 5 – yr survival, 51% 3 factors = high – intermediate risk22% of cases; 5 – yr survival, 43% 4,5 factors = high risk16% of cases; 5 – yr survival, 26% For diffuse large B cell lymphoma treated with R – CHOP: 0 factor = very good 10% of cases; 5 – yr survival, 94% 1,2 factors = good45% of cases; 5 – yr survival, 79% 3,4,5 factors = poor45% of cases; 5 – yr survival, 55%