Andrei Shustov, MDAssociate Professor, Hematology DivisionUniversity of Washington School of Medicine¬†Toni-Ann Lupinacci, RN, BSNUniversity of Washington School of Medicine¬
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San Diego T-Cell Lymphoma
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T-cell lymphomas are rare; for every person diagnosed with T-cell lymphoma, there are 10 diagnosed with B-cell lymphoma. Under the name of T-cell lymphoma, or PTCL, hide 12 different subtypes. Therefore, each case of PTCL is uncommon; some of the subtypes are exceedingly rare and require special attention.
The subtypes of PTCL most commonly diagnosed in the United States are peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma (ALCL), and T-cell prolymphocytic leukemia (T-PLL).
First, the diagnosis has to be confirmed by a qualified pathologist who has knowledge in lymphomas. In general, community pathologists in the United States are quite skilled in making the correct diagnosis by using sophisticated tests. Occasionally, referrals are made to academic centers for a “second look” by a specialty pathologist. Second, it is important to complete a staging work-up in order to find out how extensively the the lymphoma has spread through the body; this is accomplished by a combination of CT scan and PET scan technologies. In addition, a bone marrow biopsy is performed by the oncologist or pathologist to find out whether the lymphoma extended into this body compartment. Third, your physician will determine the “risk of the disease” by putting together the information from the prior steps with additional blood tests; something doctors call “risk-stratification”. This last step is important in deciding on initial therapy and a long-term plan.
Given the rarity of PTCL, it is advisable to ask your oncologist for a referral to obtain a second opinion consultation from one of the recognized national experts in T-cell lymphomas that could be within reasonable travel distance from your home.
Once the steps above are completed and you and your family have obtained education about your disease (i.e., treatment planning and discussion of possible side effects and risks of chemotherapy), your oncologist will begin treatment.
If your physician deems your lymphoma “high-risk” at the time of diagnosis, he or she may refer you for consultation to consider a bone marrow transplant in your first remission. All details, including the risks and benefits of the bone marrow transplantation, will be discussed with you by a transplant oncologist.
If the lymphoma should return after initial remission or remission is never achieved with first therapy, it is called relapsed or refractory disease. Patients with relapsed or refractory PTCL can still be cured, but it requires more intense chemotherapy regimens and bone marrow transplantation is mandatory once remission is achieved.
At any time during the course of PTCL (initial diagnosis or relapsed/refractory disease), it is always worth while to consider participation in clinical trials of new chemotherapy or biologic drugs. You might receive superior and more effective treatment on a clinical trial that would not be available for general use for a number of years. ASK YOUR ONCOLOGIST OR BROWSE OUR WEBSITE FOR AVAILABLE CLINICAL TRIALS IN YOUR AREA.
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You may just be the piece that completes the T-Cell puzzle!¬†With the help of¬†your skills, donations and time, we can all begin to put the pieces together and find a solution to defeating¬†T-Cell Leukemia and¬†Lymphoma.
Here you’ll find our monthly mini-educational sessions on different types of T-cell cancers.