Apoyo y recursos

El tratamiento para del linfoma no Hodgkin (LNH) depende del tipo histológico y del estadio. Muchas de las mejoras en la supervivencia se han logrado gracias al uso de ensayos clínicos (terapia experimental) mediante las cuales se intenta perfeccionar el mejor tratamiento disponible aceptado (tratamiento convencional o estándar).

Aunque el tratamiento estándar para pacientes con linfomas puede curar una fracción significativa, se está llevando a cabo numerosos ensayos clínicos que exploran mejoras en el tratamiento. Los pacientes deben ser incluidos en estos estudios en la medida que sea posible. Se han indicado lineamientos estandarizados en la evaluación de la respuesta para ser usados en los ensayos clínicos.[1]

Se han observado efectos tardíos del tratamiento para el LNH. Se le ha relacionado la irradiación pélvica y dosis acumulativas grandes de ciclofosfamida con un riesgo alto de infertilidad permanente.[2] Hasta por dos décadas después del diagnóstico, los pacientes tienen un riesgo elevado significativo de contraer un segundo cáncer primario, especialmente del pulmón, cerebro, riñón, la vejiga, melanoma, linfoma de Hodgkin o leucemia no linfocítica aguda.[3-5] La disfunción ventricular izquierda fue uno de los efectos tardíos más significativos en los pacientes de LNH que sobrevivieron por largo tiempo y en quienes recibieron más de 200 mg/m² de doxorrubicina.[6,7] El síndrome mielodisplásico y la leucemia mielógena aguda son complicaciones tardías de la terapia mieloablativa con apoyo autólogo de médula ósea o de células madre de la sangre periférica, al igual que con la quimioterapia convencional que contiene fármacos alquilantes.[4,8-14] La mayoría de estos pacientes presentan hematopoyesis clonal aun antes del trasplante, indicando que las lesiones hematológicas generalmente se presentan durante la quimioterapia de inducción o reinducción.[11,15,16] En una serie con 605 pacientes con un seguimiento promedio de 10 años, después de un trasplante autólogo de médula ósea (BMT, por sus siglas en inglés), condiciones en la que se utilizó ciclofosfamida y radioterapia total al cuerpo, la incidencia de un segundo cáncer fue de 21% y 10% de ellos fueron tumores sólidos.[17] Se han notificado embarazos exitosos en los que los niños nacieron sin anomalías congénitas, en mujeres jóvenes después de un BMT.[18]

Los linfomas de rápido crecimiento se están observando con cada vez más frecuencia en pacientes con VIH cuyo tratamiento requiere consideraciones especiales. (Para mayor información, consultar el sumario del PDQ sobre el Tratamiento del linfoma relacionado con el SIDA.)

Hay varias presentaciones poco comunes de linfoma que suelen requerir enfoques algo modificados de clasificación y tratamiento. El lector debe consultar los exámenes de revisión para obtener una descripción más detallada de las presentaciones extraganglionares en el sistema gastrointestinal,[19-27] la tiroidea,[28,29] el bazo,[30] los testículos,[31] los senos paranasales,[32-36] los huesos,[37,38] orbita,[39-41] y la piel.[42-50]

(Para mayor información, consultar el sumario del PDQ sobre el Tratamiento del linfoma primario del sistema nervioso central.)

Bibliografía

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