How to treat a young patient with a rare composite lymphoma diagnosis?

Here’s how readers responded to a You Make the Call Question about a young patient with a rare composite lymphoma diagnosis.

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I would have used the same regimen.

David Harrison, MD

In my 25 to 30 years of practice, I had not seen a composite lymphoma.

I feel [that] details of Hodgkin lymphoma and non-Hodgkin lymphoma are not given in the case summary [and] we need to know that.

By molecular techniques, many scholars have proven that two different ingredients tend to originate from the same clonal progenitor cell. EBV infection is not the essential transforming event during the course of tumorigenesis. The contribution of immunohistochemistry plays an important role in differential diagnoses. Therapeutic decision of composite lymphoma should be based on the component of which malignant degree is higher.

Panju Prithviraj, MD, MBBS
Port Clinton, OH

I agree entirely. Treat the more aggressive disease and EPOCH is good treatment for the HD.

Bruce G. Raphael, MD
NYU Langone Medical Center
New York, NY

I would continue therapy with DA-EPOCH-R to address the more aggressive primary mediastinal lymphoma component for up to six cycles. I would monitor response with PET and CT.

Scott W. Adams, MD
Pediatric Hematology Oncology
The Permanente Medical Group
Roseville, CA

This is a rare entity. This patient should get six cycles of same regimen DA-EPOCH-R (if possible to assess response after four cycles). In case of composite lymphoma, patients should be treated on the lines of aggressive lymphoma (if mixture of high grade/low grade or NHL/HL is present).

Abdul Hameed, MBBS, MD
Clinical Hematologist
Head of Medical Oncology
Shaukat Khanum Memorial Cancer Hospital & Research Centre
Lahore, Pakistan

I would have done exactly the same.

Clemens B. Caspar, MD
Institut Onkologie/Hämatologie at Kantonsspital Baden
Baden, Switzerland

I would go with DA-R-EPOCH as well.

Antoine Sayegh

I would continue with DA-EPOCH-R and re-evaluate after three cycles with PET/CT. Also, recheck the cardiac function at the same time for a potentially curable disease.

Adel Makary