Chapter 35 Diagnosis and Treatment of Diffuse Large B-Cell Lymphoma and Burkitt Lymphoma

Hepatitis B Prophylaxis and Therapy During Lymphoma Treatment

There is a risk of hepatitis B reactivation both from chemotherapy and rituximab, and this is a potentially fatal complication. We check hepatitis serology (hepatitis B surface antigen [HBsAg], hepatitis B surface antibody [anti-HBs], and hepatitis B core antibody [anti-HBc]) in all patients at diagnosis. Patients with active hepatitis B receive antiviral medication and LFTs, and hepatitis B viral loads are monitored closely. Patients with a history of hepatitis B infection should either receive antiviral prophylaxis or have the hepatitis B viral load monitored very closely (ideally on each cycle) with a low threshold to commence antiviral medications.

Table 35-1 Staging Evaluation for Diffuse Large B-Cell Lymphoma

All Patients	As Clinically Indicated
History and physical examination	Other viral studies
CBC and chemistry (including LDH)	CT or MRI of the head
HIV and hepatitis B and C serology	Body PET scan
Chest radiograph	Additional imaging
CT scan of the chest, abdomen, and pelvis	CSF evaluation by cytology or flow cytometry
BM aspirate and biopsy	Other tests indicated by results of staging

BM, Bone marrow; CBC, complete blood count; CSF, cerebrospinal fluid; CT, computed tomography; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; PET, positron emission tomography.

Table 35-2 Ann Arbor Staging System for Lymphomas

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