![]() Late-occurring venous thromboembolism can occur after allogeneic or autologous BMT. Successful pregnancies with children born free of congenital abnormalities have been reported in young women after autologous BMT. With a median 10-year follow-up after autologous bone marrow transplantation (BMT) with conditioning using cyclophosphamide and total-body radiation therapy, in a series of 605 patients, the incidence of a second malignancy was 21%, and 10% of those were solid tumors. Most of these patients show clonal hematopoiesis even before the transplantation, suggesting that the hematologic injury usually occurs during induction or reinduction chemotherapy. Myelodysplastic syndrome and acute myelogenous leukemia are late complications of myeloablative therapy with autologous bone marrow or peripheral blood stem cell support, as well as conventional chemotherapy-containing alkylating agents. Left ventricular dysfunction was a significant late effect in long-term survivors of high-grade NHL who received more than 200 mg/m² of doxorubicin. Yuen AR, Kamel OW, Halpern J, et al.: Long-term survival after histologic transformation of low-grade follicular lymphoma.Bastion Y, Sebban C, Berger F, et al.: Incidence, predictive factors, and outcome of lymphoma transformation in follicular lymphoma patients.Cabanillas F, Velasquez WS, Hagemeister FB, et al.: Clinical, biologic, and histologic features of late relapses in diffuse large cell lymphoma.Tan D, Horning SJ, Hoppe RT, et al.: Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience.American Cancer Society: Cancer Facts and Figures 2023.Shankland KR, Armitage JO, Hancock BW: Non-Hodgkin lymphoma.Patients who present with or convert to aggressive forms of NHL may have sustained complete remissions with combination chemotherapy regimens or aggressive consolidation with marrow or stem cell support. Patients, however, can often be re-treated with considerable success if the disease histology remains low grade. While indolent NHL is responsive to immunotherapy, radiation therapy, and chemotherapy, a continuous rate of relapse is usually seen in advanced stages. The risk of late relapse is higher in patients who manifest both indolent and aggressive histologies. Most relapses occur in the first 2 years after therapy. ![]() More than 50% of patients with aggressive NHL can be cured. In general, with modern treatment of patients with NHL, the overall survival rate at 5 years is over 60%. The aggressive type of NHL has a shorter natural history, but a significant number of these patients can be cured with intensive combination chemotherapy regimens. Most of the indolent types are nodular (or follicular) in morphology. Early-stage (stage I and stage II) indolent NHL can be effectively treated with radiation therapy alone. Indolent NHL types have a relatively good prognosis with a median survival as long as 20 years, but they usually are not curable in advanced clinical stages. NHL can be divided into two prognostic groups: the indolent lymphomas and the aggressive lymphomas. NHL usually originates in lymphoid tissues.
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