T cell lymphoma - Initial approach

 Initial assessment:

• Symptoms: Fever, wt loss, night sweats, skin rash, itching
• Exam: rash, adenopathy, cachexia,  HSM

Investigations:

1. Excisional nodal bx/ skn bx/GI bx

2. BMBX: look for hemophagocytosis

3. LP is suspected CNS involvement

4. Echo

5. PET

Disease specific

1. Immunophenotyping
2. Cytogenetics /FISH
3. Targeted genome sequencing
4. T cell clonality

Ann Arbor staging

ALK+ ALCL--> BV CHP

low or low intermediate IPI PTCL--> CHOEP

MEITL and Hepatosplenic--> ICE

EATL= CHOEP followed by ASCT or Newcastle regimen

Adult T cell leukemia- rx of HTLV with antivirals and also VCAP-AMP-VECP 

NK cell--> SMILE regimen