Diagnosis and Treatment of CD3 and CD20 Positive Lymphoid Cells

Diagnostic Approach

The National Comprehensive Cancer Network recommends that CD3 is typically a T-cell marker while CD20 is a B-cell marker; co-expression is uncommon and requires careful diagnostic evaluation 1
The National Comprehensive Cancer Network states that the Reed-Sternberg cells of Classical Hodgkin Lymphoma express CD30 in all patients and CD15 in most patients, but are usually negative for CD3 and CD45, with CD20 detectable in fewer than 40% of patients 1
The European Society for Medical Oncology recommends that immunohistochemistry is mandatory for proper diagnosis with a minimum antibody panel including CD45, CD20, and CD3 2, 3
The European Society for Medical Oncology suggests that excisional lymph node biopsy or adequate tissue biopsy providing sufficient material for formalin-fixed samples is essential 3, 4
The European Society for Medical Oncology recommends that additional immunohistochemical markers should include CD15, CD30, CD45, CD79a, and PAX5 to help distinguish between various lymphoma types 1

The European Society for Medical Oncology recommends that complete blood count, routine blood chemistry including LDH and uric acid should be performed 3
The European Society for Medical Oncology suggests that screening tests for HIV and hepatitis B and C should be done 3
The National Comprehensive Cancer Network recommends that CT scan of chest, abdomen, and pelvis should be performed 3
The National Comprehensive Cancer Network suggests that PET/CT scan (skull base to mid-thigh or vertex to feet in selected cases) should be done 1
The European Society for Medical Oncology recommends that bone marrow aspirate and biopsy should be performed 3
The European Society for Medical Oncology suggests that performance status assessment and cardiac function evaluation (left ventricular ejection fraction) should be done 3
The European Society for Medical Oncology recommends that International Prognostic Index (IPI) and age-adapted IPI should be calculated 3, 4
The European Society for Medical Oncology suggests that Ann Arbor staging system should be used 3

The European Society for Medical Oncology recommends that treatment strategies should be stratified according to age, age-adapted IPI, and feasibility of dose-intensified approaches 3
The European Society for Medical Oncology suggests that for CD20-positive lymphomas, rituximab-containing regimens are the standard of care, even in cases with aberrant marker expression 3, 4
The European Society for Medical Oncology recommends that enrollment in clinical trials should be considered whenever available 3
The European Society for Medical Oncology suggests that for young low-risk patients (aaIPI ≤1): 6-8 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) given every 21 days 4, 5
The European Society for Medical Oncology recommends that for young high-risk patients (aaIPI ≥2): 6-8 cycles of R-CHOP given every 14-21 days; consider CNS prophylaxis 5
The European Society for Medical Oncology suggests that for patients older than 60 years: 8 cycles of R-CHOP given every 21 days or 6 cycles if given every 14 days 4, 5

The European Society for Medical Oncology recommends that abnormal radiological tests at baseline should be repeated after 3-4 cycles and after the last cycle of treatment 6, 4
The European Society for Medical Oncology suggests that PET scan is highly recommended for post-treatment assessment to define complete remission according to revised response criteria 6
The European Society for Medical Oncology recommends that bone marrow aspirate and biopsy should be repeated at the end of treatment if initially involved 6
The European Society for Medical Oncology suggests that in case of therapeutic consequences based on PET positivity, histological confirmation is strongly recommended 6
The European Society for Medical Oncology recommends that history and physical examination should be done every 3 months for 1 year, every 6 months for 2 more years, and then once a year 6, 5
The European Society for Medical Oncology suggests that blood count and LDH should be done at 3, 6, 12, and 24 months, then only as needed 6
The European Society for Medical Oncology recommends that CT scans should be done at 6, 12, and 24 months after end of treatment 6
The European Society for Medical Oncology suggests that routine surveillance with PET scan is not recommended 6, 5

The European Society for Medical Oncology recommends that histological verification should be obtained whenever possible, especially in relapses occurring >12 months after initial diagnosis 6
The European Society for Medical Oncology suggests that confirm CD20 positivity to ensure potential benefit from rituximab 6
The European Society for Medical Oncology recommends that for suitable patients (adequate performance status, age <65-70 years): salvage regimens with rituximab plus chemotherapy followed by high-dose therapy with stem cell support 6
The European Society for Medical Oncology suggests that common salvage regimens include R-DHAP (rituximab, cisplatin, cytarabine, dexamethasone) or R-ICE (rituximab, ifosfamide, carboplatin, etoposide) 6
The European Society for Medical Oncology recommends that for patients not suitable for high-dose therapy: alternative salvage regimens such as R-GEMOX (rituximab, gemcitabine, oxaliplatin) 6
The European Society for Medical Oncology suggests that consider allogeneic transplantation for patients with refractory disease, early relapse, or relapse after autologous stem cell transplantation 6