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Non-Hodgkin Lymphoma

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Non-Hodgkin Lymphoma

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The most common lymphoma is non-Hodgkin lymphoma (NHL), which has 35 different subtypes. These variations help us to determine the best treatment for your exact case. There are aggressive (fast-growing) and low-grade or indolent lymphomas.

Aggressive lymphomas include:

  • Burkitt’s lymphoma: This form of non-Hodgkin's lymphoma starts in immune cells called B-cells. Burkitt lymphoma is the fastest growing human tumor. It is associated with impaired immunity and progresses rapidly if left untreated.
  • Diffuse large B-cell lymphoma (DLBL): DLBL is a cancer of B cells, a type of white blood cell responsible for producing antibodies. It is the most common type of non-Hodgkin lymphoma among adults.
  • Mantle cell lymphoma: Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma. It often starts by enlarging lymph nodes. It spreads to other tissues such as the bone marrow, liver, and gastrointestinal tract.
  • Lymphoblastic lymphoma: Lymphoblastic lymphoma is an aggressive but rare form of non-Hodgkin lymphoma. It usually develops from T-lymphocytes but occasionally from B-lymphocytes. Clinically, lymphoblastic lymphoma behaves like acute lymphoblastic leukemia (ALL), so they are treated in similar ways.

Low-grade or indolent lymphomas include:

  • Follicular lymphoma: It develops when the body makes abnormal B-lymphocytes and builds up in lymph nodes.
  • Marginal zone lymphoma: Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common form of marginal zone lymphoma. It occurs outside the lymph nodes

Other rare lymphomas:

  • AIDS-Related Lymphoma: HIV disease creates an increased risk of developing infections, lymphoma, and other cancers. AIDS treatment and lymphoma treatment combined is the therapy.
  • Primary CNS Lymphoma: Malignant cells in the lymph tissue of the brain and spinal cord. Primary CNS lymphoma may occur in people with AIDS and other disorders of the immune system or who have had a kidney transplant.
  • Cutaneous Lymphoma: In this type of non-Hodgkin lymphoma, lymphocytes become malignant and affect the skin. Cutaneous lymphoma can be treated with topical preparations.

Leukemias closer to lymphoma and managed by a lymphoma specialist:

  • Chronic Lymphocytic Leukemia (CLL): CLL is more slow-growing than its acute variation. CLL in its later stages can produce cancer cells in the lymph nodes — a secondary disease called small lymphocytic lymphoma. Because of that, if you have CLL, you are managed by a lymphoma specialist.
  • Large granular lymphocytic leukemia (LGL): This rare form of leukemia is chronic and slow-growing. It causes large granular lymphocytes to be created in the peripheral blood, especially neutrophils. This increases your risk of infection.
  • Hairy Cell Leukemia: This rare leukemia is characterized by abnormal B-lymphocyte white blood cells in the bone marrow, spleen, and peripheral blood. Under a microscope, these cells look like they are covered with tiny hair-like projections.

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Treatments


The most common types of treatment include:

  • Chemotherapy

    Chemotherapy involves taking one or more drugs by oral pill form or intravenously to kill lymphoma cells throughout your body. You may have this treatment along with other types of treatment.

    • Intravenous (infusion) chemotherapy is available at the Comprehensive Treatment Unit (CTU) at Sylvester's Miami location, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables and Deerfield Beach locations.

  • Immunotherapy

    This treatment makes use of substances made to simulate the protective actions of your immune system. These drugs help your immune system to fight the lymphoma. Adoptive Cell Transfer (ACT) is one clinical trial immunotherapy. It is for patients with aggressive diffuse large B-cell non-Hodgkin lymphoma. This therapy involves engineering your T-cells to recognize lymphoma cells and attack them. ACT's building blocks are T-cells, a type of immune cell collected from your blood. The T-cells multiply in your body to fight cancer.

  • Targeted Therapy

    This treatment uses medicines to attack parts of cancer cells that make them unique from healthy cells. Targeted therapies sometimes work in place of chemotherapy. They often have different types of side effects, which your doctor will explain.

  • Radiation Therapy

    Radiation therapy is used to consolidate gains made by systemic treatments, especially in areas where there was a large volume of disease originally or where disease persists after chemotherapy. There are lymphomas where radiation therapy may be the sole treatment (such as lymphoma around the eye). Lymphomas are often quite responsive to radiation therapy, which is very effective at alleviating pain or other symptoms from disease progression. 

     

  • Stem Cell Transplant

    Stem cells can come from a donor (allogeneic transplant) or your own body (autologous transplant). This process occurs before you undergo high dose chemotherapy or radiation therapy to kill off cancer cells. The stem cells are prepared and processed. A few days after chemotherapy or radiation therapy, the new stem cells are transfused back into your body. These healthy blood-producing stem cells replace those lost during chemotherapy or radiation treatment. A transplant also helps restore your body's natural immunity to fight infection and disease.

  • Surgery

    in rare cases, a surgeon may take out an organ, such as your spleen, if it has lymphoma.

  • Other Treatments for Rare Non-Hodgkin Lymphomas


    • AIDS-Related Lymphoma: Treated with a combination of AIDS treatment and lymphoma treatment. Patients who have AIDS-related lymphoma get treated with lower drug doses than lymphoma patients without AIDS. Highly-active antiretroviral therapy (HAART) can slow HIV progression. Slowing the progression allows some patients to receive anticancer drugs in standard or higher doses.

    • Primary CNS Lymphoma: Malignant cells that grow in the lymph tissue of the brain and spinal cord are called primary CNS lymphomas. These cancers do not usually spread beyond the central nervous system. Treatments include radiation therapy, chemotherapy, and steroid therapy.

    • Cutaneous Lymphoma: In cutaneous lymphoma, lymphocytes become malignant and affect the skin. Often cutaneous lymphoma is treated with topical preparations. Six standard treatments include photodynamic therapy (an injected drug that activates when laser light shines on the skin), radiation therapy, chemotherapy, topical medications, biologic therapy (interferon), and targeted therapy.

Tests


In addition to a complete medical history and physical examination, procedures for diagnosing non-Hodgkin lymphomas include:

  • Laboratory Tests and Scans

    • Complete Blood Count (CBC): A blood sample is drawn to check for the number of red and white blood cells as well as platelets in your blood. Hemoglobin (the protein that carries oxygen) and the portion of the sample made up of red blood cells are also evaluated.
    • Blood Chemistry Studies: Testing blood samples to measure the amounts of substances released into the blood by organs and tissues.
    • Sedimentation Rate: A sample of blood is drawn and checked for the rate at which its red blood cells accumulate at the bottom of a test tube. The sedimentation rate is a measure of how much inflammation is in the body. Higher than average rates may be a sign of lymphoma or another condition.
    • Lymph Node Biopsy: A surgeon removes all or part of a lymph node. Pathologists (cellular experts) look at it under a microscope to scan for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells occur in classical Hodgkin lymphoma.

  • Computed Tomography (CT or CAT Scan)

    This test creates detailed pictures of areas inside the body, taken from different angles. A dye is used to highlight abnormalities, like swollen lymph nodes.


  • Positron Emission Tomography (PET) Scan

    Radioactive-tagged glucose (sugar) gets injected into the blood. Potentially cancerous tissues (such as tumors) use the glucose more than healthy tissues. They show up brighter on a scan.

  • Bone Marrow Biopsy

    A small bone marrow sample is removed from the breastbone or hipbone. We look for microscopic signs of cancer. If cancer is found, tests include:

    • Immunophenotyping: This test helps diagnose the specific type of lymphoma by comparing the cancer cells to normal cells of the immune system.
    • Cytogenetic analysis: This laboratory test looks for changes in the chromosomes found in blood or bone marrow samples.
    • Multigene tests: Because no tumor has a single mutation, genomic profiling allows the pathologist to identify groups of genetic changes in your blood sample and create a tumor profile. That profile can be used to determine what type of treatment would be the most effective and how long you should have treatments like chemotherapy.

  • Staging

    Once lymphoma is diagnosed, tests are done to find out the status of the disease. Staging defines how much cancer has spread within the lymph system, and where it has spread.

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