Non-Hodgkin's Lymphoma

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What is Non-Hodgkin's Lymphoma?

There are 2 main types of lymphoma — Hodgkin's lymphoma (or Hodgkin's disease) and non-Hodgkin's lymphoma. They differ in the cells that form these types of cancer. Over 55,000 Americans will be diagnosed with non-Hodgkin's lymphoma this year, compared to just over 7,000 with Hodgkin's disease.

Some types of cancer, such as lung or colon cancers, begin in other organs and then spread to lymphatic tissue; but these are not lymphomas. Lymphomas start in the lymphatic tissue and can then spread to other organs.

Non-Hodgkin's lymphoma (also called NHL or simply "lymphoma") is a malignant (cancerous) growth of B or T cells in the lymph system. B-Cell make up the largest group (about 85% in the United States) of lymphomas, compared to T-Cell, which comprise the other 15%.

There are currently over 29 types of lymphoma within the category of non-Hodgkin's lymphoma, classified by the cell type and rate of growth. To simplify understanding, lymphomas are generally split into 2 main categories:

  • Aggressive (fast growing)
  • Indolent (slow growing)

Latest Treatment Options

Non-Hodgkin's lymphoma is generally treated with chemotherapy, radiation therapy or a combination of both. Radiation therapy may be given with chemotherapy to reduce the pain that arises when the lymph nodes enlarge and limit the function of nearby organs. In cases where lymphoma may spread to the brain and spinal cord, CNS (Central Nervous System) prophylaxis can be used as a preventive treatment. CNS prophylaxis is the injection of chemotherapy drugs directly to the spinal fluid and/or radiation to the brain and spinal cord.

Clinical trials available at Fox Chase Cancer Center in Philadelphia are underway to evaluate the effectiveness of immunotherapy. Immunotherapy includes interferons, monoclonal antibodies, cytokines and tumor vaccines, defined below:

  • Interferons are a class of natural proteins produced by the cells of the immune system in response to challenges by foreign agents such as tumor cells. Interferons belong to the large class of glycoproteins known as cytokines.
  • Monoclonal antibodies are produced by one type of immune cell, all clones of a single parent cell. They bind only to cancer cell-specific antigens and cause an immunological response against the target cancer cell.
  • Cytokines are proteins produced by white blood cells that act as chemical messengers between cells. They can stimulate or stop the growth and activity of various immune cells.
  • Tumor vaccines contain a specific protein of the tumor cell that can be used to stimulate an immune response. Different types of vaccines are used to treat different types of cancer.

Aggressive Non-Hodgkin's Lymphoma

For aggressive non-Hodgkin's lymphoma, patients are divided into low-risk and high-risk groups. Low-risk patients generally receive a standard combination of chemotherapy or may join an ECOG (Eastern Cooperative Oncology Group) protocol using the same chemotherapy with or without the monoclonal antibody Rituxan. High-risk patients may receive a series of high-dose treatments with stem-cell support in a clinical trial. Patients who relapse have access to another high-dose therapy trial with stem cell support or a study that uses estramustine plus paclitaxel.

Indolent/Low-Grade Non-Hodgkin's Lymphoma

Patients with indolent lymphoma may be treated with observation (or "active surveillance") or high-dose therapy with stem cell transplantation. For low-grade or indolent lymphoma, Fox Chase Cancer Center also offers studies based on monoclonal antibodies, including radioactive antibodies and vaccines. One study uses a new agent, bryostatin, combined with fludarabine, to fight lymphoma. Studies using novel chemotherapy combinations are also available.

Intermediate-Grade Non-Hodgkin's Lymphoma

Stem cell transplant is used for intermediate-grade non-Hodgkin's lymphoma. Stem cells are taken from a donor or from the patient, then frozen and stored. The patient then receives high-dose chemotherapy and sometimes radiation treatment. This destroys remaining cancer cells, but it also kills all normal cells in the bone marrow. After therapy, the frozen stem cells are thawed and returned to the body through a blood transfusion.

Gene Therapy

Philadelphia's Fox Chase Cancer Center leads clinical trials evaluating the effectiveness of gene-therapy in low-grade lymphoma patients using antisense DNA. See the list link at the top of the page.

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