Non-Hodgkin's Lymphomas (NHL)

Roughly 50,000 Americans develop this illness every year. The frequency of NHL has increased in past decade, which could be due to increase in number patients with HIV infection. These patients are prone to develop lymphomas. It is more frequent in men than in women. It is more commonly seen after age of 50. This disease is due to overproduction of lymphoid cells.

Causes:

The cause of this illness is unknown in majority of patients. Certain viruses like EBV or HIV have been linked to causation of lymphomas.

Signs and Symptoms:

Patients may not show any signs for sometimes. As the disease progresses, it can cause any of the following problems:

• Enlargement of lymph glands

• Enlargement of spleen

• Enlargement of Liver

• Anemia

• Low platelet count

• Frequent infections

• Fever

• Weight loss

• Night Sweats

Diagnosis:

This diagnosis is made by taking a biopsy of an enlarged lymph node or involved organ of the body. Evaluation of blood and or bone marrow under microscope may lead to this diagnosis as well.

Staging:

Refers to the extent of the disease and is a very good guideline as to the treatment plans and outcome of some lymphomas. The extent of disease could be established by physical examination, CT scan of chest, abdomen and pelvis and a bone marrow test.

• Stage 1 is when patients develop enlargement of lymph glands in one region.

• Stage 2 is when a patient has enlargement of lymph glands in 2 or more regions.

• Stage 3 is when a patient develops enlargement of spleen.

• Stage 4 s when the disease involves the liver, lung or bone marrow.

Classification and treatment:

Lymphomas are categorized into three groups:

• Low grade

• Intermediate grade

• High grade

Low grade lymphomas are not aggressive at the time of diagnosis. They progress very slowly and do not cause any major complications for a long period of time. These cases are treated like patients with CLL. Patients with very early stages of the disease (Stages 0 to 2) are not treated at all. Treatment is offered to patients who have developed a major complication form this illness such as anemia, low platelet count, frequent infections, etc. (stages 3-4) or suffer from fever, weight loss, night sweats.

Following is a list of most common drugs that are used in treatment of low grade lymphomas: Chlorambucil, Vincristine, Prednisone, Cytoxan, Fludarabine, Pentostatin and Rituxan (Rituximab).

High grade lymphomas are very aggressive and progress in a very short period of time. They must be treated as soon as diagnosed with very aggressive regimens.

Intermediate grade, as the name says it, behave somehow modestly and in most occasions are treated with aggressive chemotherapy.

The standard chemotherapy regimen for intermediate and high grade lymphomas is CHOP and Rituxan (Rituximab) together . Certain patients with high grade lymphomas are treated with Bone Marrow Transplantation:

• Patients who do not enter a remission

• Patients who relapse soon after initial remission

Remission:

Refers to the response of any cancer to the treatment.

• Complete remission refers to the situation where the disease disappears completely with the treatment.

• Partial remission refers to the situation where the disease shrinks but does not disappears completely with the treatment.

Prognosis:

Low Grade Lymphomas may remain silent for years. They may, however, gradually transition into higher stages. Prognosis of Intermediate and High Grade Lymphomas depends on the response to chemotherapy. Patients with lower stages of disease have better prognosis.  Mantle Cell ( zone ) Lymphoma is a different type of lymphoma all together.

Special Situations:

Patients with advanced lymphoma may develop any of the following complications:

• Spinal cord compression

• Brain metastasis

• Bone metastasis

• Paraneoplastic syndromes

• High Calcium level

• Pain

• High Uric acid

• Pleural effusion

Survival:

Survival of patients with lymphoma, in whom cure is not possible, could vary from months to years, depending on the extent of cancer, overall condition of the patient as well as their response to treatments and the duration of their response.

Follow up:

After completion of treatment, and in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow up shall be scheduled on a regular basis and initially every 1-3 months for 1-2 years. The frequency of follow up will depend on the condition of the patient and their disease. In each follow up visits, patients are examined and normally a Chest X-ray is obtained every few months and CT scan of chest and abdomen.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy with same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas, where the cancer has spread to. If patients experience pain, different pain medications could be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.