Lymphoma

Key Terms to Know

• B-cell vs T-cell: Two main types of lymphocytes that can become malignant.
• Indolent vs Aggressive: Indolent = slow-growing (often incurable but survivable long-term); Aggressive = fast-growing (curability higher with treatment).
• Monoclonal antibodies: Targeted drugs like rituximab (Rituxan) that bind to cancer cells. Revolutionized NHL treatment.
• Ann Arbor Staging: Stage I-IV based on lymph node involvement and organ spread.
• Remission: Cancer is undetectable; doesn't necessarily mean cured; ongoing monitoring essential.

Risk Factors

• Age: Hodgkin more common in 20s and 55+ age groups; NHL increases with age.
• Immune suppression: HIV/AIDS, immunosuppressive medications (post-transplant), autoimmune diseases.
• Viral infections: EBV (Epstein-Barr virus), HCV (hepatitis C), HHV-8, HTLV-1.
• Autoimmune diseases: Celiac disease, rheumatoid arthritis, Sjögren syndrome.
• Genetic predisposition: Family history of lymphoma or other cancers.
• Environmental exposures: Pesticides, certain occupational chemicals.

Symptoms and Diagnosis

Common symptoms:

• Painless swelling of lymph nodes (neck, armpits, groin)
• Fever
• Night sweats (sometimes drenching)
• Unintentional weight loss
• Fatigue and weakness
• Abdominal pain or bloating (if abdominal lymph nodes involved)

These symptoms can be caused by many conditions. However, persistent enlarged lymph nodes lasting >2 weeks warrant evaluation.

Diagnosis involves:

• Lymph node biopsy: Definitive diagnosis. A sample is examined under the microscope.
• Blood tests: CBC, metabolic panel, LDH level (prognostic factor).
• Imaging (CT, PET): Determines extent of disease (staging).
• Bone marrow biopsy (if indicated): Checks for involvement.

Staging and Prognosis

Ann Arbor Staging:

• Stage I: One lymph node group involved.
• Stage II: Two or more lymph node groups on same side of diaphragm.
• Stage III: Lymph node involvement on both sides of diaphragm.
• Stage IV: Involvement of organs outside lymphatic system (liver, lungs, bone marrow, etc.).

Prognosis varies widely based on type, stage, age, LDH level, and other factors. Discuss your specific prognosis with your oncology team.

Treatment Options

Chemotherapy

Standard for most lymphomas:

• ABVD: Doxorubicin, bleomycin, vinblastine, dacarbazine. Standard for Hodgkin lymphoma.
• R-CHOP: Rituximab + chemotherapy. Standard for diffuse large B-cell lymphoma (DLBCL) and other B-cell NHLs.
• Other regimens: Varies by subtype and individual factors.

Monoclonal Antibodies

Rituximab (Rituxan) targets CD20 on B-cells; used for many B-cell lymphomas. Often combined with chemotherapy.

Radiation Therapy

Used for localized disease (early-stage) or as consolidation after chemotherapy.

Targeted/Novel Therapies

• Proteasome inhibitors (bortezomib, carfilzomib): For mantle cell lymphoma.
• BCL2 inhibitors (venetoclax): For chronic lymphocytic leukemia/small lymphocytic lymphoma.
• Other targeted drugs: Based on specific subtype and mutations.

Stem Cell Transplant

Autologous (using patient's own cells): For relapsed/refractory disease or high-risk disease.

CAR-T Cell Therapy

FDA-approved for relapsed/refractory DLBCL and some other NHLs. Engineered immune cells targeting CD19 on B-cells.

Observation ("Watch and Wait")

For some indolent lymphomas: Slow-growing lymphomas don't always need immediate treatment; monitoring for progression is an option.

Common Side Effects and Management

• Nausea and vomiting: Anti-nausea medications are highly effective.
• Hair loss: Temporary; regrows after treatment.
• Infections: White blood cell counts drop; prophylactic antibiotics may be used.
• Fatigue: Common during and after treatment; pacing and rest help.
• Peripheral neuropathy: Nerve damage from some chemotherapy drugs; usually improves over time.
• Infertility: Chemotherapy can affect fertility; discuss fertility preservation before treatment.
• Secondary malignancy risk: Rare but possible; long-term monitoring important.