Non-Hodgkin's lymphoma: signs and symptoms
On this page, you will find more information about body changes and other things that may indicate a problem that may require medical attention. To see other pages, use the menu.
People with LNH may experience a variety of symptoms. However, many people, especially those with follicular lymphoma, small lymphocytic lymphoma, marginal zone lymphoma and indolent subtypes, will not have any symptoms. Other conditions other than lymphoma may also cause many of these symptoms.
There are very few changes, or symptoms, that are specific to the lymphoma. This explains why it is sometimes difficult to get a diagnosis. The symptoms of LNH depend on where the cancer and the affected organ originate.
General Symptoms:
Enlarged lymph nodes in the abdomen, groin, neck, or armpits
Enlarged liver or spleen
Fever unrelated to infection or other disease
Weight loss without known cause
Sweating and chills
Fatigue
Examples of symptoms related to a specific location of the tumor:
A lump in the abdomen can cause abdominal distention or back or abdomen pain.
A tumor in the center of the chest can exert pressure on the trachea and cause coughing, chest pain, shortness of breath, or other breathing problems.
If you are concerned about any changes you have experienced, talk to your doctor. Your doctor will ask you when and how often you have had symptoms, among other questions. This is to help figure out the cause of the problem, ie the diagnosis.
If LNH is diagnosed, your doctor may also use certain symptoms to help describe the disease; This is called staging. For many decades, physicians divided each LNH stadium into categories "A" and "B" according to specific symptoms, as mentioned below. However, the last stage-determination system published in 2014, known as the Lugano classification, eliminated such categories because they do not necessarily affect the treatment.
A means that a person has not had symptoms B.
B means that a person experienced the following symptoms:
Loss of weight without apparent reason of more than 10% of the original body weight during the 6 months prior to diagnosis.
Fever for no apparent reason, with temperatures above 38 °c (100.4 °f).
Night sweats that soak. Most patients report that their sleepwear or sheets end up literally wet. Occasionally, important sweats occur during the day.
Once a physician diagnoses and determines the LNH stage, symptom relief remains an important aspect of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk to your health care team about the symptoms you are experiencing, including any new symptoms or a change in symptom.
The next section of this guide is diagnostic. Explain what tests may be needed to get more information about the cause of the symptoms. Or, use the menu to choose another section, in order to continue reading this guide
Non-Hodgkin's lymphoma: Risk factors
On this page, you will find more information about the factors that increase the likelihood of developing lymphoma. To see other pages, use the menu.
A risk factor is everything that increases the likelihood of a person developing cancer. While risk factors often influence cancer development, most do not directly cause cancer. Some people with several risk factors never develop cancer, while other people without known risk factors do. But knowing the risk factors and talking to your doctor about it can help you make more informed decisions about lifestyle choices and health care.
The exact cause of LNH is unknown and most people diagnosed with LNH will not know what the cause is. However, the following factors may increase a person's risk of developing LNH:
Age. The risk of having LNH increases with age. The most frequent subtypes occur most frequently in people between 60 and 70 years.
Sex. Men are slightly more likely to suffer LNH than women.
Bacterial infections. Some types of LNH are associated with specific infections. For example, lymphoma of the lymphoid tissue associated with the mucosa (mucosa-associated lymphoid tissue, MALT) of the stomach is believed to be caused by an infection of a bacterium known as Helicobacter pylori. When this lymphoma is diagnosed at an early stage, it will sometimes disappear if the infection is eliminated with antibiotics. Infections can also cause other types of MALT lymphoma, including those that affect the lungs, lacrimal glands, and skin.
Virus. Viruses cause some types of LNH. For example, as explained in the Subtypes section, the Epstein-Barr virus (EBV, which is the virus that causes mononucleosis, also known as "Mono") is associated with some types of LNH. These include Burkitt's lymphoma, lymphomas that occur after an organ transplant and, on rare occasions, other lymphomas that occur in people who are otherwise healthy. However, it is likely that the virus is not the only factor that determines the risk of cancer, so people who suffer from mononucleosis do not necessarily have a higher risk of developing a LNH in the future. In addition, hepatitis C infection has been associated with increased risk of lymphomas in the marginal area of the spleen (see subtypes section). Researchers have also discovered other viruses as important factors among the causes of some rare types of lymphoma.
Immunodeficiency disorders. Immune system disorders, such as HIV/AIDS, increase the risk of LNH, especially aggressive B-cell lymphomas.
Autoimmune disorders. People with autoimmune disorders, such as rheumatoid arthritis and Sjogren's syndrome, are at increased risk of developing certain types of LNH. In addition, some medications used to treat autoimmune disorders may increase the risk of LNH.
Organ transplant. Patients receiving organ transplants have a higher risk of developing LNH. This is due to medications that patients should receive to reduce the role of the immune system in order to avoid rejection of the transplanted organ.
Pre-treatment against cancer. Pre-treatments with certain medications for other types of cancer may increase the risk of LNH.
Exposure to chemicals. Exposure to chemicals, such as certain pesticides, herbicides, and petrochemical substances, may increase the risk of LNH.
Genetic factors. Initial studies have discovered several genetic changes that could be associated with a small number of lymphoma cases. At present, there is no widely accepted genetic evidence to identify hereditary risk factors for LNH or to reliably predict the risk of a person to present LNH.
Vaccines. Several studies have identified an association between the Bacillus Calmette and Guérin vaccine (BCG) and an increased risk of LNH. The BCG vaccine is a vaccine for tuberculosis. On the contrary, research has also associated other vaccines with a reduction in the risk of LNH, such as those against smallpox, cholera, yellow fever, influenza, rubella, tetanus and poliomyelitis. In general, the relationship between vaccines and lymphoma remains unclear and controversial.
Breast implants. Placement of breast implants may increase the risk of lymphomas.
Exposure to ionizing radiation. This may include radiation exposure due to atomic bombs, nuclear reactor accidents, and medical radiotherapy.
Non-Hodgkin's lymphoma: signs and symptoms
On this page, you will find more information about body changes and other things that may indicate a problem that may require medical attention. To see other pages, use the menu.
People with LNH may experience a variety of symptoms. However, many people, especially those with follicular lymphoma, small lymphocytic lymphoma, marginal zone lymphoma and indolent subtypes, will not have any symptoms. Other conditions other than lymphoma may also cause many of these symptoms.
There are very few changes, or symptoms, that are specific to the lymphoma. This explains why it is sometimes difficult to get a diagnosis. The symptoms of LNH depend on where the cancer and the affected organ originate.
General Symptoms:
Enlarged lymph nodes in the abdomen, groin, neck, or armpits
Enlarged liver or spleen
Fever unrelated to infection or other disease
Weight loss without known cause
Sweating and chills
Fatigue
Examples of symptoms related to a specific location of the tumor:
A lump in the abdomen can cause abdominal distention or back or abdomen pain.
A tumor in the center of the chest can exert pressure on the trachea and cause coughing, chest pain, shortness of breath, or other breathing problems.
If you are concerned about any changes you have experienced, talk to your doctor. Your doctor will ask you when and how often you have had symptoms, among other questions. This is to help figure out the cause of the problem, ie the diagnosis.
If LNH is diagnosed, your doctor may also use certain symptoms to help describe the disease; This is called staging. For many decades, physicians divided each LNH stadium into categories "A" and "B" according to specific symptoms, as mentioned below. However, the last stage-determination system published in 2014, known as the Lugano classification, eliminated such categories because they do not necessarily affect the treatment.
A means that a person has not had symptoms B.
B means that a person experienced the following symptoms:
Loss of weight without apparent reason of more than 10% of the original body weight during the 6 months prior to diagnosis.
Fever for no apparent reason, with temperatures above 38 °c (100.4 °f).
Night sweats that soak. Most patients report that their sleepwear or sheets end up literally wet. Occasionally, important sweats occur during the day.
Once a physician diagnoses and determines the LNH stage, symptom relief remains an important aspect of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk to your health care team about the symptoms you are experiencing, including any new symptoms or a change in symptom.
The next section of this guide is diagnostic. Explain what tests may be needed to get more information about the cause of the symptoms. Alternatively, use the menu to choose another section to continue reading this guide.
Non-Hodgkin's lymphoma: diagnosis
On this page: you will find a list of the frequent tests, procedures, and scans that physicians use to find out the cause of the medical problem. To see other pages, use the menu.
Doctors perform many tests to detect or diagnose cancer. They also perform tests to find out if the cancer has spread to other parts of the body from where it started. If this happens, it represents the spread of the disease, which is similar to "metastasis" in other forms of cancer. For example, imaging tests may show whether the cancer has spread. Image tests show images of the inside of the body. Doctors can also test to determine which treatments might work best.
In most types of cancer, a biopsy is the only safe way for the doctor to determine whether a particular area of the body has cancer. During the biopsy, the Doctor takes a small sample of tissue to test in a lab. If a biopsy cannot be done, your doctor may suggest that other tests be done to help you establish a diagnosis.
This list describes options for diagnosing the LNH. Not all the tests listed below will be used for all people. Your doctor may consider these factors when choosing a diagnostic test:
Type of lymphoma suspected
Your signs and symptoms
Your age and medical condition
The results of previous medical tests
In order to determine if a person has LNH, the doctor will first get the full medical records. It will also perform a physical examination and pay special attention to lymph nodes, liver and spleen. Your doctor will also look for signs of an infection that may cause swelling of the lymph nodes and may prescribe an antibiotic. If the swelling of the lymph nodes persists after antibiotic treatment, the cause may not be an infection. If your doctor suspects the presence of lymphoma, you recommend a biopsy, as well as lab tests and imaging.
In addition to physical examination, the following tests may be used to diagnose and manage LNH:
Biopsy. A biopsy is the removal of a small amount of tissue to be examined through a microscope. Other tests may indicate the presence of cancer, but only a biopsy can make a definitive diagnosis and determine the subtype. This tissue can be removed by a thin needle, a needle for deep biopsy, or surgery. To diagnose lymphoma, tissue is usually extracted from the lymph nodes found in the neck, under an arm, or in the groin. A biopsy of the chest or abdomen with a thin needle may also be performed during a computed tomography (CT) or ultrasound (see below), or from the stomach or intestines during endoscopy. Endoscopy is a test that allows the doctor to observe the inside of the body with a thin, flexible, lighted tube. It may also be necessary to perform a skin biopsy, depending on the subtype of lymphoma suspected.
Having enough tissue in the biopsy sample is very important to formulate the diagnosis. Needle biopsy specimens are rarely large enough to perform a definitive lymphoma diagnosis. In most cases, it is necessary to perform a deep biopsy or surgical biopsy to perform the diagnosis and to classify the lymphoma correctly. Subsequently, a pathologist or hematopatólogo with experience in diagnosing lymphomas analyses the samples. A pathologist is a physician who specializes in interpreting laboratory analyses and evaluating cells, tissues, and organs for diagnosing diseases. A Hematopatólogo is a pathologist who has additional training in the diagnosis of blood cancer. Because there are many subtypes of lymphomas and because some of these subtypes are uncommon or rare, it may be helpful to look for a second opinion (in English) that includes a formal hematopathology review of anterior tissue biopsies.
CT or CAT scan. A CT creates a three-dimensional image of the interior of the body using X-rays taken from different angles. A computer then combines these images in a detailed view of cross sections that shows abnormalities or tumors. A CT can also be used to measure the size of the tumor. Sometimes a special dye, called contrast medium, is given before the scan, in order to obtain better details in the image. This dye can be injected into a vein of
Non-Hodgkin's lymphoma: treatment options
On this page: you will learn about the different ways that physicians use to treat people with this type of lymphoma. To see other pages, use the menu.
This section describes the treatments that are the standard of care for this type of cancer. "Standard of care" means the best known treatments. When making decisions related to the treatment plan, patients are also advised to consider participating in clinical trials. A clinical trial is a research study that proves a new approach to treatment. Doctors want to know if it is safe, effective and possibly better than standard treatment. Clinical trials may test a new drug, a new combination of standard treatments or new doses of standard drugs or other treatments. Your doctor can help you consider all of your treatment options. For more information on clinical trials, see the clinical trials and latest research sections.
General description of the treatment
In cancer care, different types of physicians often work together to create a comprehensive patient treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including medical aides, oncology nurses, social workers, pharmacists, consultants, nutritionists, and others.
There are 4 main treatments for LNH:
Chemotherapy
Radiotherapy
Immunotherapy, such as monoclonal antibodies, immune-control inhibitors and T-cells with CAR
Targeted therapy with newer drugs that block certain lymphoma cell functions
Sometimes the doctor and patient may consider surgery or stem cell transplantation. Patients often receive a combination of these treatments.
These treatment options are described below. Treatment options and recommendations depend on a number of factors, including:
The type and the stadium of the LNH
Possible Side effects
Patient preferences and general health
Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to get information about all your treatment options and be sure to ask questions about things that are unclear. Also, talk to your doctor about the goals of each treatment and what you can expect while you receive the treatment. Learn more about how to make treatment decisions.
Watchful wait
Some people with indolent lymphoma may not need immediate treatment if their overall condition is good and the lymphoma does not cause symptoms or problems in other organs. During vigilant waiting, also called monitoring and waiting or active surveillance, physicians closely monitor patients through physical examinations, CT, or other imaging tests and laboratory analyses performed on a regular basis. Treatment only begins if the symptoms or tests indicate that the cancer is getting worse. Vigilant waiting in some people with indolent lymphoma does not affect survival probabilities, as long as careful and regular follow-up is performed.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by inhibiting their ability to grow and divide. It is the main treatment for LNH. A clinical oncologist, who is a doctor specializing in the treatment of cancer with drugs, or a hematologist, who is a doctor who specializes in the treatment of blood disorders, are the ones who administer chemotherapy. Most of the time, a clinical oncologist or hematologist is the primary cancer specialist for the care of people with lymphoma.
Systemic chemotherapy enters the bloodstream to reach cancer cells throughout the body. Some of the common methods for administering chemotherapy include an intravenous (I.V.) tube that is placed in a vein with a needle, or a pill or capsule that is swallowed (by mouth).
A chemotherapy regimen or program is usually a specific amount of cycles that are given in a given period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time. The chemotherapy regimen used depends on the stage and the type of LNH. The most frequent combination of chemotherapy for the initial treatment of aggressive LNH is called CHOP and includes 4 medications:
Cyclophosphamide (Cytoxan, Neosar)
Doxorubicin (Adriamycin)
Prednisone (various trademarks)
Vincristine (Oncovin, Vincasar)
In the case of patients with B-cell lymphoma, adding rituximab to chop chemotherapy provides better results than chop chemotherapy as a single treatment. See the section on monoclonal antibodies below. There are also other frequent combinations of chemotherapy regimens, including the following:
BR (Bendamustine and rituximab)
Fludarabine-based combinations (Fludara, Oforta)
R-CVP (cyclophosphamide, prednisone, rituximab and vincristine)
The side effects of chemotherapy depend on the patient and the dose used. These may include fatigue, temporary reductions in blood counts, risk of infection, nausea and vomiting, hair loss, lost appetite, and diarrhea. These side effects can be controlled during treatment and usually disappear at the end of treatment.
In addition, chemotherapy may cause long-term side effects, also known as late effects. People with lymphoma may also be concerned if treatment can affect their sexual function and fertility. Talk to health care team members about these issues before you begin treatment. Learn more about the late effects of treatment.
Learn more about the basics of chemotherapy and how to prepare for treatment. Medications used to treat cancer are constantly assessed. Talking to your doctor often is the best way to get information about the medications you prescribed, your purpose, and your potential side effects or interactions with other medications. Learn more about your prescription drugs using the searchable drug databases.
Radiotherapy
Radiotherapy is the use of X-rays, electrons, or high-potency protons to destroy cancer cells. The Doctor who specializes in administering radiation therapy to treat cancer is called a radiation oncologist. The treatment with radiotherapy for the LNH is always of external beam, which is that which is applied from an external machine to the body.
A radiotherapy regimen usually consists of a specific amount of treatments that are given within a given period of time.
Non-Hodgkin's lymphoma: treatment options
On this page: you will learn about the different ways that physicians use to treat people with this type of lymphoma. To see other pages, use the menu.
This section describes the treatments that are the standard of care for this type of cancer. "Standard of care" means the best known treatments. When making decisions related to the treatment plan, patients are also advised to consider participating in clinical trials. A clinical trial is a research study that proves a new approach to treatment. Doctors want to know if it is safe, effective and possibly better than standard treatment. Clinical trials may test a new drug, a new combination of standard treatments or new doses of standard drugs or other treatments. Your doctor can help you consider all of your treatment options. For more information on clinical trials, see the clinical trials and latest research sections.
General description of the treatment
In cancer care, different types of physicians often work together to create a comprehensive patient treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including medical aides, oncology nurses, social workers, pharmacists, consultants, nutritionists, and others.
There are 4 main treatments for LNH:
Chemotherapy
Radiotherapy
Immunotherapy, such as monoclonal antibodies, immune-control inhibitors and T-cells with CAR
Targeted therapy with newer drugs that block certain lymphoma cell functions
Sometimes the doctor and patient may consider surgery or stem cell transplantation. Patients often receive a combination of these treatments.
These treatment options are described below. Treatment options and recommendations depend on a number of factors, including:
The type and the stadium of the LNH
Possible Side effects
Patient preferences and general health
Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to get information about all your treatment options and be sure to ask questions about things that are unclear. Also, talk to your doctor about the goals of each treatment and what you can expect while you receive the treatment. Learn more about how to make treatment decisions.
Watchful wait
Some people with indolent lymphoma may not need immediate treatment if their overall condition is good and the lymphoma does not cause symptoms or problems in other organs. During vigilant waiting, also called monitoring and waiting or active surveillance, physicians closely monitor patients through physical examinations, CT, or other imaging tests and laboratory analyses performed on a regular basis. Treatment only begins if the symptoms or tests indicate that the cancer is getting worse. Vigilant waiting in some people with indolent lymphoma does not affect survival probabilities, as long as careful and regular follow-up is performed.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by inhibiting their ability to grow and divide. It is the main treatment for LNH. A clinical oncologist, who is a doctor specializing in the treatment of cancer with drugs, or a hematologist, who is a doctor who specializes in the treatment of blood disorders, are the ones who administer chemotherapy. Most of the time, a clinical oncologist or hematologist is the primary cancer specialist for the care of people with lymphoma.
Systemic chemotherapy enters the bloodstream to reach cancer cells throughout the body. Some of the common methods for administering chemotherapy include an intravenous (I.V.) tube that is placed in a vein with a needle, or a pill or capsule that is swallowed (by mouth).
A chemotherapy regimen or program is usually a specific amount of cycles that are given in a given period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time. The chemotherapy regimen used depends on the stage and the type of LNH. The most frequent combination of chemotherapy for the initial treatment of aggressive LNH is called CHOP and includes 4 medications:
Cyclophosphamide (Cytoxan, Neosar)
Doxorubicin (Adriamycin)
Prednisone (various trademarks)
Vincristine (Oncovin, Vincasar)
In the case of patients with B-cell lymphoma, adding rituximab to chop chemotherapy provides better results than chop chemotherapy as a single treatment. See the section on monoclonal antibodies below. There are also other frequent combinations of chemotherapy regimens, including the following:
BR (Bendamustine and rituximab)
Fludarabine-based combinations (Fludara, Oforta)
R-CVP (cyclophosphamide, prednisone, rituximab and vincristine)
The side effects of chemotherapy depend on the patient and the dose used. These may include fatigue, temporary reductions in blood counts, risk of infection, nausea and vomiting, hair loss, lost appetite, and diarrhea. These side effects can be controlled during treatment and usually disappear at the end of treatment.
In addition, chemotherapy may cause long-term side effects, also known as late effects. People with lymphoma may also be concerned if treatment can affect their sexual function and fertility. Talk to health care team members about these issues before you begin treatment. Learn more about the late effects of treatment.
Learn more about the basics of chemotherapy and how to prepare for treatment. Medications used to treat cancer are constantly assessed. Talking to your doctor often is the best way to get information about the medications you prescribed, your purpose, and your potential side effects or interactions with other medications. Learn more about your prescription drugs using the searchable drug databases.
Radiotherapy
Radiotherapy is the use of X-rays, electrons, or high-potency protons to destroy cancer cells. The Doctor who specializes in administering radiation therapy to treat cancer is called a radiation oncologist. The treatment with radiotherapy for the LNH is always of external beam, which is that which is applied from an external machine to the body.
A radiotherapy regimen usually consists of a specific amount of treatments that are given within a given period of time.
Radiotherapy is usually given after or as a complement to chemotherapy, depending on the subtype of LNH. It is most frequently given to patients with lymphoma that is localized, which means that it affects only 1 or 2 adjacent areas, or that they have a particularly large lymph node, usually, of more than 7 to 10 centimeters transversally. It can also be prescribed for pain treatment or at very low doses (only 2 treatments) for patients with advanced disease who have localized symptoms that can be relieved with radiation therapy.
General side effects of radiotherapy may include fatigue and nausea. Most side effects are related to the region of the body that receives the radiation. These side effects may include mild skin reactions, dry mouth, temporary hair loss, or liquid stools. People who have received radiation therapy to the chest may experience inflammation of the lungs called pneumonitis. People who received radiation therapy in the bones may experience low blood counts.
Most side effects disappear shortly after treatment ends, but radiotherapy may also produce late effects, such as secondary cancers or damage to the heart and blood vessels if they were found within the field of Radiation. Sexual and infertility problems may occur after radiotherapy in the pelvis. Before you begin treatment, talk with your doctor about possible sexual and fertility-related side effects of your treatment and the existing options for preserving fertility, both in men and women. .
Learn more about the basic concepts of radiotherapy.
Directed therapy and immunotherapy
Targeted therapy is a treatment that targets cancer-specific genes or proteins, or tissue conditions that contribute to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and, at the same time, limits the damage to healthy cells.
Recent studies show that not all tumors have the same targets. To determine the most effective treatment, your health care provider can test to identify the genes, proteins, and other factors involved in the tumor. This helps physicians find the most effective treatment that best suits each patient, whenever possible. In addition, many research studies are being conducted to obtain more information on specific molecular objectives and new treatments addressed to them. Learn more about the basic concepts of targeted treatments.
For LNH, monoclonal antibodies are the main form of targeted therapy used in the treatment plan. A monoclonal antibody recognizes a specific protein and binds to it, but it does not affect cells that do not have that protein. A monoclonal antibody called rituximab is used for the treatment of many different types of B-cell LNH. Rituximab acts by attacking a molecule called CD20 that is found on the surface of all B cells and B-cell LNH. When the antibody binds to this molecule, the patient's immune system is activated to destroy some lymphoma cells or to make the lymphoma cells more susceptible to destruction due to chemotherapy.
While the antibody can work well on its own, research shows that it worked best when it was combined with chemotherapy in patients with most types of B-cell LNH. Rituximab is also given after a remission of indolent lymphomas to increase the duration of remission. There are two other monoclonal antibodies against CD20 that are approved for use in lymphomas: obinutuzumab (Gazyva) and Ofatumumab (Arzerra).
Brentuximab Vedotin is another type of monoclonal antibody, called a drug conjugate with antibodies. Antibody-based drug conjugates bind to targets in cancer cells and then release a small amount of chemotherapy or other toxins directly into the tumor. Brentuximab Vedotin was approved in 2011 for the treatment of systemic anaplastic large cell lymphoma in patients who did not benefit from at least 1 type of chemotherapy. The drug was also approved for patients with Hodgkin's lymphoma who did not benefit from stem cell transplantation or who were unable to undergo stem cell transplantation. Currently, other newer monoclonal antibodies to lymphoma are being investigated.
The radiolabeled antibodies are monoclonal antibodies with United radioactive particles. The particles are designed to focus radiation directly into the lymphoma cells. In general, radioactive antibodies are believed to be more potent than regular monoclonal antibodies, but more damaging to the bone marrow. This type of therapy is also known as radiotherapy (RIT).
Talk to your doctor about the possible side effects of a specific medication and how they can be handled.
Bone marrow/stem cell transplant
Stem cell transplantation is a medical procedure in which bone marrow or peripheral blood cells that contain highly specialized cells, called hematopoietic stem cells, are used as part of a treatment plan. Hematopoietic stem cells are blood-forming cells and are found in both the bloodstream and bone marrow. Currently, this procedure is most often referred to as stem cell transplantation rather than bone marrow transplantation. This is because usually what is transplant is the stem cells obtained from the blood and not the cells of the bone marrow tissue itself.
Stem cell transplantation is considered an aggressive treatment. It is usually used only in people with LNH whose disease is progressive or recurrent (see stadia). In some subtypes of LNH, such as mantle cell lymphoma and some T-cell lymphomas, physicians may recommend stem cell transplantation as part of the initial treatment plan to prevent recurrence. Before recommending a transplant, physicians will talk to the patient about the risks of this treatment. Physicians also consider other factors, such as the type of LNH, the results of previous treatments, age, and the general health status of the patient. It is important to talk to a doctor at an experienced transplant center about the risks and benefits of stem cell transplantation.
There are 2 types of stem cell transplantation, depending on the origin of the replacement blood stem cells: allogeneic (Alotrasplante) and autologous (autotransplant).
A alotrasplante uses stem cells from a donor that is a healthy person, ideally a sibling or non-kinship donor compatible. Treatment includes immunochemotherapy, radiation therapy, or immunotherapy plus "graft-versus-lymphoma" activity, which occurs when the donor cells recognize and destroy the patient's lymphoma cells. The risks of alotrasplante are usually much higher than those of autotransplant, and include graft-versus-host disease, which occurs when donor cells damage the patient's tissues or organs.
In Autotransplant, the patient's own stem cells are used after the administration of chemotherapy in high doses. In Autotransplant, the goal is to destroy all cancer cells present in the marrow, blood and other parts of the body by using high doses of chemotherapy, immunotherapy and/or radiotherapy. Autologous stem cells are infused after the completion of high dose therapy to allow replacement blood stem cells to re-create healthy bone marrow. A risk of autografting is the possibility of small amounts of lymphoma cells present in the collection of stem cells.
Learn more about the basic concepts of stem cell and bone marrow transplantation.
How to get care for symptoms and side effects
Lymphoma and treatment often cause side effects. In addition to treatment to retard, stop or eliminate the disease, an important aspect of care is to alleviate the symptoms and side effects of the person. This approach is called palliative care or supportive care and includes providing patient support with physical, emotional and social needs.
Palliative care is any treatment that focuses on reducing symptoms, improving quality of life and providing support to patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. Palliative care acts best when they begin as soon as they are needed in the cancer treatment process. People often receive treatment for lymphoma and treatment to alleviate side effects at the same time. In fact, patients who receive both treatments often have less severe symptoms, better quality of life, and report that they are more satisfied with the treatment.
Palliative treatments vary widely and often include medications, nutritional changes, relaxation techniques, emotional support and other therapies. You may also receive palliative treatments similar to those used to eliminate cancer, such as chemotherapy, surgery, or radiation therapy. Talk to your doctor about the goals of each treatment in your treatment plan.
Before you begin treatment, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. Also, during and after treatment, be sure to tell your doctor or other health care team member if you experience a problem so that it can be addressed as soon as possible. Learn more about palliative care.
Referral and probability of recurrence
A complete remission occurs when the lymphoma cannot be detected in the body and there are no symptoms. This can also be called "no evidence of disease, NED." Partial remission occurs when the lymphoma has had a regression of more than 50% compared to its pre-treatment status, but it can still be detected.
A referral may be temporary or permanent. This uncertainty causes many people to worry about cancer coming back. Although many referrals are permanent, it is important to talk with your doctor about the possibility of the disease returning. Understanding your risk of recurrence and treatment options can help make you feel more prepared if, in effect, the lymphoma returns. Learn more about how to cope with fear of recurrence.
As explained in the Stadiums section, if the cancer returns after the original treatment, it is called recurrent cancer. It may reappear in the same place (which is called local recurrence), in the vicinity (regional recurrence), or elsewhere (distance recurrence).
When this happens, a test cycle will begin again to get as much information as possible about recurrence. In most cases, another tissue biopsy is needed to check that the lymphoma has not changed or become a more aggressive subtype. After the tests are done, you and your doctor will talk about your treatment options.
The treatment of recurrent LNH depends on 3 factors:
Where the cancer is and if it has become a more aggressive subtype
The types of treatment previously managed
The general health of the patient
The treatment plan will often include treatments described above such as chemotherapy, radiation therapy, targeted therapy, or stem cell transplantation. However, they may be combined in a different way or managed at a different rate. Your doctor may also suggest clinical trials that are studying new methods to treat this type of recurrent cancer. Whatever treatment plan you choose, palliative care will be important in relieving symptoms and side effects.
Frequently, people with recurrent cancer experience emotions such as unbelief or fear. Patients are advised to talk to the health care team about these feelings and to consult on support services that will help them cope with the situation. Learn more about coping with cancer recurrence.
Progressive LNH
Some patients with LNH may not experience complete remission and present small amounts of stable residual disease. Or, they will present a residual disease that grows actively despite treatment. If there is a small amount of stable residual disease, some patients with indolent LNH may remain in observation for a while or receive treatment with monoclonal antibodies or other medications. These patients may experience pauses in treatment, some may last for years. If the lymphoma begins to grow or spread, which is known as progression of the disease, the active treatment will begin again.
It is important to understand that remission is not always possible in some types of indolent lymphomas. However, patients can be safely controlled, even if there are traces of the disease. This is possible as long as there are no symptoms and the lymphoma has not affected blood counts or other organs.
In the case of patients with LNH with residual disease growing even though the patient receives an active treatment, see "Refractory LNH" below.
Refractory LNH
If standard treatments cease to be effective in the treatment of LNH or lymphoma reappears within 6 months after standard treatment, it is called refractory LNH. Patients with this diagnosis are encouraged to speak with expert lymphoma physicians to discuss options for the best treatment plan. Learn more about finding a second opinion before you begin treatment in order to be calm with your chosen treatment plan. This analysis may include clinical trials.
The choice of treatment for refractory LNH depends on 4 factors:
Where cancer is located
The Lymphoma Subtype
The type of treatment previously managed
The general health of the patient
Your doctor may suggest chemotherapy, stem cell transplantation, or admission to a clinical trial. Palliative care will also be important to help alleviate symptoms and side effects.
For most patients, receiving a refractory LNH diagnosis is very stressful and sometimes difficult to cope with. Patients and their families are advised to talk about how they feel about doctors, nurses, social workers, or other health care team members. It may also be helpful to talk to other patients, even through a support group.
If the treatment fails
Recovering from LNH is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful and, for many people, talking about advanced cancer is difficult. However, people with advanced LNH, especially those with indolent lymphomas, may continue to live a long time after receiving the advanced cancer diagnosis. It is important to keep open and candid conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is here to help you. Many team members have special skills, experience and knowledge to provide support to patients and their families. Making sure a person is physically comfortable and not feeling pain is extremely important.
Patients with advanced cancer and with a life expectancy of less than 6 months may want to consider a type of palliative care called terminally ill care. Terminally ill care is designed to provide the best possible quality of life for people who are close to the end of life. You and your family are encouraged to think about where you would be most comfortable: At home, at the hospital, or at a hospice facility. Nursing care and special equipment can make staying at home a feasible alternative for many families. Learn more about planning for advanced cancer care.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about suffering and loss.
The following section of this guide is about clinical trials. It offers more information on research studies that focus on finding better ways to care for people with cancer. Alternatively, use the menu to choose another section to continue reading this guide.
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