What Patients Need to Know About Lymphoma, and the Importance of Personalized Care.

Lymphoma is a heterogenous group of blood cancers that requires a balance of focused treatment and personalized care. These cancers affect the lymphocytes—disease-fighting cells of the immune system. Lymphoma is a result of these cells, which comprise up to 40% of the body’s white blood cells, mutating and replicating uncontrollably by various mechanisms. 

There are two primary types of lymphocytes that help defend the body from illness: B-cells and T-cells. B-cells produce antibodies that attack invasive bacteria, viruses, and toxins. T-cells destroy existing cells that are sick or cancerous.

The two categories of lymphoma—Hodgkin’s and non-Hodgkin’s—force healthy lymphocytes to go on the offensive. They become abnormal cancer cells and compromise the immune system, which is the body’s defensive network. The cancer cells lodge inside lymph nodes, which are small, bean-shaped clusters of immune cells in a network scattered around the body. The resulting uncomfortable swelling can be an early sign of cancer.

Since lymph nodes exist throughout the body, lymphoma can impact multiple organs, and it affects each patient differently. Treatment requires attentive care that is tailored to your personal condition, as well as how fast the cancer is growing. 

With the advent of modern cancer treatment options—such as immunotherapies, targeted therapies and precise radiation therapy—the outlook is promising. Depending on the type and stage of the lymphoma, the majority of patients respond to treatment. Given the diverse variety of lymphomas, some even do not require treatment and are observed, and some are maintained with therapy as a chronic disease for many years.

Differences between Hodgkin’s and non-Hodgkin’s lymphoma.

 There are two main forms of lymphoma: Hodgkin’s and non-Hodgkin’s. Both arise from uncontrolled growth of lymphocytes in various parts and stages of the immune system.

Hodgkin’s lymphoma accounts for approximately 20% of U.S. lymphoma cases each year. It typically occurs in the upper body and is identified by the presence of abnormal cells called Reed-Sternberg cells. Hodgkin’s lymphoma is more common in early adulthood and after age 55.

Non-Hodgkin’s lymphomas (NHL) are the most common, comprising approximately 80% of U.S. cases. NHL can affect lymph nodes anywhere in the body, and doctors have identified more than 80 subtypes of NHL as of 2022. They are usually categorized based on their aggressiveness or the type of lymphocyte affected. It is common in younger patients, though more than half of patients are diagnosed at age 65 or older.

Lymphoma causes and risk factors.

Scientists know that a single or accumulation of genetic mutations in lymphocytes cause these cells to malfunction, grow uncontrollably, and become cancerous, but more research is needed to understand what triggers these processes. Possible risk factors include advancing age, a suppressed immune system, and environmental factors such as exposure to radiation, carcinogens, pesticides, herbicides, viruses, and bacteria.

Risk factors for Hodgkin’s lymphoma may include:

• Virus infection: Patients may have higher risk if they have viruses like human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV)
• Family history: Patients who have parents or siblings with Hodgkin lymphoma may be at higher risk
• Inherited diseases: Patients with inherited immune system diseases, like Wiskott-Aldrich syndrome, could be at higher risk

Risk factors for non-Hodgkin’s lymphoma may include:

• Gender: Overall, male patients may be at higher risk, but some types are more common in female patients
• Race: White patients are more likely to develop the disease, although it is not uncommon in African-Americans, Asians, and Hispanics depending on the type of NHL
• Certain medical conditions: Patients with inherited immune system diseases or autoimmune diseases like rheumatoid arthritis, Sjogren’s syndrome, or lupus could be at higher risk
• Infections: Such as HIV, EBV, hepatitis C, or helicobacter pylori
• Lifestyle: Obesity, diet, physical inactivity, and smoking

Some patients have few or no known risk factors. It’s more important to know the symptoms and to seek early medical advice or treatment if signs arise as there is no approved screening for prevention. An early start on disease treatment allows for an optimized approach to care given the complex nature of the disease and the diagnostics needed to better tailor the treatment as personalized medicine.

Lymphoma symptoms and detection.

 A key symptom of lymphoma is swollen but painless lymph nodes in the neck, armpit, groin, chest, or stomach. Other symptoms might include:

• Unexplained persistent fevers
• Night sweats
• Unexplained weight loss
• Enlarging spleen, abdominal pain
• Cough and shortness of breath
• Generalized itchy skin
• Malaise and fatigue

If you’re experiencing any of these symptoms on a regular basis, it’s important to inform your doctor, who can use a variety of tools to check for lymphoma. Common detection tools include:

• Physical examination and an understanding of your health history
• Blood and urine laboratory tests
• Imaging tests such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) scans
• Lymph node biopsy, which is using a needle or surgically removing the lymph node to assess for any abnormalities and check for any molecular or genetic mutations
• Bone marrow aspiration and biopsy, which uses a hollow needle under local anesthesia, to remove a small sample of bone marrow from the back of the hipbone to check for any lymphoma cells or other abnormalities
  

If you’re diagnosed with lymphoma, you and your doctor will determine your treatment options depending on the type, its stage, and your age and health history. In some slow-growing cases, treatment may be watchful monitoring, with medical intervention not being necessary until there are signs of growth or spread. Aggressive cases may require immediate treatment with chemotherapy, immunotherapy, radiation, stem-cell transplantation, or a combination of these treatments. Very rare cases can be treated surgically, but usually surgery is not the main modality of treatment of lymphomas. 

Lymphoma treatments: Personalized to the patient.

 Treatments for lymphoma depend largely on the type, stage, or having any symptoms related to the disease. The goal is to cure the disease or keep it in remission while also mitigating potential short-term and long-term side effects with goals of preserving quality of life. Your doctor is your partner on this journey to give you advice on the risks and benefits of therapy.

At MedStar Health, you’ll collaborate with a team of experts who care for you—and we’ll walk with you through your initial diagnosis, treatment, survival, and recovery. Our approach will be tailored to suit your lymphoma while also considering your needs and goals. 

Treatments for Hodgkin’s lymphoma and non-Hodgkin’s lymphoma may include:

Chemotherapy.

 Chemotherapy drugs—which destroy faster dividing cancer cells throughout the body—can be given through an intravenous (IV) therapy, subcutaneously (SC), or taken as a pill. They are given in cycles that include treatment and rest periods allowing the body to recover. This treatment involves several drug combinations and can cause side effects like fatigue, compromised immune system, and increased chances of infection.

Radiation therapy.

Radiation therapy uses doses of high-energy particles, such as electrons or protons, carefully beamed at a particular part of the body, to destroy cancer cells. Treatments are often given five days a week for several weeks. Side effects range from skin irritation, dry mouth, and diarrhea to an increased risk of cancer in the body part that was exposed to radiation.  

Biologically targeted drugs.

These drugs target specific genes, proteins, and enzymes that are involved in the growth and survival of cancer cells. Examples include proteasome, BCL2, HDAC, BTK, EZH2, and nuclear export inhibitors. Some inhibitors may be given as pills, and some may be given through IV or SC therapy. Common side effects include nausea, diarrhea, fatigue, and low blood cell counts.

Immunotherapy.

Immunotherapy can either teach the immune system to detect and destroy cancer cells or use man-made antibodies—proteins made by the immune system to fight infections—to slow or stop lymphoma growth. These proteins, called monoclonal antibodies (such as CD20, CD30, CD79), are administered via injection under the skin or through IV therapy. Immunotherapy can:

• Block cancer cell signals, halting their growth
• Bind to cancer cells, triggering your immune system to kill them
• Attach to toxins, chemotherapy, or radioactive substances, carrying these materials to the cancer cell and killing it
  

Immunotherapy also includes drugs called immune checkpoint inhibitors, which indirectly help the immune system to better find and attack cancer cells. They are given through IV therapy.

Another form of immunotherapy can be found in immunomodulating drugs. They assist in the proper functioning of your immune system, and doctors are learning more about how and why they work. They are given as pills to be taken by mouth.

All immunotherapy treatments carry a risk of side effects, including an overstimulated or misdirected immune system response. These side effects can be mild, moderate, or severe, and can be potentially life-threatening under certain circumstances. Most side effects can be managed safely if they’re recognized and addressed early in treatment.

Stem cell transplantation.

This therapy replaces or reinforces the patient’s damaged bone marrow cells with either the patient’s healthy cells or from a donor. The bone marrow is the factory and regulator of production of red blood cells, white blood cells, and platelets that help oxygenate the body, fight infections, and prevent the body from bleeding or clotting excessively, respectively. Side effects include significant immune suppression, serious infections, bleeding and bruising, blood transfusions, graft-vs-host disease (GVHD), rash, and diarrhea.

Chimeric antigen receptor (CAR) T-cell therapy.

This is a newer form of therapy, where a patient’s blood and T-cells are drawn and taken to a laboratory. There, the cells are engineered to recognize and attack cancer cells that harbor certain receptors and then reinfused back to patient. Side effects include fatigue, fevers, and cytokine release syndrome (CRS), which is an exaggerated inflammatory response of a patient’s immune system to the CAR T-cells and can be potentially lethal.  

We’re here for you.

If you’ve been diagnosed with lymphoma, you can trust us to be your partner during your journey. Our team approach—combined with our ever-growing toolkit of treatments and resources for our patients—can give you hope and a restored quality of life. We’ll guide you along the path to remission, and, when you get there, we’ll stay with you—offering vigilant monitoring and after-care solutions—to ensure your future is bright.