Tuesday, June 20, 2006

Bone Marrow Transplantation for Non-Hodgkin's Lymphoma

If you have non-Hodgkin's lymphoma, or NHL, then you have one of the three different subgroups: either low grade, intermediate grade, or high grade. I will discuss the use of bone marrow transplantation for each grade of NHL, but let us first examine the different ways bone marrow can be transplanted.
Types of Bone Marrow Transplantation

There are three types of bone marrow transplantation: autologous, allogeneic, and syngeneic.

Autologous Bone Marrow Transplantation
With autologous bone marrow transplants, a portion of your own bone marrow cells are removed and stored in a freezer before you receive chemotherapy, or chemotherapy and radiation therapy together (chemoradiotherapy), in powerful doses so that as many cancer cells can be killed as possible. Then your bone marrow cells that were stored in the freezer—and which were saved from the toxic effects of your therapy—are put back in your body. The benefit of this type of bone marrow transplantation is that higher doses of chemotherapy can be given to knock out the cancer without fear of harming the bone marrow.


Allogeneic Bone Marrow Transplantation
An allogeneic bone marrow transplant uses bone marrow cells from another person (donor). The donor could be a family member (usually a sibling) or be unrelated. Bone marrow cells from unrelated donors come through programs such as the National Marrow Donor Program or one of the Umbilical Cord Blood banks recently established around the country.

There are three benefits of allogeneic bone marrow transplantation. The first is similar to that with autologous bone marrow transplantation: the ability to administer very high doses of chemotherapy and radiotherapy to hit the cancer the hardest. The second benefit is the possibility of a "graft versus tumor effect." (Physicians refer to transplanted organs or bone marrow as grafts.) When an allogeneic transplant is performed successfully, the recipient in effect receives a new immune system (from the donor's cells). The new immune system can then attack the cancer in the recipient. This effect is particularly powerful in leukemias, and its importance in NHL is being actively studied. A serious side effect of an allogeneic transplant may occur if this new immune system reacts against your normal cells in what is called "graft-versus-host disease." However, when this occurs along with a graft-versus-tumor effect, the benefit to you may outweigh any unwanted side effects.

A third benefit of this type of bone marrow transplant is of particular importance in diseases in which there may be cancer cells in your bone marrow (which can happen with NHL) because with allogeneic transplantation you receive "new" healthy bone marrow.

more >>http://www.lymphomafocus.org/focus_article.asp?b=lymphoma&f=lymphoma_treatment&c=trreatment_bonemarrow&pg=2

Cutting Edge Therapy: Monoclonal Antibody Treatment for Non-Hodgkin's Lymphoma

Chemotherapy and radiation therapy have been effective treatments for patients with non-Hodgkin’s lymphoma, or NHL. Patients with NHL usually respond well to either treatment, and some can be cured. However, for many patients, these treatments are not that effective and can be very toxic. Because of these limitations, intensive efforts have been made to develop new therapies to fight NHL.
"Monoclonal-antibody–based" therapy is a new development in NHL therapy and has been demonstrated to be safe and effective for certain types of patients. One drug rituximab (also known as Rituxan®) has been approved by the FDA for treatment of NHL. (I will discuss it in detail later in this article). Other monoclonal antibody treatments, such as Bexxar®, are being studied and may soon be available as well. All offer great promise in further improving the effectiveness and tolerability of the current treatment for NHL. (rituxumab, Bexxar, and other similar treatments will be discussed later in the article.)

What Are Monoclonal Antibodies?

Antibodies are substances made by our own immune system to fight against various foreign substances. Our bloodstream contains many different types. Each antibody has a specific target (antigen) that it looks for and binds to, like a key, which fits only into one lock. When an antibody binds to its antigen target, the antibody alerts the immune system to respond against the foreign substance. This is an important part of our body’s defense against infection.


A monoclonal antibody is one that is generated in a laboratory, not in our body, to be directed against one single target. Rather than a diverse group of antibodies like those found in our bodies, monoclonal antibodies are made to be all exactly the same. The reason why they were developed was to allow a treatment to be directed to one specific target. Monoclonal antibodies developed to treat cancers are made to be directed against a single target on a tumor to cause anti-tumor effects.

Different antibodies have been engineered and developed through different processes. For several reasons, most antibodies are initially created as murine (or mouse) type. This does not mean that they are made in an animal but simply that the antibody structure is from a mouse antibody. Antibodies can be chimeric (half mouse, half human) or humanized (mostly human). All types have been evaluated, yet the potential differences in efficacy or toxicity have not definitively been established.

How Do Monoclonal Antibody Treatments Work in Lymphoma?

Most non-Hodgkin’s lymphoma patients (about 90%) have tumors that are made up of B cells (B lymphocytes), a type of white blood cell. Since most NHL patients have these similar B cells, treatment using a monoclonal antibody directed against these tumor B cells has great potential to be effective in different patients. Several different monoclonal antibodies have been evaluated as potential treatments for lymphoma.
As treatment for NHL, monoclonal antibodies have been tested either alone ("naked" antibodies) or have been joined with a toxin which can kill cells, in order to target this toxin directly towards tumor cells. Radioactive particles have also been attached to monoclonal antibodies (radiolabeled antibodies) to make radiation therapy more effective. Patients who have low blood counts or have a lot of tumor cells in their bone marrow may not be candidates for treatment with radiolabeled antibodies because the radiation may destroy too many of their red and white blood cells (a side effect called hematologic toxicity). The differences in monoclonal antibody structure and targets, whether or not they are linked to radioactive particles or toxins, as well as the differences in patients, play an important role in the choice of treatment and how effective and safe a particular type of monoclonal antibody will be.

What Monoclonal Antibody Treatments Are Available for NHL?

Rituximab (Rituxan®)
Rituxan is the only monoclonal antibody treatment currently approved for NHL. Rituxan is a chimeric antibody that binds to a specific antigen target present on the surface of B cells (again -- this is the cancer cell type in most NHL patients). If Rituxan is given as a course of treatment without anything else, it is usually given once a week for 4 weeks. People receive it as outpatients, but it is given intravenously, over a period of several hours. Most of the common side effects are fever, chills, rigors or shakes, and are most likely to occur during the first treatment. In contrast to many chemotherapy agents, Rituxan does not have other significant side effects like nausea, vomiting, hair loss, and low blood counts. Rituxan has been most extensively studied in patients that have relapsed low grade NHL: about 50% of the patients respond with about 5% having a complete remission. Rituximab has also been combined with a radioactive particle to enhance its effect with directed radiation therapy, as mentioned above. This treatment (called Y2B8 or Zevalin) is given twice intravenously in an outpatient clinic, with a week between doses. During the week between doses, nuclear medicine scans are used to determine the dosing in the second treatment. In the initial studies the anti-tumor effects and response rates are significantly higher using this radiolabeled combination, and the toxic side effects like low blood counts appear to be manageable.

more >> http://www.lymphomafocus.org/focus_article.asp?b=lymphoma&f=lymphoma_treatment&c=treatment_monoclonal&pg=3

Immunohistochemistry is a diagnostic test

Immunohistochemistry is a diagnostic test. It uses antibodies previously marked with a substance that can be seen under the microscope. The antibodies are specific to an antigen that the test is able to detect. These antibodies have high affinity to their antigens so the test has high specificity, not necessarily high sensitivity which depends on other factors.

It is widely used to detect and classify cancer cells Antibodies can be polyclonal or monoclonal. How can this test affect treatment options for a given disease? I will explain this through an example:

Cells, cancer or not, have, different antigens (markers) on their membranes, such as receptors, glycoproteins, etc. This markers define populations of cells like CD4 and CD8 T-lymphocytes and B-lymphocytes (CD-20 + or -). This markers, when they are unique to a specific type of cell, can help not only to differentiate them, but also to target them with specific antibodies. These antibodies can be used for tests and also as treatments.

I will explain this through an example:

A patient comes to the office with a biopsy of his pleura, and it reports "Diffuse large B-cell lymphoma". The immunoperoxidase shows CD20 (+) (a B cell marker) and Bcl-6 (a marker of its origin from the germinal center).

If this patient didn't have a CD20 (+) report then he wouldn't be eligible for Rituximab therapy and the prognosis would be far more somber.

Rituximab is a genetically engineered chimeric murine/human monoclonal antibody that targets CD20 receptors that are present in certain B-cell non-Hodgkin lymphomas. Once it reaches its intended target, it activates other immune cells and the complement system to destroy the b-cell. It is part of the new therapies that are being used in Hemato-oncology.

Before Rituximab, the standard therapy for B-cell lymphoma was CHOP therapy. This therapy had a success rate of 40% to 50%. (3-year event-free rate)

When Rituximab is used in conjunction with CHOP chemotherapy, it has shown a success rate of up to 99% (when used in early stages).

Now you see the difference.

However this new therapies are not exempt of potentially hazardous effects, and this page is not intended as an advertisement of Rituximab, but to show an example of the application of antibodies in different settings (diagnostic and therapeutic.

Francisco Santander M.D. Visit the source Immunohistochemistry and new lymphoma treatments

Lymphoma

Summary
Lymphoma is cancer of the lymphoid tissue, which is part of the lymphatic system. A major component of the immune system, the lymphatic system consists of organs, lymph nodes and lymphatic vessels. This system manufactures lymphocytes and transports lymph (fluid made of plasma and white blood cells) from tissues to the bloodstream. Although other forms of cancer may spread to parts of the lymphatic system, lymphoma is the only form that originates in the system.

Lymphoid tissue is formed by various types of immune cells that work together to resist some types of infection and other threats, such as cancer. Lymphocytes are the main type of cell found in the lymphoid tissue. In lymphoma, abnormal lymphocytes continually grow for no reason. This results in abnormal enlargement of the lymph nodes and other body organs containing lymphocytes, causing lumps to develop in the body.

Lymphomas can be categorized into two main groups. One group, characterized by the presence of specific cells (called Reed-Sternberg cells), is known as Hodgkin’s lymphoma or Hodgkin’s disease. All other forms of lymphomas are known as non-Hodgkin’s lymphoma. Cases of non-Hodgkin’s lymphoma are far more common.


Most lymphomas develop as a result of noninherited mutations in the genes of growing lymphocytes. According to the National Cancer Institute (NCI), lymphomas account for about 5 percent of all cases of cancer in the United States. They can occur in both children and adults.

Monday, October 03, 2005

Non-Hodgkin's lymphoma

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Non-Hodgkin's lymphoma

(Redirected from Non-Hodgkins lymphoma)
Non-Hodgkin's lymphoma
ICD-10 code: C82-C85
ICD-9 code:

Non-Hodgkin's lymphoma is a type of cancer. Lymphoma is a general term for cancers that develop in the lymphatic system. Hodgkin's disease is one type of lymphoma. All other lymphomas are grouped together and are called non-Hodgkin's lymphoma. Lymphomas account for about 5 percent of all cases of cancer in the United States.


The human lymphatic systemThe lymphatic system is part of the body's immune system. It helps the body fight disease and infection. The lymphatic system includes a network of thin tubes that branch, like blood vessels, into tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are small organs called lymph nodes. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen. Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue is also found in other parts of the body, including the stomach, intestines, and skin.

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. To understand non-Hodgkin's lymphoma, it is helpful to know about normal cells and what happens when they become cancerous. The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed, creating a mass of extra tissue. This mass is called a growth or tumor. Tumors can be either benign (not cancerous) or malignant (cancerous).

In non-Hodgkin's lymphoma, cells in the lymphatic system become abnormal. They divide and grow without any order or control, or old cells do not die as cells normally do. Because lymphatic tissue is present in many parts of the body, non-Hodgkin's lymphoma can start almost anywhere in the body. Non-Hodgkin's lymphoma may occur in a single lymph node, a group of lymph nodes, or in another organ. This type of cancer can spread to almost any part of the body, including the liver, bone marrow, and spleen.

Contents [hide]
1 Symptoms
2 Diagnosis
3 Types of Non-Hodgkin's Lymphoma
4 Etiology
5 Staging
5.1 Stages of NHL
6 Treatment
7 Getting a Second Opinion
8 Preparing for Treatment
9 Methods of Treatment
10 Clinical Trials
11 Side Effects of Treatment
11.1 Chemotherapy
11.2 Radiation Therapy
11.3 Bone Marrow Transplantation
11.4 Biological Therapy
11.5 Surgery
12 Nutrition During Cancer Treatment
13 Recovery and Outlook
14 Followup Care
15 Risk Factors Associated with Non-Hodgkin's Lymphoma
16 Notable NHL patients
17 References:




Symptoms
The most common symptom of non-Hodgkin's lymphoma is a painless swelling of the lymph nodes in the neck, underarm, or groin.

Other symptoms may include the following:

Unexplained fever
Night sweats
Constant fatigue
Unexplained weight loss
Itchy skin
Reddened patches on the skin
When symptoms like these occur, they are not sure signs of non-Hodgkin's lymphoma. They may also be caused by other, less serious conditions, such as the flu or other infections. Only a doctor can make a diagnosis. When symptoms are present, it is important to see a doctor so that any illness can be diagnosed and treated as early as possible. Do not wait to feel pain; early non-Hodgkin's lymphoma may not cause pain.


Diagnosis
If non-Hodgkin's lymphoma is suspected, the doctor asks about the person's medical history and performs a physical exam. The exam includes feeling to see if the lymph nodes in the neck, underarm, or groin are enlarged. In addition to checking general signs of health, the doctor may perform blood tests.

The doctor may also order tests that produce pictures of the inside of the body. These may include:

X-rays: Pictures of areas inside the body created by high-energy radiation.
CT scan (also known as a "CAT scan"): A series of detailed pictures of areas inside the body. The pictures are created by a computer linked to an x-ray machine.
MRI (magnetic resonance imaging): Detailed pictures of areas inside the body produced with a powerful magnet linked to a computer.
Lymphangiogram: Pictures of the lymphatic system taken with x-rays after a special dye is injected to outline the lymph nodes and vessels.
A biopsy is needed to make a diagnosis. A surgeon removes a sample of tissue so that a pathologist can examine it under a microscope to check for cancer cells. A biopsy for non-Hodgkin's lymphoma is usually taken from a lymph node, but other tissues may be sampled as well. Sometimes, an operation called a laparotomy may be performed. During this operation, a surgeon cuts into the abdomen and removes samples of tissue to be checked under a microscope.

A patient who needs a biopsy may want to ask the doctor some of the following questions:

Why do I need to have a biopsy?
How long will the biopsy take? Will it hurt?
How soon will I know the results?
If I do have cancer, who will talk with me about treatment? When?

Types of Non-Hodgkin's Lymphoma
Over the years, doctors have used a variety of terms to classify the many different types of non-Hodgkin's lymphoma. Most often, they are grouped by how the cancer cells look under a microscope and how quickly they are likely to grow and spread. Aggressive lymphomas, also known as intermediate and high-grade lymphomas, tend to grow and spread quickly and cause severe symptoms. Indolent lymphomas, also referred to as low-grade lymphomas, tend to grow quite slowly and cause fewer symptoms. One of the paradoxes of non-Hodgkin's lymphoma is that the indolent lymphomas generally cannot be cured by chemotherapy, while in a significant number of cases aggressive lymphomas can be. Current lymphoma classification is complex. Common types of lymphomas include follicular lymphoma and diffuse large B cell lymphoma.

Details of the most popular classifications of lymphoma can be found in the lymphoma page.


Etiology
The etiology of most lymphomas is not known. Rare types of lymphomas are caused by viruses. Burkitt's lymphoma, extranodal NK/T cell lymphoma and Hodgkin's disease are caused by the Epstein-Barr virus. Adult T-cell lymphoma/leukemia is caused by the HTLV-1 virus, endemic in parts of Japan and the Caribbean. Lymphoma of the stomach is often caused by the Helicobacter bacteria.


Staging
If non-Hodgkin's lymphoma is diagnosed, the doctor needs to learn the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Treatment decisions depend on these findings.

The doctor considers the following to determine the stage of non-Hodgkin's lymphoma:

The number and location of affected lymph nodes;
Whether the affected lymph nodes are above, below, or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen); and
Whether the disease has spread to the bone marrow, spleen, or to organs outside the lymphatic system, such as the liver.
In staging, the doctor may use some of the same tests used for the diagnosis of non-Hodgkin's lymphoma. Other staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone. A pathologist examines the sample under a microscope to check for cancer cells.


Stages of NHL
The various stages of NHL (the Ann Arbor staging classification, developed for Hodgkin's lymphoma) are based on how far the cancer has spread throughout and beyond the lymphatic system, and whether constitutional symptoms (fever, night sweats, or weight loss) are present.

Stage I
"Stage I" indicates that the cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.
Stage II
"Stage II" indicates that the cancer is located in two separate regions, an affected lymph node or organ within the lymphatic system and a second affected area, and that both affected areas are confined to one side of the diaphagm - that is, both are above the diaphragm, or both are below the diaphragm.
Stage III
"Stage III" indicates that the cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.
Stage IV
"Stage IV" indicates that the cancer has spread beyond the lymphatic system and involves one or more major organs, possibly including the bone marrow or skin.
The absence of constitutional symptoms is denoted by adding an "A" to the stage; the presence is denoted by adding a "B" to the stage.

Staging in Non-Hodkin's lymphomas is far less significant in determining therapy than it is in Hodgkin's lymphoma.


Treatment
The doctor develops a treatment plan to fit each patient's needs. Treatment for non-Hodgkin's lymphoma depends on the stage of the disease, the type of cells involved, whether they are indolent or aggressive, and the age and general health of the patient.

Non-Hodgkin's lymphoma is often treated by a team of specialists that may include a hematologist, medical oncologist, and/or radiation oncologist. Non-Hodgkin's lymphoma is usually treated with chemotherapy, radiation therapy, or a combination of these treatments. In some cases, bone marrow transplantation, biological therapies, or surgery may be options. For indolent lymphomas, the doctor may decide to wait until the disease causes symptoms before starting treatment. Often, this approach is called "watchful waiting."

Taking part in a clinical trial (research study) to evaluate promising new ways to treat non-Hodgkin's lymphoma is an important option for many people with this disease.


Getting a Second Opinion
Before starting treatment, patients may want a second opinion to confirm their diagnosis and treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it.

There are a number of ways to find a doctor who can give a second opinion:

The patient's doctor may be able to suggest specialists to consult.
In the United States, The Cancer Information Service, at 1-800-4-CANCER, can tell callers about cancer treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.
In the United States, The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and medical background. This resource, produced by the American Board of Medical Specialties, is available in most public libraries and on the Internet.

Preparing for Treatment
Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for people to think of everything they want to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

These are some questions a patient may want to ask the doctor before treatment begins:

What kind of non-Hodgkin's lymphoma do I have?
What is the stage of the disease?
What are my treatment choices? Which do you recommend for me? Why?
What are the risks and possible side effects of each treatment?
What side effects should I report to you?
How long will treatment last?
What are the chances that the treatment will be successful?
Will treatment affect my normal activities? If so, for how long?
Are new treatments under study? Would a clinical trial be appropriate for me?
What is the treatment likely to cost?
Patients do not need to ask all their questions or remember all the answers at one time. They will have other chances to ask the doctor to explain things and to get more information.


Methods of Treatment
Chemotherapy and radiation therapy are the most common treatments for non-Hodgkin's lymphoma, although bone marrow transplantation, biological therapies, or surgery are sometimes used.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for non-Hodgkin's lymphoma usually consists of a combination of several drugs. Patients may receive chemotherapy alone or in combination with radiation therapy.

Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic treatment because the drugs enter the bloodstream and travel throughout the body.

Usually a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.


Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. Treatment with radiation may be given alone or with chemotherapy. Radiation therapy is local treatment; it affects cancer cells only in the treated area. Radiation therapy for non-Hodgkin's lymphoma comes from a machine that aims the high-energy rays at a specific area of the body. There is no radioactivity in the body when the treatment is over.


Sometimes patients are given chemotherapy and/or radiation therapy to kill undetected cancer cells that may be present in the central nervous system (CNS). In this treatment, called central nervous system prophylaxis, the doctor injects anticancer drugs directly into the cerebrospinal fluid.

Bone marrow transplantation (BMT) may also be a treatment option, especially for patients whose non-Hodgkin's lymphoma has recurred (come back). BMT provides the patient with healthy stem cells (very immature cells that produce blood cells) to replace cells damaged or destroyed by treatment with very high doses of chemotherapy and/or radiation therapy. The healthy bone marrow may come from a donor, or it may be marrow that was removed from the patient, treated to destroy cancer cells, stored, and then given back to the person following the high-dose treatment. Until the transplanted bone marrow begins to produce enough white blood cells, patients have to be carefully protected from infection. They usually stay in the hospital for several weeks.




Biological therapy (also called immunotherapy) is a form of treatment that uses the body's immune system, either directly or indirectly, to fight cancer or to lessen the side effects that can be caused by some cancer treatments. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes also called biological response modifier therapy.





Clinical Trials
Many people with non-Hodgkin's lymphoma take part in clinical trials (research studies). Doctors conduct clinical trials to learn about the effectiveness and side effects of new treatments. In some trials, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group; or they may compare one standard treatment with another. Research like this has led to significant advances in the treatment of cancer. Each achievement brings researchers closer to the eventual control of cancer.

Doctors are studying radiation therapy, new ways of giving chemotherapy, new anticancer drugs and drug combinations, biological therapies, bone marrow transplantation, peripheral blood stem cell transplantation, and new ways of combining various types of treatment. Some studies are designed to find ways to reduce the side effects of treatment and to improve the patient's quality of life.





Side Effects of Treatment
Treatments for non-Hodgkin's lymphoma are very powerful. It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes side effects.

The side effects of cancer treatment depend mainly on the type and extent of the therapy. Side effects may not be the same for everyone, and they may even change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment. They can also lessen or control many of the side effects that may occur during and after treatment.


Chemotherapy
The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. As with other types of treatment, side effects may vary from person to person.

Anticancer drugs generally affect cells that divide rapidly. In addition to cancer cells, these include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected, the patient is more likely to get infections, may bruise or bleed easily, and may feel unusually weak and tired. The patient's blood count is monitored during chemotherapy and, if necessary, the doctor may decide to postpone treatment to allow blood counts to recover.

Cells in hair roots also divide rapidly; therefore, chemotherapy may lead to hair loss. Patients may have other side effects such as poor appetite, nausea and vomiting, or mouth and lip sores. They may also experience dizziness and darkening of skin and fingernails. Another common side effect is peripheral neuropathy.

Most side effects go away gradually during the recovery periods between treatments or after treatment is over. However, certain anticancer drugs can increase the risk of developing a second cancer later in life.

In some men and women, chemotherapy causes a loss of fertility (the ability to produce children). Loss of fertility may be temporary or permanent, depending on the drugs used and the patient's age. For men, sperm banking before treatment may be an option. Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Menstrual periods are more likely to return in young women. The National Cancer Institute booklet Chemotherapy and You has helpful information about chemotherapy and coping with side effects.


Radiation Therapy
The side effects of radiation depend on the treatment dose and the part of the body that is treated. During radiation therapy, people are likely to become extremely tired, especially in the later weeks of treatment. Rest is important, but doctors usually advise patients to try to stay as active as they can.

It is common to lose hair in the treated area and for the skin to become red, dry, tender, or itchy. There may also be permanent darkening or "bronzing" of the skin in the treated area.

When the chest and neck are treated, patients may have a dry, sore throat and trouble swallowing. Some patients may have tingling or numbness in their arms, legs, and lower back. Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. Often, changes in diet or medicine can ease these problems.

Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection. If that happens, patients need to be careful to avoid possible sources of infection. The doctor monitors a patient's blood count during radiation therapy. In some cases, treatment may have to be postponed to allow blood counts to recover.

Although the side effects of radiation therapy can be difficult, they can usually be treated or controlled. It may also help to know that, in most cases, side effects are not permanent. However, patients may want to discuss with their doctor the possible long-term effects of radiation treatment on fertility and the increased chance of second cancers after treatment is over. The National Cancer Institute booklet "Radiation Therapy and You" has helpful information about radiation therapy and managing its side effects.


Bone Marrow Transplantation
Patients who have a bone marrow transplant face an increased risk of infection, bleeding, and other side effects from the large doses of chemotherapy and radiation they receive. In addition, graft-versus-host disease (GVHD) may occur in patients who receive bone marrow from a donor. In GVHD, the donated marrow attacks the patient's tissues (most often the liver, the skin, and the digestive tract). GVHD can range from mild to very severe. It can occur any time after the transplant (even years later). In most cases, GVHD can be treated effectively with the use of steriods and other immunosuppressant drugs.


Biological Therapy
The side effects caused by biological therapy vary with the specific type of treatment. These treatments may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a skin rash, or retain fluid. These problems can be severe, but they usually go away after treatment stops.


Surgery
The side effects of surgery depend on the location of the tumor, the type of operation, the patient's general health, and other factors. Although patients are often uncomfortable during the first few days after surgery, the pain can usually be controlled with medicine. People can talk with their doctor or nurse about pain relief. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient.





Nutrition During Cancer Treatment
Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength. Good nutrition often helps people feel better and have more energy.

Some people with cancer find it hard to eat a balanced diet because they may lose their appetite. In addition, common side effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult. Often, foods taste different. Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.

Doctors, nurses, and dietitians can offer advice on how to get enough calories and protein during cancer treatment. Patients and their families also may want to read the National Cancer Institute(USA) booklet Eating Hints for Cancer Patients, which contains many useful suggestions.


Recovery and Outlook
It is natural for anyone facing cancer to be concerned about what the future holds. Understanding the nature of cancer and what to expect can help patients and their loved ones plan treatment, anticipate lifestyle changes, and make quality of life and financial decisions.

Cancer patients frequently ask their doctors or search on their own for an answer to the question, "What is my prognosis?" Prognosis is a prediction of the future course and outcome of a disease and an indication of the likelihood of recovery. However, it is only an estimate. When doctors discuss a patient's prognosis, they are attempting to project what is likely to occur for that individual patient.

Sometimes patients use statistics to try to figure out their chances of being cured; however, statistics reflect the experience of a large group of patients and cannot be used to predict what will happen to a particular patient because no two patients are alike. The prognosis for a person with non-Hodgkin's lymphoma can be affected by many factors, particularly the type and stage of the cancer and the patient's age, general health, and response to treatment. The doctor who is most familiar with a patient's situation is in the best position to help interpret statistics and discuss that person's prognosis.

When doctors talk about surviving cancer, they may use the term remission rather than cure. Although many people with non-Hodgkin's lymphoma are successfully treated, doctors use the term remission because cancer can return. It is important to discuss the possibility of recurrence with the doctor.


Followup Care
People who have had non-Hodgkin's lymphoma should have regular followup examinations after their treatment is over. Followup care is an important part of the overall treatment plan, and people should not hesitate to discuss it with their health care provider. Regular followup care ensures that patients are carefully monitored, any changes in health are discussed, and new or recurrent cancer can be detected and treated as soon as possible. Between followup appointments, people who have had non-Hodgkin's lymphoma should report any health problems as soon as they appear.


Risk Factors Associated with Non-Hodgkin's Lymphoma
The incidence of non-Hodgkin's lymphoma has increased dramatically over the last couple of decades. This disease has gone from being relatively rare to being the fifth most common cancer in the United States. At this time, little is known about the reasons for this increase or about exactly what causes non-Hodgkin's lymphoma.

Doctors can seldom explain why one person gets non-Hodgkin's lymphoma and another does not. It is clear, however, that cancer is not caused by an injury, and is not contagious; no one can "catch" non-Hodgkin's lymphoma from another person.

By studying patterns of cancer in the population, researchers have found certain risk factors that are more common in people who get non-Hodgkin's lymphoma than in those who do not. However, most people with these risk factors do not get non-Hodgkin's lymphoma, and many who do get this disease have none of the known risk factors.

The following are some of the risk factors associated with this disease:

Age/Sex -- The likelihood of getting non-Hodgkin's lymphoma increases with age and is more common in men than in women.
Weakened Immune System (AIDS-related lymphoma) -- Non-Hodgkin's lymphoma is more common among people with inherited immune deficiencies, autoimmune diseases, or HIV/AIDS, and among people taking immunosuppressant drugs following organ transplants. (see Post-transplant lymphoproliferative disorder)
Viruses -- Human T-lymphotropic virus type I (HTLV-1) and Epstein-Barr virus are two infectious agents that increase the chance of developing non-Hodgkin's lymphoma.
Environment -- People who work extensively with or are otherwise exposed to certain chemicals, such as pesticides, solvents, or fertilizers, have a greater chance of developing non-Hodgkin's lymphoma.
People who are concerned about non-Hodgkin's lymphoma should talk with their doctor about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the person's age, medical history, and other factors.


Notable NHL patients
Notable persons treated for Non-Hodgkin's lymphoma include:

Jackie Kennedy Onassis, widow of former U.S. president John F. Kennedy
U.S. Senator Paul Tsongas
British soap opera star Anne Kirkbride
Velvet Underground guitar player Sterling Morrison
The former Shah Mohammed Reza Pahlevi of Iran (although this was probably CLL).
King Hussein of Jordan
U.S. Nobel Prize laureate Jack S. Kilby, inventor of the integrated circuit
Croatian basketball player, coach, and diplomat Krešimir Ćosić
Saku Koivu, NHL star, captain of the Montreal Canadiens.

References:
"What You Need to Know About Non-Hodgkins Lymphoma". NIH Publication No. 99-1567. URL accessed on January 22, 2002.
The original version of this article was edited down from the source above. As a work of an agency of the U.S. Federal Government, this document is a public domain resource that can be used as source material for Wikipedia.
Please see the NIH Policies page for more information
"Non-Hodgkin's lymphoma Fact Sheet". Genentech, Inc.. URL accessed on April 25, 2005.
"Staging NHL". Cancer Research UK 2002. URL accessed on April 25, 2005.
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