Non-Hodgkin’s Lymphoma

 

 

OVERVIEW

Lymphoma is a cancer that develops in the lymphatic system. Lymphomas - including Hodgkin's disease and non-Hodgkin's lymphoma - account for about 5 percent of all cases of cancer in the United States. In 2007, the American Cancer Society estimates that 63,000 men and women will be diagnosed with non-Hodgkin's lymphoma in the United States.

The lymphatic system is part of the body's immune system. It aids in the body's fight against disease and infection. The lymphatic system includes a network of thin tubes (lymphatic vessels) that branch into tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting white blood cells called lymphocytes.

Along this network of vessels are small, bean-shaped organs called lymph nodes, clusters of which are located in the abdomen, chest, groin, neck, and underarms. Lymph nodes make and store white blood cells that fight infection. Lymphoid tissue is found in many places in throughout the body, including lymph nodes, the thymus (a small gland found behind the chest bone and in front of the heart), the spleen (an organ on the left side of the abdomen next to the stomach), the tonsils and adenoids, in the bone marrow (blood-cell producing tissue inside the large bones), and scattered within other systems, including the digestive and respiratory systems.

Non-Hodgkin's lymphoma begins in lymphoid tissue, which is formed by several types of immune system cells that work together to resist infection. The main cell type is the lymphocyte, of which there are two main types (B lymphocytes or B cells, and T lymphocytes or T cells). B cells help protect the body against bacteria by maturing into plasma cells and producing immunoglobulin (antibodies). T cells help protect the body against viruses, fungi, and some bacteria. B cell lymphomas account for 85 percent of non-Hodgkin's lymphomas. T cell lymphomas account for 15 percent.

At The Cancer Center at Hackensack University Medical Center, our chief of the Division of Lymphoma is internationally renowned for his research and skills in diagnosing, treating, and managing all types of lymphoma, including Hodgkin's disease and non-Hodgkin's lymphomas. Hematologist/oncologist Andre Goy, M.D., M.S., specializes in developing and investigating innovative new treatment advances for lymphoma, including stem cell transplantation, cellular therapy, immunotherapy, and novel targeted therapies that attack only the cancer cells and spare healthy tissue. Dr. Goy has trained and/or worked at some of the world's leading medical institutions, including Memorial Sloan-Kettering Cancer Center in New York City, the University of Texas' M.D. Anderson Cancer Center in Houston, University Hospital Group of Paris, France, and the Pasteur Institute in Paris.

Dr. Goy's award-winning research is being funded by several pharmaceutical companies, the Susan Vaughan Foundation for Translational Research in Lymphoma, and the U.S. Food and Drug Administration. He recently participated in the PINNACLE trial that evaluated the safety and efficacy of using a novel targeted therapy called Velcade to treat patients whose mantle cell lymphoma, an aggressive type of non-Hodgkin's lymphoma, is resistant to standard therapy or has recurred. Velcade is an injectable chemotherapeutic drug that blocks one of the clinical pathways associated with unregulated cancer growth. It had previously been approved by the Food and Drug Administration for treating patients with multiple myeloma. As a result of the PINNACLE trial, it is now being used to treat mantle cell lymphoma. Dr. Goy is continuing his studies to learn whether Velcade is more effective alone or used in combination with other chemotherapeutic drugs and/or stem cell transplantation.

A crucial component to the accurate diagnosis of non-Hodgkin's lymphoma is The Cancer Center's Special Diagnostic Immunology Laboratory, one of only several sites in New Jersey where comprehensive tests are available to detect cancer at the molecular level and to stage and classify it.

The Cancer Center also features the following unique and innovative services for patients with non-Hodgkin's lymphoma:

  • board-certified hematologists/oncologists, radiation oncologists, cytopathologists who are highly skilled in diagnosing, treating, and managing patients with non-Hodgkin's lymphoma
  • a Tissue Bank, in collaboration with Stamford University, Conn., to study non-Hodgkin's lymphoma at the molecular level using samples of blood, serum, and tissue that are collected from patients and then stored
  • one of the country's 10 largest stem cell transplantation programs
  • a full range of diagnostic technology and imaging service to diagnose and monitor treatment, including the use of functional imaging, which helps to detect early resistance to chemotherapy. Treatment can be evaluated and adjusted if needed.
  • clinical trials to investigate new medications and treatment methods
  • a full range of support services

 

RISK FACTORS

Non-Hodgkin's lymphoma is the fifth most common cancer (excluding non-melanoma skin cancers) in men and women in the United States. Most patients are over age 65 when they are diagnosed. Risk factors include:

  • an abnormal or inefficient immune system
  • exposure to radiation, chemotherapeutic drugs, or certain chemicals such as benzene, herbicides, and insecticides
  • a deficient immune system
  • infection with the human T-cell leukemia/lymphoma virus
  • helicobacter pylori (a cause of stomach cancers, which can also lead to lymphoma of the stomach)

 

SYMPTOMS

There are many different signs and symptoms for non-Hodgkin's lymphoma depending on the location of the involvement of the disease. For cases involving lymph nodes near the surface of the skin, enlarged lymph nodes can be felt or seen on the sides of the neck, in the groin, in the underarm area, or above the collar. For cases involving the stomach, a swollen abdomen, abdominal blockage, or pain may be present. For cases involving the thymus, irritation or compression of the windpipe may cause coughing, shortness of breath, or suffocation when the growth or lymphoma compresses the large vein that carries blood from the head and arms back to the heart. More generalized symptoms are unexplained weight loss, fever, profuse sweating, or severe itchiness.

 

NON-HODGKIN'S LYMPHOMA TREATMENT OPTIONS

Non-Hodgkin's lymphoma treatment options may include stem cell transplantation or chemotherapy used alone or in combination with external beam radiation therapy. Treatment will depend on the specific type of lymphoma you have and the part of the body that is affected. Systemic chemotherapy may be given intravenously or intrathecally (directly into the spinal fluid to treat lymphoma cells on the surface of the brain and spinal cord). A combination of drugs is always used. Researchers at The Cancer Center are also investigating several methods of immunotherapy as alternative non-Hodkin’s lymphoma treatment options.

Emergency Blood Treatments

Hackensack University Medical Center's Department of Pathology is the largest in New Jersey. Its Blood Bank and Division of Hematology are equipped with the latest technology so that the medical center can meet emergency demands for therapeutic leukapheresis, plasmapheresis, and immunoabsorption.

Stem Cell Transplantation

Stem cell transplantation is often used to treat non-Hodgkin's lymphoma. The Cancer Center's Adult Blood and Marrow Stem Cell Transplantation Program is one of the nation's 10 largest programs, where more than 200 stem cell transplants are performed each year to treat hematologic malignancies, other types of cancer, and serious blood disorders. The doctors here have pioneered some of the techniques used in stem cell transplantation today. There are many clinical trials currently in progress at the program to refine the stem cell transplantation process and the cells used in the transplant.

Targeted Therapies

Our chief of the Division of Lymphoma, Andre Goy, M.D., M.S., is currently conducting research into a number of novel targeted therapies that attack the cancer cells and spare normal ones. You may be asked to participate in one of these trials if you meet specific criteria.

Immunotherapy

Immunotherapy (also called biologic therapy) uses naturally occurring substances produced by the immune system to attack cancerous cells. At The Cancer Center, researchers are using several types of immunotherapeutic modalities to boost the ability of patients' own immune systems to fight cancer. These include: interferon (a hormone-like protein produced by white blood cells to help the immune system fight infections) and monoclonal antibodies (antibodies manufactured in the lab to fight infection and attack lymphoma cells). Researchers at The Cancer Center are also developing vaccines to create an immune system reaction in patients with early non-Hodgkin's lymphoma or those whose disease is in remission. The vaccines use a patient's own lymphoma cells - which have been treated in the laboratory - to coax his/her immune system to fight the cancer.