Non-Hodgkin Lymphoma

At the UofL Brown Cancer Center, our goal is to treat non-Hodgkin lymphoma with methods that are strong on the disease, but as gentle as possible on your body.

Overview

At UofL Brown Cancer Center our goal is to treat non-Hodgkin lymphoma with methods that are strong on the disease, but as gentle as possible on your body.

Drawing upon a wide range of treatments for every stage of disease, as well as clinical trials of new and novel agents, our physicians in our Multidisciplinary Blood and Marrow Transplant Clinic, design a treatment plan that is uniquely yours. We are constantly working to bring new treatments to patients, including targeted biological agents that help your body fight the cancer.

While some patients with non-Hodgkin lymphoma can be successfully treated, for many the most effective course is to keep knocking back the disease over a period of many years. In these cases, personalized long-term care is especially important. Our teams of specialized physicians, as well as support staff including nurses, physician assistants, dietitians, social workers and many others, work closely together to give you higher chance for successful treatment.

At UofL Brown Cancer Center, we continue to research ways to improve your health and quality of life. We are able to offer clinical trials for non-Hodgkin lymphoma.

Lymphomas are cancers of the lymphoid system, which includes the lymph nodes, bone marrow, spleen, and thymus. Lymphomas arise from a type of white blood cell called lymphocytes. Hodgkin lymphoma is a form of lymphoma that is notable for large cells with multiple nuclei; about 10 percent of lymphomas are of the Hodgkin type, and the rest are called non-Hodgkin lymphoma (NHL). About 60,000 people per year in the US will be diagnosed with NHL.

Lymphocytes are classified as either B cells or T cells depending on where they mature in the body, and lymphomas are also classified based upon whether they come from B cells or T cells. Most NHL cases come from B cells.

Lymphomas are also classified based on the aggressiveness of the cells. Aggressiveness is assessed by how fast the cells divide under the microscope and how quickly they can cause unpleasant symptoms or medical complications. Categories of aggressiveness are as follows:

Highly Aggressive:

  • Burkitt lymphoma (BL)

Aggressive:

  • Diffuse large B cell lymphoma (DLBCL), the most common aggressive lymphoma
  • Mantle cell lymphoma (MCL)
  • T cell lymphomas

Indolent:

  • Follicular lymphoma (FL), the most common indolent lymphoma
  • Small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL)
  • Waldenstrom macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL)
  • Marginal zone lymphoma (MZL)
  • Cutaneous T cell lymphoma (CTCL)

Most types of NHL occur most commonly in older persons, with peak ages of incidence in the 60s or 70s. BL is a notable exception, as it occurs most commonly in children and peaks at age 11. HIV infection causes an increased risk of certain lymphomas, notably BL and DLBCL.

NHL typically presents with lymph node swelling, with possible locations including the neck, chest, armpits, groin, and abdomen. Other possible symptoms include weight loss, night sweats, and unexplained fevers (called “B symptoms”). The spleen or liver can be enlarged. Low blood counts can occur if the bone marrow is involved. NHL can also invade the brain and spinal regions, causing stroke-like symptoms such as weakness, numbness, or impaired brain functioning. Highly aggressive and some aggressive lymphomas have increased risk of involving the nervous system. Skin involvement can also occur in NHL, ranging in intensity from mild to severe.

NHL is diagnosed based on biopsy of involved lymphoid tissue. A pathologist must look at the tissue under the microscope or perform an experiment called flow cytometry to look at characteristic molecules on the surfaces of the cells. The pathologist is greatly helped if the physician performing the biopsy obtains as much tissue as possible—excisional biopsies are the most helpful.

Bone marrow biopsy may also be used to complete staging, in other words, determining the extent of disease. Other studies used for staging and prognostic estimation include complete blood count, CT scans, and PET scans. CT and PET scans may be performed together as PET-CT scans. Occasionally lumbar puncture may be required to rule out nervous system involvement. For patients with BL and DLBCL, HIV testing should be performed as well.

Stage is from I to IV, where stages I and II indicate less diffuse body involvement of lymphoid or non-lymphoid tissues, and stages III and IV indicate more diffuse involvement of lymphoid and non-lymphoid tissues (see below).

  • Stage I (early stage): One lymph node region is involved. If the cancer is in one organ outside the lymph node such as the skin, lung, brain, etc., this is called extension, or E non-Hodgkin lymphoma.
  • Stage II (locally advanced disease): The cancer is in two or more lymph regions on one side of the diaphragm. If the cancer is in one lymph node region plus a nearby area or organ, it is considered E disease.
  • Stage III (advanced disease): Non-Hodgkin lymphoma involves lymph nodes above and below the diaphragm or one node area and one organ on opposite sides of the diaphragm.
  • Stage IV (widespread disease): The lymphoma is outside the lymph nodes and spleen and has spread to one or more organs such as bone, bone marrow, skin and other organs.

Stage I and II disease is most commonly treated with a combination of chemotherapy and involved field or site (where the disease is located) radiation, though chemotherapy or radiation alone is sometimes used. Stage III and IV disease are typically treated with chemotherapy alone, though radiation may be delivered to bulky sites of disease.

Cure rates for NHL depend on the subtype. Approximately 50 percent of patients with aggressive lymphomas can be cured with the initial line of therapy. Indolent lymphomas typically respond well to initial therapy but almost always recur and are generally considered to be incurable.

Chemotherapy for B-cell NHL generally includes rituximab, an antibody directed against a specific molecule (CD20) on the surface of B cells.

Patients who have return of disease after initial treatment or have an inadequate response to treatment may be candidates for stem cell transplantation or clinical trials. Certain lymphomas (the most aggressive variants of DLBCL, MCL, and some T cell lymphomas) may warrant stem cell transplantation after initial response to treatment (called “remission”).

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions.

To learn more about the physicians who make the academic difference in treatment for non-Hodgkin lymphoma, visit the UofL Physicians website here.