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Non-Hodgkin's Lymphoma


Lymphoma is a general term for cancers that develop in the lymphatic system (the tissues and organs that produce, store and carry white blood cells).

 

Hodgkin's disease is one type of lymphoma. It develops in white blood cells, which help the body fight disease.

All other lymphomas are grouped together and are called non-Hodgkin's lymphoma (NHL). They develop in other parts of the lymphatic system, including the bone marrow, spleen, thymus and lymph nodes and can then spread to other organs.

 

It is estimated that the incidence in Spain is of 11 to 12 cases for every 100.000 persons/year. Over 95% of those cases will be adults around 60 years of age. Men have a slightly higher risk than women, although the numbers of women being diagnosed with non-Hodgkin's lymphoma has recently been increasing. Non-Hodgkin's lymphoma is more common in whites than black persons or asiatic persons.

 

Types of Non-Hodgkin's Lymphoma
 

The specific types of non-Hodgkin's lymphoma are associated with different symptoms.

 

Low-Grade Non-Hodgkin's Lymphoma
 

Low-grade, or indolent, non-Hodgkin's lymphoma progresses slowly and is associated with painless swelling of lymph nodes (usually in the neck or over the collarbone), but patients are otherwise healthy. The swelling may go away for a while, but then return.

 

If low-grade non-Hodgkin's lymphoma has spread outside of the lymph nodes, there may be discomfort in the affected area. Types of low grade non-Hodgkin's lymphomas include:

  • Marginal zone lymphoma
  • MALT lymphoma
  • Follicular lymphoma
  • Mantle cell lymphoma

Intermediate Grade Non-Hodgkin's Lymphoma
 

Intermediate grade non-Hodgkin's lymphoma grows more rapidly and is associated with more symptoms than low-grade non-Hodgkin's lymphoma. There may be pain or swelling in the legs, neck, arms or abdomen. Fever, night sweats and unexplained weight loss may also occur. Examples of Intermediate grade non-Hodgkin's lymphomas include:

  • Diffuse large cell lymphoma
  • Primary mediastinal large cell lymphoma
  • Anaplastic large cell lymphoma

High-Grade non-Hodgkin's lymphoma
 

High-grade non-Hodgkin's lymphoma grows very rapidly and has many different symptoms, depending on the location of the cancer. Symptoms may include fatigue, shortness of breath, pain, weakness in the arms and/or legs and confusion. High-grade non-Hodgkin's lymphomas include:

  • Burkitt’s lymphoma
  • Lymphoblastic lymphoma

Non-Hodgkin's lymphoma symptoms may include:

  • Painless swelling of lymph nodes in the neck, groin or underarm
  • Fevers
  • Heavy night sweats
  • Tiredness
  • Weight loss without a known reason
  • Severe itchiness
  • Reddened patches on the skin
  • Nausea, vomiting or abdominal pain
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Clinical trials
Estudio en fase Ib, de escalada de la dosis, para determinar la dosis recomendada para la fase II de TAK-659 en combinación con bendamustina (± rituximab), gemcitabina, lenalidomida o ibrutinib para el tratamiento de pacientes con linfoma no-Hodgkin en estadio avanzado después de haber recibido al menos 1 línea de tratamiento anterior
Un ensayo clinico fase 2 analizando la factibilidad y actividad de claritromicina más lenalidomida en combinación: Un tratamiento completamente oral para pacientes con linfoma asociado a tejido linfoide de las mucosas (MALT) refractario o en recaída.
Ensayo de fase 1a/2a, abierto y multicéntrico, para investigar la seguridad, tolerabilidad y actividad antitumoral de dosis repetidas de Sym015, una mezcla de anticuerpos monoclonales dirigida frente al receptor MET, en pacientes con tumores malignos sólidos en fase avanzada
ESTUDIO DE FASE I PARA EVALUAR LA SEGURIDAD Y LA TOLERABILIDAD DEL REGN1979, UN ANTICUERPO MONOCLONAL BIESPECÍFICO CONTRA CD20 Y CD3, Y EL REGN2810, UN ANTICUERPO MONOCLONAL CONTRA LA PROTEÍNA DE MUERTE CELULAR PROGRAMADA 1, EN PACIENTES CON NEOPLASIAS MALIGNAS DE LINFOCITOS B.
Ensayo Clínico Fase II multicéntrico para evaluar la eficacia y seguridad de Ibrutinib en combinación con rituximab en pacientes con formas clínicas indolentes de Linfoma de Células del Manto.
Ensayo Clínico fase II multicéntrico para evaluar la eficacia y la seguridad de Ibrutinib en combinación con rituximab, gemcitabina, oxaliplatino y dexametasona seguido de Ibrutinib como tratamiento de mantenimiento en pacientes con Linfoma difuso de células B grandes con tipo NO GCB resistente al tratamiento o recidivante no candidatos a recibir un TACM”.
Estudio Fase II de Plitidepsin en Pacientes con Linfoma Angioinmunoblástico de células T en Recaída o Refractario.
Estudio fase IIIB, prospectivo, randomizado, abierto que evalúa la eficacia y seguridad de Heparina/Edoxaban versus Dalteparina en tromboembolismo venoso asociado con cáncer.
Estudio de fase III, abierto, multicéntrico y aleatorizado de Zevalin (ibritumomab tiuxetan) administrado de forma secuencial frente a observación en pacientes de 60 años o mayores con linfoma difuso de células B grandes recién diagnosticado en remisión completa con una PET negativa después de la terapia con R-CHOP o similar a R-CHOP
Ensayo clínico fase III, aleatorizado, observador-ciego, controlado con placebo, multicéntrico, para evaluar la eficacia profiláctica, seguridad e inmunogenicidad de la vacuna candidata frente a Herpes Zóster g E/ AS01b de GSK Biologicals cuando se administra por vía intramuscular en una pauta de dosis a adultos receptores de trasplante autólogo de progenitores hematopoyéticos (TPH). Estudio de eficacia clínica de la vacuna frente a Herpes Zoster (Ge/AS01B) en adultos mayores de 18 años receptores de trasplante autólogo de progenitores hematopoyéticos
Ensayo de fase III aleatorizado, controlado, doble ciego para comparar la eficacia, la seguridad y la farmacocinética de GP2013 más CVP frente a MabThera® más CVP, seguido de tratamiento de mantenimiento con GP2013 o MabThera®, en pacientes con linfoma folicular en estadio avanzado no tratado previamente.

NHL has no known cause, and most people diagnosed with NHL don’t have any risk factors.

Since there are no screening tests to find NHL in its earliest stages, the best approach is to take notice of any unusual symptoms and seek medical attention promptly.

Some common tests used to identify NHL include:

 

Biopsy: The removal of a piece of tissue from an area of suspected cancer for examination under a microscope. Non-Hodgkin’s Lymphoma is diagnosed by looking at cancer cells and determining how they are growing in the lymph nodes or other tissues. The information provided by this tissue sample is crucial to the diagnosis and treatment of NHL.

 

X-Ray: This procedure uses radiation to take pictures of an area inside the body.

 

Computerized Axial Tomography (CT) scan: A CT scan takes X-rays from different angles around the body. The images are then combined using a computer to give a detailed image. CT scans are most commonly performed on the neck, chest, abdomen and/or pelvis. 

 

Positron Emission Tomography (PET) scan: PET is a technology that combines the fields of medicine, computer science, chemistry, physics and physiology to study the function of organs such as the heart, brain and bone. Rather than providing an image of the tissue such as X-rays, CTs, ultrasounds or MRIs, PET scans provide information about how tissue functions.

 

Magnetic Resonance Imaging (MRI): MRI is similar to a CT scan but uses magnets and radio frequency waves instead of X-rays. MRI can provide important information about tissues and organs that is not available from other imaging techniques. It is less used in NHL than are CT scans, but it can be useful in evaluation of the bones and brain.

 

Lymphangiogram: A special X-ray of the lymphatic system. A dye (contrast medium) is injected into the lymphatic vessels in both feet. When the body is X-rayed, lymph nodes and lymphatic vessels containing the dye are more clearly seen on the film.

 

Gallium (radioisotope) Scan: Radioactive gallium is a chemical that collects in some tumors. A small amount of gallium is injected into a blood vessel, and it circulates throughout the body. The body is then scanned from several angles to see if the gallium has collected in a tumor. This test can be very useful in managing NHL.

 

Blood Tests: These are performed to determine if the different types of blood cells are normal in numbers and appearance and if blood chemistry is normal.

 

Bone Marrow Aspiration and Biopsy: Bone marrow contains immature cells called stem cells, which go on to develop into three types of cells: red blood cells, which deliver oxygen and take away carbon dioxide; white blood cells, which protect the body from infection; and platelets, which help blood to clot. Bone marrow is obtained by numbing the skin, tissue and surface of the bone with a local anesthetic. A thin needle is inserted into the hip or another large bone to collect a small sample.

 

Echocardiogram: This diagnostic test evaluates the size and function of the heart.

 

Pulmonary Function Test: This test will determine how well the lungs function. It is an important test since some drugs used to treat NHL may affect lung function.

 

Staging
 

Staging is a standardized method to determine if the cancer has spread, and to determine the best possible treatment. Accurate staging also helps to predict patient’s prognosis and how the disease might progress.

 

Stage I (early stage): One lymph node region is involved. If the cancer is found in one organ outside the lymph node such as the skin, lung, brain, etc., this is called "extension," or "E" disease.

 

Stage II (locally advanced disease): The cancer is found in two or more lymph regions on one side of the diaphragm. If the cancer is found in one lymph node region plus a nearby area or organ, the situation is considered "E" disease.

 

Stage III (advanced disease): The disease involves lymph nodes both 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.

 

In addition, each stage is classified as "A" or "B". An "A" means asymptomatic, which is used for patients who do not complain of fever, drenching sweat or unexplained weight loss. When patients have any of these symptoms, "B" is assigned to their stage.

Treatment for NHL depends on disease stage, the patient’s general health and other factors. Treatment may consist of chemotherapy, radiation therapy, bone marrow or stem cell transplantation or a combination of these treatments.

Chemotherapy
Chemotherapy uses drugs to treat cancer. There are many different types of drugs available to treat NHL. Doctors may prescribe a single drug, but combinations of drugs are most often used. Chemotherapy drugs work in various ways and have different side effects. Giving several drugs at once may increase their effectiveness but also may increase side effects.

Radiation Therapy
Radiation is a special kind of energy carried by waves or a stream of energy particles. It may be delivered by a radiation machine or by radioactive substances injected into the bloodstream. External beam radiation equipment aims radiation at tumors or certain areas of the body, killing cancer cells in the target area.

The following technological means and types of radiation therapy are used with this disease:

  • Virtual CT simulation
  • Intensity modulated radiartio therapy (IMRT)
  • Total skin electron therapy (TSET)

Bone Marrow & Stem Cell Transplantation

Autologous or allogeneic bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) restore the supply of normal cells that have been destroyed by high-dose chemotherapy and/or radiation therapy. In autologous transplantation, the bone marrow or blood stem cells are collected from the patient. Allogeneic transplantation involves collection of bone marrow or stem cells from a carefully matched donor, who may be a family member or unrelated individual.

Peripheral blood stem cell transplantation is the most common procedure, in which stem cells are collected from the blood by pheresis, a procedure similar to donating blood. Before the transplant, patients receive high doses of chemotherapy, alone or in combination with radiation, to destroy as many cancer cells as possible. They then receive the bone marrow or stem cell transplant. In bone marrow transplantation, which is seldom done, stem cells are taken from the donor or patient's hip bone.

Clinical Trials
 

Enrollment in a clinical trial (research study) may also be an option for some NHL patients. All patients who participate in clinical trials are volunteers. They can choose to stop their participation in a clinical trial at any time. To learn more about clinical trials and the current clinical trials for NHL patients at MD Anderson, search our online clinical trials database.