Lymphomas: Caring for Patients in the Greater Philadelphia Area

The hematology-oncology specialists at Consultants in Medical Oncology and Hematology provide the latest treatment options for patients all types of lymphoma including non-Hodgkin and Hodgkin lymphomas. You have access to the latest blood cancer treatments and clinical trials right here, close to home.

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Types of Lymphomas

There are two primary categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Beyond that, there are many different subtypes, especially subtypes of non-Hodgkin lymphoma. 

Some lymphomas arise from B-lymphocytes, while others arise from T-lymphocytes. Lymphomas are also described by their growth rate, with rapidly growing lymphomas referred to as “aggressive” and slow-growing lymphomas referred to as “indolent.”

When caught early, most lymphomas can be successfully treated. There is some difference in the treatments and their likely outcome (prognosis) based on the type of non-Hodgkin lymphoma. A medical oncologist, who treats cancer, is also trained in blood diseases, including lymphoma. The medical oncologist/hematologist will be the lead for your treatment planning.

 

Non-Hodgkin Lymphomas

Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma. Generally, it develops in the lymph nodes and lymphatic tissue found in organs such as the stomach, intestines or skin. Sometimes, however, NHL involves bone marrow and blood. 

There are several different subtypes of non-Hodgkin lymphoma, which are categorized by the characteristics of the lymphoma cells, including their appearance, the presence of proteins on the surface of the cells, their genetic features, and how fast (or slow) they progress.

Common subtypes of NHL that are aggressive (fast-growing):

  • Anaplastic large-cell lymphoma
  • Diffuse large B-cell lymphoma (DLBCL)
  • Mantle cell lymphoma (MCL)
  • Acquired immune deficiency syndrome (AIDS)-associated lymphoma
  • Burkitt lymphoma
  • Peripheral T-cell lymphoma (PTCL)
  • Central nervous system (CNS) lymphoma
  • Lymphoblastic lymphoma
  • Transformed follicular and transformed mucosa-associated lymphoid tissue (MALT) lymphomas

Common subtypes of NHL that are indolent (slow-growing): 

  • Cutaneous B-cell lymphoma
  • Cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome)
  • Lymphomatoid granulomatosis
  • Follicular lymphoma
  • Waldenström macroglobulinemia (lymphoplasmacytic lymphoma) 
  • Hairy cell leukemia
  • Lymphoplasmacytic lymphoma/Waldenström macroglobulinemia
  • Marginal zone B-cell lymphoma
  • Gastric mucosa-associated lymphoid tissue (MALT) lymphoma
  • Chronic lymphocytic leukemia/small-cell lymphocytic lymphoma (CLL/SLL)
  • Primary central nervous system lymphoma

Hodgkin Lymphoma

Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes abnormal. The abnormal cell divides, making copies of itself. The new cells divide, making more abnormal cells, and so on. This uncontrolled growth may form a tumor, involve many parts of the lymphatic system, or spread to other parts of the body. 

Hodgkin lymphoma tends to affect young adults in the prime of their lives. However, thanks to remarkable advances in treatment, it is now considered one of the most curable cancers. 

Hodgkin lymphoma is divided into two main subtypes, which are:

Classical Hodgkin Lymphoma (CHL)

Characterized by the presence of very large cells called Reed-Sternberg (RS) cells

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)

Characterized by the presence of lymphocyte-predominant cells, sometimes termed “popcorn cells” — a variant of Reed-Sternberg cells

About 95% of people with Hodgkin lymphoma have classical Hodgkin lymphoma, whereas Nodular lymphocyte-predominant Hodgkin lymphoma affects about 5% of Hodgkin lymphoma patients.

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Lymphoma Detection and Diagnosis

Currently, there is no screening test available for lymphoma. However, there are times when lymphoma can be caught early by paying attention to the signs and symptoms related to it such as an unexplained, painless enlarged/swollen lymph node that doesn’t go away on its own in a week or so, or if you have an unexplained fever or night sweats you should talk to your primary care physician who can run some tests and determine if you should see a medical oncologist/hematologist for more testing.

Tests Used to Diagnose Lymphoma

There are several tests and procedures used to diagnose lymphoma, which include: 

Physical Examination

During a physical exam, your doctor will check for swollen lymph nodes, including in your neck, underarm and groin, as well as a swollen spleen or liver.

Lymph Node Biopsy

Your doctor may recommend a lymph node biopsy procedure to remove all or part of a lymph node for laboratory testing. Advanced tests can determine if lymphoma cells are present and what types of cells are involved.

Blood Tests

Blood tests that count the number of cells in a sample of your blood can give your doctor information about your diagnosis.

Imaging Tests

Imaging tests can help your doctor look for signs of lymphoma in other areas of your body. Tests may include CT, MRI and positron emission tomography (PET).

Removing a Sample of Bone Marrow for Testing

Sometimes, a bone marrow aspiration and biopsy procedure may be necessary. This involves inserting a needle into your hipbone to remove a sample of bone marrow, which is then analyzed to look for lymphoma cells.

In some cases, the doctor may request additional tests and procedures to determine if you have lymphoma. 

Because many types of lymphoma exist, the key to developing an effective treatment plan is knowing your specific type and subtype. Research shows that having a biopsy sample reviewed by an expert pathologist improves the chances of an accurate diagnosis. It is also a good idea to consider getting a second opinion from a specialist who can confirm your diagnosis.

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Staging Lymphomas

Staging is a way of describing where the lymphoma is located, if or where it has spread, and whether it is affecting other parts of the body. Knowing the stage helps the doctor to decide what kind of treatment is best. It can also predict the patient’s chance of recovery (prognosis). 

Lymphoma Staging Tests

Using the diagnostic tests and the results of the biopsy, the oncology team will give the lymphoma a “stage.”

Over the years, there have been many different systems used for staging lymphomas. The current staging system, however, is known as the Lugano classification, which is based on the older Ann Arbor system. The stages are described by Roman numerals I through IV (1-4).

Lymphoma Stages

Stage I

Either of these conditions applies:

  • The lymphoma cells are in one lymph node group (such as in the neck or underarm).
  • The lymphoma cells are not in the lymph nodes but have spread to one part of a tissue or organ (such as the lung, but not the liver or bone marrow).

Stage II

Either of these conditions:

  • The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm.
  • The lymphoma cells are in one part of an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.

Stage III

The lymphoma is in lymph nodes above and below the diaphragm. It also may be found in one part of a tissue or an organ near these lymph node groups.

Stage IV

Lymphoma cells are found in several parts of one or more organs or tissues (in addition to the lymph nodes). Or it is in the liver, blood, or bone marrow.

Recurrent

The disease returns after treatment.

In addition to these stage numbers, your doctor may also describe the stage as A or B:

  • A: You have not had weight loss, drenching night sweats, or fevers.
  • B: You have had weight loss, drenching night sweats, or fevers.

If B is used in the assigned stage it is more advanced than A in that stage.

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Lymphoma Treatment Options

There are many different treatment options available for blood cancers like lymphoma. Some of these are standard treatments, while others are being tested in clinical trials. At CMOH, one of our medical oncologists/hematologists will discuss both treatment choices and the expected results. Once you understand what to expect, your lymphoma specialist, as well as the rest of the cancer care team, will work together to develop a treatment plan that meets your needs. 

There are several factors that will affect your choice of treatment. These can include: 

  • The type of lymphoma you have
  • Its stage (where the lymphoma is found)
  • How quickly the cancer is growing (whether it is indolent or aggressive lymphoma)
  • Your age
  • Your overall health

Regardless of what type of lymphoma you have been diagnosed with, you can expect some form of chemotherapy, radiation therapy, biologic therapy (immunotherapy), or a combination of treatments. Bone or blood marrow, as well as stem cell transplantation, may also sometimes be done under special circumstances.

Watchful Waiting

Oncologists sometimes suggest watchful waiting – putting off cancer treatment until symptoms arise – for people with indolent (slow-growing) lymphoma. For some patients, cancer treatment might not be needed for a long time. Sometimes the tumor may even shrink for a while without therapy. Putting off treatment allows patients to avoid the side effects of chemotherapy or radiation therapy.

If you and your doctor agree that watchful waiting is a good idea, it is likely you’ll be checked regularly (every 3 months), only receiving treatment if symptoms occur or get worse. Some people do not choose watchful waiting because they don’t want to worry about having cancer that is not treated. If this is something you agree with now, but later become worried about, please discuss your feelings with your doctor.

Chemotherapy for Lymphomas

Chemotherapy for lymphoma uses drugs to kill lymphoma cells. It is considered a systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

You may receive chemotherapy by mouth, through a vein, an injection under the skin, or in the space around the spinal cord. Treatment is usually in an outpatient part of the hospital, at the doctor’s office, or at home. Some people need to stay in the hospital during treatment.

Chemotherapy is given in cycles, meaning you have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.

If you have lymphoma in the stomach caused by H. pylori infection, your doctor may treat this lymphoma with antibiotics. After the drug cures the infection, the lymphoma also may go away.

Targeted Therapy for Lymphoma

Targeted therapy is a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread. It blocks the growth and spread of cancer cells and limits damage to healthy cells. 

Targeted therapies used for lymphoma treatment include:

Monoclonal Antibodies

Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading.

Kinase Inhibitors

This treatment blocks certain proteins, which may help keep lymphoma cells from growing and may kill them.

Immunomodulatory Drugs

These drugs will modulate, or influence, how the body's immune system responds or works.

Immunotherapy for Lymphoma

Immunotherapy, also called biologic therapy, is a treatment that helps the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.  

Immunotherapy treatments for lymphoma include: 

Modified T Cells

A treatment called CAR T therapy, changes the patient's T cells (a type of immune system cell) so they attack certain proteins on the surface of cancer cells.

Checkpoint Inhibitors

These work by blocking checkpoint proteins from binding with their partner proteins. This prevents the “off” signal from being sent, allowing the T cells to kill cancer cells. 

Radiation Therapy for Lymphoma

Radiation therapy (also called radiotherapy) uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.

There are a few different ways lymphoma is treated with radiation therapy:

  • As the primary treatment for some types of non-Hodgkin lymphomas that are found in stages 1 or 2.
  • When the lymphoma is considered aggressive radiation is sometimes used in combination with chemotherapy.
  • People who need a stem cell transplant are likely to have radiation to the whole body along with high-dose chemotherapy to try to kill lymphoma cells throughout the body.
  • Radiation therapy can be used to treat pain caused by lymphoma that formed tumors in other organs, such as the brain or spinal cord.

Bone and Blood Marrow Transplantation

If lymphoma returns after treatment, you may receive a bone or blood marrow transplantation. A transplant of your own blood-forming stem cells allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy lymphoma cells as well as healthy blood cells in the bone marrow.

Bone and blood marrow transplants are usually performed in a hospital. Before you receive high-dose treatment, your stem cells are removed, frozen, stored, and in some cases, treated to kill lymphoma cells that may be present. After you receive high-dose treatment to kill lymphoma cells, your stored stem cells are thawed and given back to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.

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Choosing the Lymphoma Care Team for You or a Loved One

Consultants in Medical Oncology and Hematology is committed to providing our patients with the most advanced treatments for all types of cancers of the blood, including lymphomas. Please find the CMOH location that is most convenient for you in the greater Philadelphia area and call to request an appointment.

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