Treatment For Non-Hodgkin Lymphoma
- Newlywed Erinn Shaw, 30, initially suspected she was having a heart attack or had gotten stabbed as rock band Snow Patrol was jamming out on stage during the TRNSMT festival in Glasgow, Scotland on September 12, 2021. It wasn’t until she was rushed to the hospital that she learned of her diagnosisgrey zone lymphoma.
- Gray zone lymphoma (GZL) “is called ‘gray zone’ lymphoma because it has features intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL), but cannot be assigned specifically to either type,” according to The National Center for Advancing Translational Sciences explains.
- Treatment paths for non-Hodgkin lymphoma can vary depending on what type of non-Hodgkin lymphoma you have.
Erinn Shaw, now 30, initially suspected she was having a heart attack or had gotten stabbed as rock band Snow Patrol was jamming out on stage during the TRNSMT festival in Glasgow on September 12, 2021. It wasn’t until she was rushed to the hospital that she learned of her diagnosisgrey zone lymphoma, a rare and aggressive type of cancer that affects the immune system. The National Center for Advancing Translational Sciences explains, “it is called ‘gray zone’ lymphoma because it has features intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL), but cannot be assigned specifically to either type.”
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Her complex combination treatment, called dose-adjusted e-poch chemo, started with 24-hour infusion bags for five days, and then she would come off of it for about one to two weeks. It treatment was repeated five times at Beatson Cancer Centre.
Erinn recounted, “I had 606 hours of dose-adjusted e-poch chemo it’s not the most straightforward chemo. I was hooked up for five days in a row to my chemotherapy. I had that regime five times."
Months later, in June 2022, Erinn learned her scans had come back clear and she was in remission. Her lymphoma nurse, Michelle, had called her to share the exciting news, saying, “I can't wait until your appointment on Monday to tell you this news. We've actually had to triple-check it because we can't believe your PET scan's clear.”
Erinn added, “She said there was no detection of disease at that present moment. As you can imagine that was out the blue and from last year being told I wasn't going to make the Christmas to being told that. It was a crazy moment."
Non-Hodgkin Lymphoma: It's More Than Just One Type
When doctors diagnose people with non-Hodgkin lymphoma, they're not talking about a single cancer, but many. "Non-Hodgkin lymphoma is a big category," Dr. Julie Vose, chief of hematology/oncology at the University of Nebraska Medical Center, tells SurvivorNet.
All non-Hodgkin lymphomas start in white blood cells called lymphocytes, which are part of your body's immune system. From there, doctors separate these cancers into types based on the specific kind of lymphocytes they grow from: B cells or T cells. Knowing whether you have a B-cell or a T-cell lymphoma is important, because it will determine what kind of treatment you get.
What Are B-Cell Lymphomas?
B cells make proteins called antibodies that protect your body against bacteria, viruses, and other germs. Germs have a protein called an antigen on their surface, to which the antibody attaches. That signals your immune system to attack the invading organism.
Learning The Different Types of Non-Hodgkin Lymphoma
If you live in the United States and are diagnosed with non-Hodgkin lymphoma, there's a good chance it's the B-cell variety. About 85% of all lymphomas diagnosed in North America are B-cell lymphomas. And in the United States, these cancers affect white people more often than African Americans or Asian people.
T-cell lymphomas are more common in other parts of the world, such as Asia. That may have to do with causes that are unique to those regions, Dr. Vose says.
Doctors further divide B-cell lymphomas into a few subtypes:
Diffuse large B-cell lymphoma is the most common type. One out of every three people diagnosed with lymphoma in the United States has this type. If you have diffuse large B-cell lymphoma, the first sign might have been a swollen gland in your neck, armpit, or belly. This is a fast-growing cancer, but it is treatable. In many people, it's curable.
Follicular lymphoma is the second most common type of lymphoma, and it usually starts later in life. Although it's not as curable as diffuse large B-cell lymphoma, it grows slowly. "Patients often have symptoms for months or years before they're diagnosed," Dr. Vose says. Some people with this cancer don't need to start treatment right away. People who do go on treatment have a good likelihood of going into remission.
Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) are variations on the same type of cancer. They both affect a cell called a small lymphocyte. The difference is, CLL cells are in the blood and bone marrow, while SLL cells are in the lymph nodes and spleen. Both cancers grow so slowly that many people live for decades with them.
Mantle cell lymphoma is a relatively rare cancer. It can be challenging to treat, because it grows quickly and it doesn't respond as well to cancer drugs as some of the other lymphomas. But researchers are working on new therapies that will hopefully improve survival for people who are diagnosed with this cancer.
Marginal zone lymphomas start in cells that look small under the microscope. This is a group of cancers that tend to grow slowly.
There are other types of B-cell lymphomas, including Burkitt lymphoma, hairy cell leukemia, and Grey Zone Lymphomathe type Erinn Shaw was diagnosed withbut they are rare.
Related: Finding Lymphoma Early: Do you Know the Symptoms and Risks?
According to a case report in the Journal of Hematology, “Gray zone lymphoma (GZL) is an uncommon neoplasm with intermediate features of both classic Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL). It was identified in the World Health Organization (WHO) classification as its own neoplasm in 2008.”
What Are T-Cell Lymphomas?
The other category of non-Hodgkin lymphoma are the T-cell lymphomas. T cells either destroy germs themselves, or boost the activity of other immune cells. These types of lymphomas are much less common than B-cell cancers, affecting only about 15% of people with non-Hodgkin lymphoma.
T-cell lymphoma comes in different types, and all of them are pretty rare.
T-lymphoblastic lymphoma/leukemia affects mostly teens and young adults. It grows quickly, but is very curable.
Peripheral T-cell lymphomas are a group of cancers that develop in mature T cells. Depending on the type, they can affect a variety of organs, including the skin, lungs, and intestines. Some of these cancers grow faster than others.
Next Steps
Once your doctor has identified which type of non-Hodgkin lymphoma you have, you'll talk about treatments. Which therapy your doctor recommends will depend on your cancer type, where it is in your body, and how aggressive it is. Make sure you understand why your doctor has suggested a particular treatment and how it might help you before moving forward.
Treatment for Non-Hodgkin Lymphoma
Shaw underwent a chemotherapy combination for her cancer, but treatment for non-Hodgkin lymphoma can vary greatly depending on the nature of each case. For starters, doctors will first try to determine how fast your non-Hodgkin lymphoma is likely to grow and spread.
"The two main classifications I think of in terms of non-Hodgkin lymphoma are lymphomas that are more indolent and those that are more aggressive, because those are treated very differently," Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Institute, previously told SurvivorNet.
Indolent lymphomas grow slowly and often don't cause any symptoms, so they may not need immediate treatment. At the opposite end of the spectrum are aggressive lymphomas, which grow and spread quickly and need to be treated right away.
Treatment Options For Non-Hodgkin Lymphoma
Another way to classify non-Hodgkin lymphoma is based on the type of cell it affects. All of these cancers involve lymphocytes white blood cells that help your immune system fight off germs and get rid of abnormal cells.
Once the work of determining your type of cancer is finished, your doctor can focus on the next important step how to treat you. If you have an indolent cancer and you don't have any bothersome symptoms, you may not need treatment right away, Dr. Crombie says.
Indolent cancers may still require chemotherapy, but if your cancer is more aggressive whether it's T-cell or B-cell you can expect to get chemotherapy. Chemo may be part of a cocktail of drugs that are given in combination. These drugs work synergistically, going after your cancer in different ways to treat it more effectively.
Sometimes radiation therapy is used together with chemotherapy. Radiation uses high-energy x-rays to eliminate cancer cells. The radiation typically given for non-Hodgkin lymphoma is delivered from a machine outside the body, which is called external beam radiation.
One more thing your doctor will want to investigate is your cancer's genetic makeup. Using a sample of your cancer cells taken during a biopsy, your doctor will test for genetic mutations and other abnormalities.
In some people with non-Hodgkin lymphoma, genes have swapped places, which doctors refer to as translocations. C-MYC, BCL2, or BCL6 are three common translocations. Having one of them could affect how your cancer spreads, and how well you might do in the future. Translocations can also change the course of your treatment.
"If patients have those translocations, sometimes we give a slightly different version of chemotherapy," Dr. Crombie said.
Contributing: SurvivorNet Staff
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